After new doctors have finished their 2 year foundation programme, mainly in hospitals, they can apply for GP training which takes 3 years half of which is in relevant hospital departments, after which they are able to pick and choose where to work as a GP, as there are a huge number of vacancies. Salaries are high and practices are begging to get new doctors to replace the many who are retiring. Earnings are as good as for NHS specialists, there is no out of hours or weekend work and there is a guaranteed job at the end of it, which there is not for other specialties. For example, there are many trained anaesthetists who cannot get jobs. And in order to qualify as a specialist, you have to do a minimum of 6-7 years training, with a lot of on unsocial hours work.
And GPs can run their own practices, and are thus more independent of NHS managers, who blight the life of many specialists. So obviously, with more money, nice hours, a much shorter training, and the promise of being able to run their own show, young doctors are likely to prefer to train as a GP.
Except they are not!
GP training programmes are undersubscribed despite many areas resorting to golden hellos of £20,000! And extra rounds of recruitment. And the GP registrars on training schemes are very often put off by their training and few of them opt for full time GP work at the end of their 3 year programme. So when there should be a glut of applicants for GP vacancies there is a dearth, and nowhere near enough to replace all the GP's who have had a bellyful and a good pension and are retiring.
The whole basis of the NHS is threatened by understaffed GP practices. The OECD gives the NHS a good rating overall, but bad marks for many aspects of specialist care. They say the best thing about the NHS is that patients have a ' medical home' which helps coordinate care and stops specialists advice conflicting with each other. This will be less effective with understaffed practices, nurse practitioners, temporary locum doctors and generally poor continuity of care.
So whose fault is this?, and how can it be sorted?
There are a few possibilities. Press coverage from the Daily Mail is unflattering to GP's image. The pressure of regulation from the General Medical Council and the Care Quality Commission are tiresome and a bit threatening. The 'dumping' of work by hospitals onto GP's is increasing . The rapidly rising risk and cost of complaints and being sued is off putting. However the main issue putting young doctors off is, somewhat amazingly, the Royal College of GP's, the organisation that is supposed to be encouraging quality General Practice, and their senior members who run the GP training schemes in the various ' deaneries' around the country.
These doctors and their staff became used to having lots of good applicants over the years and failed to realise that they gradually made the training schemes worse and less attractive in many ways. They made the training much more rigid, and stopped the practice of giving credit for relevant experience. Thus a doctor who has been training in Emergency medicine and wants to switch to GP now has to do another spell of Emergency work. They have reduced the flexibility which used to allow trainees and trainers the chance of choosing each other. Now many areas allocate the trainees to practices by a method which seems neither fair nor transparent. They have allowed the service demands of hospitals to trump the learning needs of trainees so that they are forced to work more than their fair share of nights and weekends than specialty trainees. The training process has become an elaborate tick box exercise with some very poor quality educational sessions. As practices have got busier in recent years some are demanding more work from trainees and spending less time and effort on debriefing and educating them. And trainees are forced to sign up for college membership and have to pay over £1000 a go for an arduous exam which has a high failure rate, and which has been severely criticised for being unfair to ethnic minorities (and males!). Repeated failure is, as one would expect, catastrophic for a medical career and leaves doctors with almost no options.
In short the RCGP have blindly and bit by bit for various reasons succeeded in putting off many of our best and brightest young doctors from the idea of General Practice. They need to stop blaming other people and sort it out.
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