Looking to the future: general practice through the eyes of GP trainees

There is undoubtedly a workforce crisis in primary care – practices are struggling to recruit and retain experienced GPs and insufficient numbers are entering training.

NHS England’s recently published General practice forward view re-states a number of measures aiming to provide an extra 5,000 GPs by 2020, including initiatives to boost training numbers through a major recruitment campaign, enhanced training opportunities and targeted bursaries to train in areas with the worst GP shortages. But will these measures be enough?

As part of our recent report Understanding pressures in general practice we conducted a survey of GP trainees, exploring their intended future working patterns along with their views on the pressures facing general practice. We received responses from 318 trainees, and the key findings are:

  • A minority of respondents intend to work full-time in general practice.
  • A greater proportion intend to do part-time work, particularly at earlier career stages.
  • Many respondents intend to have ‘portfolio careers’ (defined as ‘part of the working week spent on clinical work in general practice and the rest of their time spent on other work’ which may amount to full-time working hours) – particularly at later career stages.
  • The most commonly cited reason for not wishing to pursue full-time clinical work in general practice is ‘intensity of the working day’ for both male and female trainees.
  • Many respondents do not intend to take on partnerships.
  • Medical education or other clinical NHS work are favoured options for additional work alongside general practice.

Some of the findings – particularly the popularity of portfolio working – are perhaps no surprise, as a trend away from full-time clinical work is well established among senior GPs. This could be a positive development for the profession, as research has shown there may be benefits to portfolio working for professionals and their patients. It seems this is not necessarily about working less but working differently, and many trainees intend to combine clinical work in general practice with other work in the health service. Flexible careers and opportunities for portfolio working are principal factors attracting trainees into the specialty. It is important that the changing aspirations of the next generation of GPs are recognised, and there is some welcome acknowledgement of this in the General practice forward view.

However, the overwhelming preference for portfolio or part-time careers has implications for capacity within the future GP workforce, and the adequacy of workforce planning to meet future demand in primary care. These changing work preferences must be recognised; if most GPs intend to work in general practice only part-time then it’s necessary to train even more GPs than the numbers currently assumed.

Our findings also challenge a commonly held assumption: that changing work patterns are a consequence of more women entering the GP workforce. It appears that this is only true to an extent. More female than male respondents opted for part-time work, while the opposite was true for full-time work and portfolio working. However, these differences diminish significantly over progressive career points; looking ahead to 10 years after qualification, a fifth of male respondents and a quarter of female respondents intend to work part-time, and just under half of both male and female respondents intend to have portfolio careers. It seems changing work patterns cannot simply be attributed to feminisation of the workforce; there are more complex factors at play.

Reasons commonly given by respondents for not intending to pursue full-time clinical work include: intensity of the working day; family commitments; long working hours; volume of administrative work; and work-related stress. Many of these drivers relate to unattractive aspects of the work in general practice, rather than the attractions of other work. Reduced clinical time was seen as a way to achieve a manageable yet fulfilling career. Many seemed to view this not as a choice but as a necessity for their work to be sustainable, while some expressed concern that even part-time or portfolio working would not sufficiently alleviate the pressures. These comments from survey respondents offer further insight:

'Patient complexity, demand and not enough time means that the workload is not sustainable.'

'Time pressure and workload has made it impossible to be a full-time GP for a protracted period of time without incurring costs to one’s own health and wellbeing. To prevent burn out, I intend to spread my work across different areas to gain more job satisfaction and better work/life balance. This is driving GPs away from full-time clinical work or partnerships, as they attempt to protect themselves and their careers from destruction.'

'There is not enough time with patients. I worry about missing a diagnosis.'

'Work related stress/illness is an issue. It’s a tough job. Resilience is fashionable, but the greater question needs to be asked; is there unsustainable expectation of the current workforce?'

So what does this survey tell us overall? I was left with an impression of trainees who are worried for the sustainability of their careers and their chosen specialty. This resonates with the concerns I have heard from my peers and former colleagues, who I trained with as a junior doctor. To me, the findings from our survey – particularly the detailed comments – speak volumes about the current state of general practice, as seen through (comparatively) fresh eyes.

GPs train on the job; they witness the pressures facing the service and the impact on their senior colleagues. Their views are inevitably shaped by these experiences. Enhanced training options, streamlined application processes and incentive payments are all welcome, but they are sticking plasters. The remedy must be prolonged investment and reform to general practice to make this a truly attractive and rewarding career.

View the full results from our survey

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Comments

#547646 Terry
Member of the public

As you say in your last sentence 'there must be prolonged investment and reform...' but there must also be a realisation that the NHS is not the only service to experience change and pressures. We are in a changing and more challenging world right across the board with junior doctors not helping themselves by the latest strikes by making some reality to the phrase 'Trust me I am NOT a doctor'.

#547655 William Denby
GP Registrar

Thanks for this piece. I would be very interested in helping with future work with Kings Fund and GP StR/First5.

My view is that there is a fear of change here. UK General Practice cannot continue in the traditional way in today's Health Economy and therefore the much vaunted 'new ways of working' and MCPs need to be viewed much more as a solution than just another central scheme to cause problems.

From where this trainee sits I see real threat to the professional and financial autonomy of UK GPs and also the Partnership model - which predates the NHS. It is crucial that GPs senior and junior view this threat as an opportunity and use the many many strengths in the medical (and GP) cadre. The recent Junior Doctors dispute has seen the junior voice come through - now we need that voice, with good ideas and good leadership, to drive the change the NHS needs.

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