1) Re-commission the GP workload survey and introduce a national survey of GP vacancies.
2) Health Education England and NHS England should develop a regular extraction of ‘long-term workforce data’ – including productivity data – from GP clinical computer systems, for workforce planning.
3) NHS England should review the threshold for reinclusion on the Performers’ List and explore whether there can be more ‘flexibility’ for returning GPs.
4) NHS England and HEE should provide and fund a GP returner programme, to fund training practices and other organisations in providing GPs with training to return to work. Funding should be prioritised for returners training in under-doctored areas.
5) Conduct research to identify why doctors are leaving general practice early, and what the barriers to returning are.
6) Promote and financially support the GP Retainer scheme (or a successor scheme) and prioritise the funding to retain GPs in under-doctored areas.
7) NHS England, HEE and the RCGP should establish networks for senior GP – “Twenty Plus” groups – to provide educational and support activities, facilitate portfolio careers, and balance clinical and non-clinical commitments.
8) NHS England should review how more flexible employment models can retain GPs towards the end of their careers. They should also consider reintroducing the Flexible Careers Scheme, which provided salary contribution and professional support for GPs looking to cut down their clinical commitments, and move to part-time working, but remain in practice.
9) Launch a general practice marketing campaign, to promote an ‘accurate and positive’ image of general practices to the general public and other audiences.
10) The Medical Schools Councils should evaluate why there is such high variation between medical schools in the proportion of medical students choosing General Practice as a career: 11% of students at Cambridge were appointed to GP training, compared to 39% at Keele.
11) Medical schools should be incentivised by the Department of Health to boost the proportion of graduates choosing GP training as a first choice.
12) All trainees should have exposure to general practice, or a placement in the community during their foundation programme.
13) Promote GP integrated clinical academic training programmes in foundation and specialty training to raise general practice’s profile as an academic discipline.
14) Set a target of 3,250 GP trainees in Specialty Training 1 by 2015.
15) Decrease the number of ST1 or Core Training 1 places in specialty or hospital-based disciplines to create the capacity for GP training, especially in oversupplied specialties.
16) Review the long-term targets for GP trainees and specialty places after NHS England publishes its Review of Primary Care report, and implement ad part of the Shape of Trainine report.
17) Boosting GP trainee places in under-doctored areas should be incentivised and made a priority in the short-term, but training places nationally should consider trainee allocation on a ‘weighted population capitation basis’. This would mean local trainee targets set in a similair way to practice and CCG funding, accounting for geographic factors, population size, and population need.
18) Local Education and Training Board funding for GP training should also be allocated on the weighted capitation basis (above), to match the allocation of GPs. But in the short-term funding will have to favour under-doctored areas to allow them to expand places or fund schemes to attract trainees to these areas.
19) HEE and the GP National Recruitment Office must assess why 25% of applicants for GP training positions are considered ‘unappointable’.
20) There should be more flexibility for doctors from other specialities to retrain as GPs, particularly around recognising priority training and career progression.
21) there should be a mandatory, fully-funded induction and refresher training course and evaluation for eligible overseas doctors without prior experience as a GP in the UK.
22) As GP training places cost more to fund, the report recommends that 2,025 speciality training places could be decommissioned to allow GP numbers to be boosted without costing HEE more money.
23) The decommissioning and rebadging of specialty training posts should be led by LETB postgraduate deans or associate deans from a specialty background. GP schools will need specialty leadership to expand GP numbers successfully.
24) LETBs should explore the use of a ‘federated practice model’ for training – as traditional one-to-one training is seen as a limiting factor to expanding training capacity. The federated model would expose trainees to a wider range of health professionals, allow practices to manage multiple trainees, and benefit other primary care health professionals.
25) LETBs should run local programmes to recruit and develop their primary care training capacity, and should allocate £10-20k per programme to this.
