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A profession fast losing its appeal

It’s been widely accepted for some time now that general practice needs more GPs. The shift of work from secondary to primary care is an ongoing trend, the ‘retirement time bomb’ seems to have been ticking for years – and the small matter of GPs taking on commissioning responsibility, now just four weeks away, has been on the horizon since 2010. But our investigation this month suggests long-standing fears of a recruitment crisis have finally been realised, with the average vacancy rate for GP posts at practices quadrupling in just two years.

It is important, of course, not to overstate the case. An average vacancy rate is a crude measure which masks regional variation, and there have always been cyclical fluctuations in the jobs market. Just a few years ago, we were talking about a recruitment crisis in general practice which consisted of there being too few jobs for GPs, rather than the other way round. 

It’s also worth acknowledging the shortages are partly due to general practice’s rapidly changing demographics. 2013 is supposed to be the year when women will for the first time make up the majority of the GP workforce, but it’s not just female GPs who are increasingly keen on a better work-life balance. Portfolio careers, meanwhile, are fast becoming the norm. Dr David Weinstein, for instance, the Brighton GP featured in our Working Life photo essay this month (page 64), works every Friday in A&E and says the variety makes him a better doctor.

Whatever the causes, both CCGs and the Department of Health must do more to ensure practices can plug the gaps. Adequate backfill for partners taking on commissioning work and including sessional GPs in CCG work will help somewhat; asking practices to pay locums’ superannuation and then reimbursing them according to list size rather than locum use, as is currently the plan, will probably not.

But beyond the immediate difficulties in filling vacancies, the jobs crisis raises fundamental questions about the future of the profession, and how it can attract the new blood it desperately needs. 

General practice has always been a hard sell to medical graduates tempted by the glamour of hospital medicine, but in the years after the introduction of the 2004 contract, healthy earnings, acceptable hours and a degree of independence made it an attractive alternative. Yet, despite the DH boldly declaring that GP registrars should account for 50% of specialty training places by 2015 and opening up more training slots as a result, deaneries are struggling to fill the ones they have.

If ministers are serious about increasing the number of GPs, they must make it an enticing career option once again. GPs cite an unmanageable workload and ‘box-ticking’ clinical culture as off-putting factors for would-be trainees, while increasing bureaucracy and contractual uncertainty are dissuading many from the financial commitment of partnership. In the past few months alone, ministers have brought in revalidation, ripped up the GP contract and gone to war over pensions.

If they really do value general practice, they have a funny way of showing it.

For an older generation general practice will always be, as Dr Peter Swinyard puts it, ‘the best job in the world’. But that generation is a retiring breed. Their successors need to know it will still be the best job in the world in 20 years’ time.

Steve Nowottny is the Editor at Pulse