Government must act to fix the ‘leaky’ GP training pipeline and paying for student loans could be a cost-effective way of doing this, a think tank has suggested.
As it stands, two filled training posts are required to get one fully-qualified, full-time equivalent (FTE) GP joiner due to high rates of attrition, according to a Nuffield Trust report published today.
The report urged policymakers to ‘seriously consider’ implementing a student loans forgiveness scheme for nurses, midwives and allied health professionals.
And it added: ‘The proposal should also consider the costs and benefits of including doctors and dentists in the scheme, although for this group the proposal could, for example, include an option to delay (interest-free) the start of repayment for a number of years, subject to remaining in training.’
The Nuffield Trust said its proposal is based on previous work by London Economics and would ‘gradually write off outstanding student debt, clearing it after 10 years of eligible employment, with the aim of increasing applications to study, reducing attrition during training and improving participation and retention in public services on qualifying’.
‘The estimated cost would be somewhere in the region of £230m for nurses, midwives and allied health professionals per cohort in England. A similar scheme or early-career loan repayment holidays for doctors and dentists in eligible NHS roles should also be seriously considered. We believe this would represent a very sound investment,’ the report said.
And while the think tank recognised that NHS England’s recent long-term workforce plan included proposals which could decrease attrition and improve workforce supply, it warned that ‘any gains rely on an already overstretched NHS implementing these policies well’.
The authors said their research indicates that current Government strategies to ‘ensure a sustainable GP training pipeline’ are likely ‘falling well short of what is needed’.
They recommended that new schemes are developed to retain GPs which could include ‘reimagining the current GP fellowship scheme to provide more funded posts designed around the motivations of this group of doctors as well as the needs of the NHS’.
According to the Nuffield Trust’s analysis of NHS Digital and Health Education England (HEE) data, which the authors warned is ‘limited’ in some places, they estimated that ‘every two filled training posts in general practice result in around one fully-qualified, FTE GP joiner’.
They said: ‘This is partly because the proportion of fully qualified GP joiners working full time has fallen, from three in four in 2016/17 to one in three in 2022/23.
‘Such a loss in the training pipeline comes at a significant cost, particularly given that all GP trainee salaries are funded through central training budgets (on top of funding provided during medical school and foundation training).’
The authors also said that despite initiatives offering financial incentives for GP joiners, in the year to December 2022, the joiner rate for fully-qualified GPs in England was 8%, which is the lowest rate across the previous six years.
According to the research, the medical training pipeline – from undergraduate to foundation years – has ‘failed significantly’ to provide the UK doctors needed to fill GP training posts, with the system becoming ‘increasingly reliant’ on international medical graduates (IMGs).
The report also found that of those who graduated from medical school 10 years ago, just under a third (29%) are now on the GP register.
This finding aligns with Pulse’s own analysis over the summer, which mapped the progress of about 7,800 medical students who started medical school in 2012.
The Nuffield Trust argued that public bodies ‘must better manage the value for money’ of the £5bn that is currently spent on clinical education and training, and that focussing solely on increasing the number of people training ‘seems unwise’.
The authors said: ‘In fact, general practitioner (GP) training places increased by a third around the middle of the last decade but the numbers subsequently joining as permanent, fully qualified GPs remained unmoved. So it is crucial to plug the leaks in the pipeline.’
Nuffield Trust recommendations
- National bodies must act quickly to correct some of the inaccurate and negative perceptions of clinical training and careers.
- Public bodies must better manage the value for money of the £5 billion spent on clinical education and training
- Government must commission an independent review on degree-level clinical apprenticeships.
- Government must now seriously consider a formal proposal for a student loans forgiveness scheme for nurses, midwives and allied
health professionals. The proposal should also consider the costs and benefits of including doctors and dentists in the scheme.
- Government should also formally evaluate other models currently used to improve participation.
- The Office of Manpower Economics, as part of its secretarial role for the pay review bodies, should undertake (or commission) a substantive analysis of the competitiveness of NHS (and other public sector) starting and early-career salaries for clinicians.
- The apparent inequalities in career advancement opportunities between professions must be urgently addressed.
- Workforce planners at national and regional levels must proactively plan for the increased desire for more diverse career pathways.
- Government needs to urgently revisit the policies in place for promoting the supply of GPs into NHS services.
- The data on attrition, participation and retention in public services need improving.
Meanwhile, figures published today as part of NHS England’s GP workforce data, showed that in the twelve months to August 2023 the number of all FTE GPs, including those in training, increased by 387, from 37,085 to 37,472. And the total GP headcount increased by 1.2% from 46,311 to 46,853.
However, over the same period, the number of FTE GPs who are fully qualified has decreased by 269 (1%) and the number of FTE GP partners decreased by 2.3% from 16,764 to 16,386.
Chair of the BMA’s GPCE Dr Katie Bramall-Stainer said that the ‘modest rise’ is positive, and is likely down to the new joiners who finished their GP training in August.
But she added: ‘What must not be diminished however, is how long they are retained, and our profound concerns regarding the longer-term trend in the number of fully qualified GPs massively declining in recent years.
‘The truth is that we have thousands fewer fully qualified, full time equivalent GPs today than we did 8 years ago, and unsurprisingly, our current workforce is subsequently stretched beyond capacity.’
Responding to the Nuffield Trust’s report, vice chair of the RCGP Dr Victoria Tzortziou Brown said that there is now a ‘serious workload and workforce crisis’ with general practice having been ‘allowed to decline for well over a decade’.
She said: ‘The sad fact is that the job of a “full time” GP is now largely unmanageable, and even working ‘part time’ in general practice often means working what would normally be considered full-time, or longer, and includes many hours of paperwork on top of patient appointments.’
Dr Tzortziou Brown called for ‘urgent solutions’ to prevent burnout, including a ‘fully-funded national retention scheme’ and a reduction in the amount of time GPs spend on bureaucracy.
Last month, a Pulse survey, answered by 376 GP partners across the UK, revealed that nearly one in five GP positions in the UK are unfilled.
And a recent study found that more than one in three medical students plan to leave the NHS within two years of graduating.