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Only quarter of medical graduates rate general practice as first choice

Only a quarter of medical graduates chose general practice as their first choice of specialty, shows a new analysis that sheds light on one of the reasons for a growing crisis in the GP workforce, experts claim.

In results that a former RCGP chair says show how workforce planning has gone ‘terribly wrong’, only 28% of medical graduates cited general practice as their first choice career, compared with 71% of graduates citing secondary care specialties as their first choice career.

This falls well short of the target of 50% of training places being for GPs by 2015 set by former health secretary Andrew Lansley.

The study - published in the Medical Teacher journal - looked at 9,348 questionnaire responses from people who graduated in 2005, 2008 and 2009 one year after they graduated. They were asked to state their choices of long-term career.

It also showed a marked difference between males and females choosing general practice. Around 24% of men cited general practice as their first choice, which remained constant over the three cohorts, while 36% of women chose general practice in 2009 - which was a decrease from the 40% in 2005.

The researchers concluded: ‘General practice is still substantially under-represented in [newly-qualified doctors’] preferences.’

The latest figures on GP recruitment are not encouraging despite Lansley’s commitment. Pulse revealed last year that there had been a decrease in the number of GP training places in England in 2012, compared with the previous year, and a rise in hospital training places.

Study leader Professor Michael Goldacre, a professor of public health at Oxford University, said there was ‘some cause for concern’ about the figures showing a relative lack of interest in general practice from newly-qualified doctors.

He told Pulse: ‘Clearly we observe that a much smaller percentage express a preference for a career in general practice than the NHS actually needs.

‘We note that the deficit is eventually likely to be made up by the fact that doctors will go where the training places and jobs are. That is a mitigating factor.’

The latest figures from the NHS Information Centre show there are rising numbers of consultants practising in England, compared with GPs. Some 39,088 consultants were practising in England in 2011, compared with 27,218 GPs. This compares roughly even figures between the professions in 2001, with 27,782 consultants and 27,938 GPs.

Professor Mayur Lakhani, a former chair of the RCGP and a GP in Leicestershire, said the figures were ‘astounding’.

‘Workforce planning has gone terribly wrong. The system should have been producing more GPs. Instead it has been producing more consultants. The needs of patients are clear – they need more generalists.

‘Pulse’s investigations shows that practices are at breaking point – there is so much work being transferred into practices, and I feel it as a practicing GP. Like a rubber band, it has been stretched and stretched. Yet the numbers of GPs are the same.

‘At a time when all the policies have been about making the health service more primary care centred. Workforce planning has not really delivered extra capacity in primary care.’

He added that educators should look at ways to ensure a higher percentage of medical graduates want to pursue a career in general practice ‘from the outset’.

Professor Bill Irish, who is director of GP Education at the Severn Deanery and chairs a Government taskforce on GP recruitment and retention, said: ‘One of the problems is that not enough people apply to GP specialty training.

‘There is a regional issue too – the Kent, Surrey and Sussex deanery has filled its training places for the past couple of years. But in areas in the north of England, it is difficult to recruit enough to maintain current levels.

‘As a taskforce group, we want to understand what guides or prevents people becoming GPs.’

Professor Richard Baker of Leicester University’s health sciences department, who has been collecting data on workforce numbers over two decades, said the problem was not about an increase in specialists, which was necessary. However, the flatlining of GP numbers was ‘a pressing problem’.

He added: ‘My concern is it not about complaining about the growth in specialists. The anxiety is that it takes a long time to train a GP. And in order to fill the gap, are we going to look to other ways to deliver primary care other than by GPs? We need to have a very informed debate about how to manage that.’