Exclusive The GMC has announced radical new proposals that will enable thousands of secondary care SAS doctors to enter general practice.
In its State of Medical Education and Practice workforce report, it is calling on the governments of the UK to change legislation to make it easier for qualified doctors to enter the GP register to solve recruitment problems within the profession.
This will enable practices to recruit staff and associate specialist (SAS) doctors from the UK or potentially directly from overseas.
This could also offer a route back in to general practice for the thousands of former GP trainees who had failed the MRCGP exam four times and had to leave the profession as a result.
Speaking to Pulse, GMC chief executive Charlie Massey said that were the proposals to be adopted, this could lead to ’10,000 or more doctors’ entering general practice over the next few years.
These are recommendations by the GMC, but if they are adopted by the governments of the UK, it would require an amendment to secondary legislation – but without having to be passed by parliament.
The GMC said that the issue of supervision of these doctors in primary care would still need to be discussed.
The report revealed there were 64,000 licenced SAS doctors in the UK, a 40% increase over the past five years.
It said: ‘We must make the most of the incredible pool of ability at our disposal in SAS and LE (locally employed) doctors. One way to start immediately would be for the government to change the Performers List criteria, to allow more doctors to work in general practice.
‘Lifting the barriers that prevent SAS doctors from working alongside GPs in complementary primary care roles would expand SAS doctors’ career options and provide new opportunities for those who want them. Importantly, it would also give GPs much-needed support, allowing them to focus on the areas of practice where their particular skills and specialist expertise are most in demand, to the benefit of health services, doctors and patients.’
Speaking to Pulse before the launch of the report, Mr Massey said: ‘We’ve essentially got a bit of the care system that we know is desperately in need of workforce in general practice, and we’ve got a massively increasing number of doctors who are prevented by red tape from being able to work there. So, let’s remove that red tape, and then work out who and how many and in what way and how quickly we’re able to move people into primary care.’
When asked how many doctors could move into general practice, Mr Massey answered: ‘We’re into the thousands, certainly. And, I think it’s possibly even into the ten thousand or more over that period of time, that would make a real difference to GPs and primary care.’
Mr Massey added that this could provide a route back into general practice for failed GP trainees. He said: ‘I think part of the problem we have at the moment in primary care is that it’s incredibly high stakes, because if you don’t get your MRCGP, the door is then firmly shut in terms of an ability to work to your level of clinical ability in a primary care setting. But, obviously, one needs to make sure that those doctors are being deployed appropriately with the appropriate level of supervision in a way that is improving patient care.’
Dr Alan Stout, BMA UK GP committee (GPCUK) co-chair, said that the GMC’s proposals will ‘rightly trigger a debate’. He added: ‘Introducing a wider pool of staff who are able to bring their skills and expertise to general practice has the potential to help practices meet the growing needs of patients, reducing the need for referrals, while easing some of the current pressure GPs and their teams are experiencing.’
However, he added: ‘Policymakers must not overlook the fact that GPs are specialists in their own right, having undergone rigorous training to practise as community-based expert medical generalists.’
Professor Martin Marshall, chair of the RCGP, said: ‘GPs and our teams are working under intense workload and workforce pressures, and we are keen to explore solutions to this.
‘We would need to see more detailed proposals from the GMC about how SAS-grade doctors could work in general practice and integrate with existing teams, and the College should be part of discussions around this potential role. What is clear is that SAS-grade doctors, like other members of the wider practice team, must not be seen as a replacement for GPs who are expert medical generalists and have completed their three-year training programme and have been assessed on their specialist clinical and communication skills required to practise independently as a GP in the UK.’
Dr Ujjwala Mohite, BMA UK SAS committee chair (SASC UK), said: ‘The NHS has a staffing crisis across the board, with nowhere near enough doctors to meet demand in both primary and secondary care. But such a plan should not be a case of employing largely international medical graduates cheaply and on poor terms to plug staffing gaps, as we see with many locally employed doctors.’
READERS' COMMENTS [19]
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What about drop appraisals/ revalidation for GP’s with certain criteria of experience, sort out renumeration that doesn’t penalise work, and support practice’s to take on a casual basis, the pool of vastly efficient retirees who can actually do the job! The stifling bureaucracy of micro management and quality charade has to go if you want to increase capacity rather than window dressing!
This is a very good and constructive plan and there are thousands of doctors with strong clinical skills and would make such a difference to general practice. Every other speciality has access to middle grade doctors but general practice does not! Actually in GP they will have a clearer path to progress to being a Independent GP like any other GP trainee if they wish to do it.
The same should apply for older consultants from secondary care who wish to reduce demanding on call work.
I actually suggested this idea to Dr Chaand Nagpaul when he came to address my local LMC about 3 years ago but I was told not a workable idea.
But stuff the current lot of GPs. Your institutes are crumbling. Put your feet up.
Either MRCGP exam or the candidates were inappropriate as who would want a failed GP to treat them.
Doctors with skills in different specialities are welcome to GP land to help in those specialities but training and supervision/guidance in pathways needs to be sorted out and there are few of us left to guide them.
But there are also major issues in secondary care for recruitment.More shift of the chairs on the Titanic i am afraid.The whole of the medical workforce is threadbare due to decades of successive colour government not training enough to replace the attritional nature of the career and teating the whole workforce like crap(BMA allowing it).Collapse is inevitiable to to the nature of the last few dacades of mismangement.Chicken are now coming home to roost.This will not solve the problems we have.This will not stop the exodus.
These are more distractions. from the real issue and doubt will make much real world impact with the likely onerous supervision required for the few secondary care Doctors that may wish to change. Nothing stopping the SAS trainees for applying for GP training and likely will get 6 or 12mths accredited from work done off their 3- 4 year training, which would be less problematic than creating another “middle tier” of General Practitioner
GPs are highly trained professionals with multiple skill sets and in the main more highly skilled than Secondary care Doctors who focus on narrow clinical areas with lots of managerial support
Trainees are given lots of support, added time if they fail exams and the bar is not set that high once they are in
The underlying problem is the lack of resources, loss of clear direction, muddled PCNs, and that GPs are being targeted unfairly for the ills of the NHS. Correct those and the numbers of motivated GPs will significantly increase
Just waiting for the headline ‘Government have recruited TEN THOUSAND NEW GPs’
Cynical moi!
It would be a reasonable idea if hospitals were full to the brim of doctors resulting in SAS struggling to find work. It might be good for those individuals who will have a choice away from the hospital. SAS doctors often face pretty crappy conditions unprotected by a deanery and essentially totally controlled by acute trust managers who have a monopoly on employing them.
But for the system it’ll be a disaster. GP surgeries don’t have to stick to the national pay scales, meaning the best SAS doctors (who want to) can be attracted away from secondary care. That’ll make the secondary care staffing issue much more acute.
There are about 20000 SAS doctors in the NHS. If each practice takes on 2 SAS doctors 75% would be gone…… the acute sector would collapse. Just look at pharmacies – they were indeed oversupplied with pharmacists just a few years ago – but now many are closing or reducing their hours purely because they cannot recruit pharmacist time.
Enable 10,000.
Disable 10,000.
Net: zero effect
“He who dares, wins, Rodders. He who dares, wins”.
System leaders desperation is palpable
Political masters facing 15 years in the political wilderness in full panic mode
Deals behind closed doors never a good way of addressing 12 years of populism polarisation and now post truth when its come to workforce and workload
I suspect once the SAS land, they will see the state of GP and then RELP. The root causes have to be addressed first.
Let’s all face it, GMC and CQC and NHSE. Your plan stinks, you’ve been found out, and the workforce is acting in accordance with its own self preservation and not your bend over backwards mentality – you missed the trick over years, looking after a valuable workforce, now watch the cookie crumble and the public suffer at your doorstep. Riots are on the horizon. And no GP bullying will mean anything, old one trick pony.
I have GP trained for nearly 20 years and have had only 1 trainee that didn’t complete training and pass their exams. They were unsuitable for General Practice and I would never have allowed them to look after my family which has always been my ultimate quality judgement.
Often it is the attitude that makes them unsuitable so they would have had to have had a huge shift in their time out of GP for me to be happy with this.
I never realised there were actually as many as 10,000 service personnel in the Special Armed Services, leave alone that many of them being Doctors with suitable experience to be GPs.
But if all these Veteran Doctors move from the Armed Forces, who is going to look after the health care needs of the deployed Army?
NHS certainly cannot cope with respectfully prioritising the Vets living in the community, because of existing waiting lists.
Mind you, Army doctors will probably be more eficient and brook no nonsense from the NHSE !
We humble civilian GPs might learn something about saying ‘no’ to new work without new resources!
Is this a cunning plan to reduce hospital waiting lists?
HoC issued stark warnings of a demoralised profession, with GPs facing burnout from working in a ‘systemically toxic environment’, with unsustainable workloads, managing intensely complex cases at speed with fear over reprisals. What is NHSE going to do about this?
Well, Decorum Est, i would guess that they will make them meet the criteria for their performers lists. So we go round the loop of requiring them all to have annual appraisals and all the other bureaucracy that is driving the rest of us away…
Are you going to care
ate tiers in the GP system?