Deaneries have been forced to cut GP training places this year because the number of applicants for general practice has dropped so sharply that medical educators claim it would otherwise be impossible to fill posts with high-quality candidates.
Only 3,144 doctors were accepted onto GP training courses across the UK this August, a 7% fall on a year ago, as deaneries abandoned plans for a further increase in GP posts. The fall in trainee numbers comes after a decade of investment in GP training that saw a marked increase in the number of GPs.
Professor Bill Irish, chair of the GP National Recruitment Office, told Pulse that deaneries had decided to cut training places after a series of steep falls in applications for general practice. Just 6,028 doctors applied to be trained as a GP in August, a fall of 5% since last year, following a slump of 40% over the previous two years.
General practice faces a reduction in new entrants just as the Government's NHS reforms place major demands on the profession, and some GPs cut their hours or take early retirement because of tax and pension changes. Practices are already finding it increasingly tough to recruit GPs or source locum cover, and in August the Government's own advisory body, the Centre for Workforce Intelligence, said an extra 450 GP training posts annually were required in England alone within the next four years.
Professor Irish, a GP in Radstock, Somerset, admitted GP training faced funding constraints, following a Pulse investigation last October that found some deaneries were facing budget cuts of up to 15%. But he said the Department of Health had actually asked for an increase in the number of GPs trained up, only for training courses to be hit by successive drops in numbers of applicants.
He added: ‘General practice isn't the first choice of many graduates. Every time we increase the number of vacancies in general practice without decreasing other opportunities, we don't fill them. What happens is deaneries realise they are not going to fill [the vacancies], or if they do it will be with weak applicants, so they would rather reduce the number of places than appoint people who aren't very good.'
He said applications in London, the home counties and Northern Ireland remained healthy, but were a problem elsewhere.
NHS Education for Scotland said it would be investigating the continued fall in applications for GP training: ‘As with the rest of the UK, we have experienced a lower number of applications during the 2011 recruitment round. This drop will be subject to further inquiry.'
GP leaders warned successive pay freezes and an unsustainable increase in workload had made general practice unattractive to the new generation of doctors.
Dr Richard Vautrey, a GP in Leeds and GPC negotiator, said: ‘Deaneries have deliberately reduced numbers – they don't want to leave vacancies open to unsuitable candidates. We need to be careful not to end up in the situation we were in before the 2003/4 contract where we had a recruitment and retention crisis. If you reduce doctors coming in at the bottom end, and increase the number retiring because of pension issues and the health bill, it doesn't bode well.'
Professor Amanda Howe, honorary secretary of the RCGP and a GP in Norwich, said: ‘Uncertainty in any specialty does make students who are undecided think twice.'
A young GP's view - Competition still fierce
For Dr Ishani Patel, a newly qualified GP in north-west London, the fall in applications to general practice comes as a real surprise – and she believes entry to the profession remains as competitive as ever.
‘I see so many FY2 doctors keen to enter and trying to get on courses to improve their chances at the GP selection process,' she said.
But since qualifying she is already aware that low morale is diverting many away from the profession, to consultancy roles or other careers.
‘They see medicine and the NHS as a harder, perhaps less fulfilling, nut to crack,' she said.