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.’