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Medical schools ‘should have funding linked to producing GPs’

Medical schools ‘have a responsibility’ for addressing the GP workforce crisis and should have their funding linked to their achievement of targets on number of GPs produced, a study led by a senior Government advisor has concluded. 

The study – ‘A systematic review of strategies to recruit and retain primary care doctors’, published in BMC Health Services Research – also found that advertising campaigns to attract junior doctors to general practice have been detrimental in some countries.

In its review of 51 studies, the paper highlights that few government interventions to increase GP recruitment – many of which are being implemented as part of the NHS’s ten-point plan for GP workforce – are supported by robust evidence.

GP leaders have said the paper shows that one-off interventions are not going to solve general practice’s ongoing workforce crisis, and that the best advert for the profession is investment so trainees see it as an attractive place to work.

The study was authored by Sir Sam Everington, chair of NHS Tower Hamlets CCG and an adviser to NHS England, and Professor Amanda Howe, vice-chair of the RCGP, among others.

It published figures revealing that fewer than 10% of graduates from Oxford and Cambridge universities went on to a career in general practice.

Health education leaders are currently conducting a review into medical school culture, and the report authors urged the Government to link funding to universities’ output.

The study concluded: ‘Medical schools have a responsibility to start taking notice of the workforce crisis in primary care and perhaps resources and funding for these universities should be based on output to meet targets.

‘Universities should be held accountable as to how much time they allocate to the primary care setting and this data should be made publically available.’

The review also found:

  • that an advertising campaign to recruit GPs in the USA had a negative effect on potential candidates, with half of those who watched the video opting for a career in general practice compared with those who didn’t watch it.
  • there could be benefits from offering additional postgraduate training in under doctored areas;
  • ‘mixed results for the use of financial incentives’, such as golden handshakes, which it said was most effective in trainees ‘who had existing links to the underserved area’;
  • that there was widespread failure to effectively evaluate the outcome of interventions with few studies employing effective comparison groups, and no randomly controlled trials on the subject.

Many of these incentives formed part of Health Education England and NHS England’s ten-point plan.

HEE are currently offering £20,000 to more than 100 junior doctors willing to train as GPs in areas like Cumbria, while it last year ran a disastrous promotional video that highlighted extra-contractual work signing sky-dive forms as a reason to be a GP.

The chair of the GPC’s education, training and workforce subcommittee, Dr Krishna Kasaraneni, told Pulse: ‘The best marketing campaign, or strategy to improve GP recruitment is investing in general practice so the job is actually enjoyable for GPs to do. It isn’t for the majority, if not all of us.’

‘When that happens, when medical students come and spend time in general practice they will see a profession they want to join. It doesn’t matter what else you tell them, unless they see it and experience it themselves it’s not going to change.’ 

A HEE spokesperson told Pulse: ’No one intervention is going to make the difference. HEE and partners in NHS England, RCGP and BMA GPC are working together on many fronts including the 10 point plan initiatives to make recruitment flexible whilst maintaining standards and other measures to enhance the GP workforce.’

Tackling toxic medical schools

Maureen Baker-RCGP 2014-Online-cropped-(c) Rachael Meyer

Maureen Baker-RCGP 2014-Online-cropped-(c) Rachael Meyer

Pulse has already shown that medical schools are beginning to recognise the problems with primary care teaching.

Earlier this year Pulse revealed that the Medical Schools Council and Health Education England (HEE) would launch a review on the ‘profile of the GP culture’ in medical schools.

This comes after RCGP chair Maureen Baker attacked the ‘toxic’ anti-GP attitudes in some UK universities at the RCGP annual conference, and top GPs reported senior staff warning students not to ‘fail and become GPs’.