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Don’t ‘sell’ general practice to us – it won’t work

The recent debate on how to ‘sell’ general practice to trainees has been interesting. Many have long advised that GPs shouldn’t be negative about their specialty. These people have good intentions but underestimate, I think, how highly trainees value candour.

Take the scenario of an FY2 having some taster days in general practice. Said doctor speaks with a GP principal and is given a good impression of GP, with a bit of gloss over issues such as indemnity or workload. Then the FY2 does their due diligence and does a bit of reading online. They find that NHS England have created a dedicated scheme to help GP retention.

They read case studies on the difficulties of working as a GP.

The read articles such as ‘Is GP in crisis?’ from the Kings Fund. The FY2 inevitably realises some sugar-coating has been employed. Not the end of the world – some may argue – but here’s the real problem: the next question that this FY2 then asks themselves. What other issues were they being ‘protected’ from and can they now trust what they were told by that GP principal? I would argue that the unintentional consequence of that questioning of, or loss of trust in, the GP principal is the worst possible outcome from an opportunity to recruit.

If you make any job attractive, regardless of the views of others or ‘banter’, people will flock to work in that job. Commentary regarding the heavy use of Microsoft Excel and PowerPoint hasn’t stopped some of my peers leaving medicine to become management consultants. The jokes about the non-surgical acumen of orthopaedic surgeons doesn’t hinder recruitment for orthopaedics at ST3. This is simply because the perceived benefits of those careers outweigh the perceived costs. It is a simplification, but that balance probably sums up the career choice of every single doctor ever.

This isn’t to say denigration of specialties in front of medical students is acceptable and doesn’t need addressing. At that stage of training I do accept the argument that perceptions matter. However, even for medical students, the perceived benefits and costs equation is just as valid.

These days most undergraduates have had people advise them that entering medicine is a bad idea. This is certainly the case amongst the sixth-form students that I have mentored for a charity over the years. Nonetheless our current crop of medical students still all took the plunge – because they think the job of being a doctor is worth it.

Perhaps the most efficient use of time and effort on improving recruitment to general practice would be to make the job attractive. It would tip that cost and benefits equation in the favour of general practice. It is something that can be influenced to a reasonable degree by the RCGP, NHS England and so on; rather than attempting to, for example, influence the nature of output from certain media outlets.

What may be helpful in the medium-term is to delve deeper into the ongoing work of Lambert and Goldacre, and to create an annual qualitative study looking at the reasons trainees choose GP at the point of entry.

A good brand knows its target market, and makes effort to keep up to speed with changes. Provided the reasons for trainees entering a VTS are compatible with the grand vision of the future of general practice then then a compelling argument can be made to tailor recruitment to the speciality specifically on these reasons.

I expect that there are some that baulk at the idea that flexibility, work-life balance or portfolio working may be strong motivations for trainees. But when push comes to shove, an army of part-time GPs is probably better than no GPs at all.

Dr Jason Sarfo-Annin is an NIHR academic clinical fellow and GPST1 in Bristol