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Medical students should be told to report denigration of GPs, says landmark review

A landmark review into attitudes to general practice in medical school says issues with ’tribalism, negativity and finance’ are deterring students who see it as a ’low status’ option.

It found that students are ‘led to perceive primary care to be of lower status’ and that even on placements in general practice they found GPs would encourage them to explore other careers.

The Health Education England review, which was led by led by GMC assessment board chair Professor Valerie Wass, calls for more funding to free up GP trainers to teach in medical schools and setting good examples as role models, and an overhaul of medical school curricula to bolster GP placements and focus on integrated, rather than specialist, medicine.

And, building on the work of the RCGP and Royal College of Psychiatrists ‘ban the bash’ campaign, medical school faculties will be tasked with weeding out undermining of general practice, and students will be encouraged to question and report denigration.

The report said: ’We identified three very significant but deeply seated issues affecting students; ”tribalism”, “negativism” and “finance”.’

It stressed that the negativisim even extends to general practice placements, where the stresses are evident and in some cases trainees say they were ’actively discouraged’ from choosing general practice and pursue secondary care careers by ‘some GPs disillusioned with their work’.

On the need for increased funding, it said: ’Appropriate funds must be available to release GPs to teach without compromising patients. Adequate funding structures, with equitable transparent accountability, must be urgently achieved to educate students in different NHS contexts outside secondary care.

’Without this they exit with little understanding of current, let alone future, health care delivery.’

It concluded that medical students want intellectual challenge, ’academic status and diversity’ and the ’current experience of primary care at medical school fails to meet these expectations’.

The report said: ’Students experience an uncomfortable divide between  primary and secondary care across which they meet unfortunate professional tribalism leading them to perceive primary care of ”lower status”. This must now be addressed as unacceptable.’

’What may sometimes be said in jest does, we learnt, impact on student choice. Work to challenge professional denigration is essential.’

Other recommendations included:

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  • Promoting general practice as a profession in schools;
  • Better training on the breadth and complexity of general practice, including the ‘business elements’;
  • Including general practice on the specialist register, something the BMA has been calling for;
  • And, for all medical schools to ensure that GPs ’contribute significantly’ to selection processes for potential students.

RCGP chair Dr Maureen Baker, who has previously labelled the anti-GP attitudes in medical schools as ’toxic’, said the ’comprehensive’ report ’draws much-needed attention to the fact that negative perceptions amongst medical students are often fostered in medical schools’.

She said: ’This is totally unacceptable, particularly at a time when we have a severe shortage of GPs across the UK and should be doing everything in our power to promote general practice.’

’It is imperative that we change the misconception that general practice is somehow run of the mill and has a lower status compared to hospital specialties. If implemented effectively, the recommendations made by Professor Wass today will go a long way to setting the record straight. As a former GP she knows what she’s talking about.’

BMA Medical Students Committee co-chair Harry Carter said: ’A key problem is that general practice is not given adequate prominence in the medical curriculum and it is encouraging that this report recommends that this problem is addressed.’

’However, it is also right not hide the fact that one of the solutions to this problem is to address the funding crisis which many GPs say is having a real impact on the service that they can provide for their patients. A comprehensive approach to solving the current crisis is the only way that more medical graduates will be encouraged into general practice.’

GP training targets still being missed

The report follows health secretary Jeremy Hunt’s announcement last month that the Government will commission an extra 1,500 medical school places next year.

At the time, Mr Hunt said the Government wanted to ’make sure a significant number of those enter general practice’.

The number of GP trainees was up across the UK for 2016/17 compared to last year but targets are still being missed, despite a major recruitment campaign.

Health Education England (HEE) had a mandated target for 3,250 GP trainees for 2016/17, but it missed this by 314 (10%).

The 2,936 that were recruited is 200 more than the previous year and represents a 90% fill rate.

HEE bids to boost numbers include looking to overhaul paths to GP registration to fast-track doctors form other specialties or trainees who have failed the RCGP final exam.