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Through the eyes of GP trainees: workforce of the future


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    Mike Nosa-Ehima

There is a workforce crisis in general practice with the GP workforce declining while workload increases. The NHS’s struggle to retain GPs is highlighted by a 2.2 per cent decline in the number of full-time equivalent (FTE) GPs to 33,062 in September 2017 compared to September 2016. A recent GP survey found that 39 per cent of respondents (and 62 per cent of respondents aged 50+) planned to leave ‘direct patient care’ by 2022.

Two years ago we conducted a survey of GP trainees as part of our work on understanding the pressures in general practice. We’ve now conducted a second survey looking at trainees’ intended working patterns once they qualify, so we can try to understand more about the choices they are likely to make and why. We received 729 responses and key findings were:

  • only 21.7 per cent of respondents planned to work in full-time clinical general practice one year after qualifying. This fell to 5.4 per cent planning to do so ten years after qualifying

  • 9 per cent (in the first year post-qualifying) intended to work part-time as a GP, with many wanting to undertake other responsibilities and have ‘portfolio’ careers, with this option becoming increasingly popular the longer they had qualified

  • 52 per cent of respondents chose ‘other clinical NHS work’ as the preferred option for work alongside their NHS general practice commitments. ‘Medical education’ was also a popular choice (39 per cent of respondents)

  • the most commonly cited reason for not undertaking full-time NHS general practice work, irrespective of gender, was ‘intensity of working day’

  • the main reasons suggested for increased workload were ‘increased patient demand’, ‘increasing and ageing population’ and ‘insufficient staff in general practice’.

  • only 37 per cent planned to be GP partners. Concerns about the sustainability of the partnership model and a mismatch between the additional administrative work/responsibility for the business and remunerations are pushing trainees away from partnership

Compared to a similar survey we ran in 2016 , this survey saw increased popularity of portfolio-working and a smaller proportion of respondents who wanted to work in full-time NHS general practice after completing training and who wanted to become partners.

The most commonly cited reason for not pursuing full-time clinical work was ‘intensity of the working day’. One respondent said, ‘I enjoy the variety of general practice but I dislike the relentless pressure, the mounting paperwork and the rigidity of ten-minute appointments. I don’t feel satisfied with the care I provide in a primary care environment.’

I am a GP trainee currently working six general practice clinical sessions a week (three days) and for six months I spent one and a half days a week at The King’s Fund carrying out research and analysis. This portfolio approach to working significantly increased my enjoyment of both jobs and reduced stress. This was reflected in our survey with many of our respondents feeling portfolio-working was a necessity, with one commenting that ‘at the present point, the only way to manage the unreasonable workload in direct clinical care delivery is by portfolio-working.’

An increase in portfolio-working has implications for future workforce capacity and workforce planning targets, but could bring benefits for patients and the wider system. By engaging in other work, such as working in out-of-hours settings or spending time in other specialties, GPs can deepen their knowledge and skills and develop special interests, allowing them to offer patients more clinical options in primary care settings. This flexibility and the ability to develop special interests are some of the more attractive aspects of a career in general practice, and Health Education England and the Royal College of General Practitioners have recognised this by showcasing them as part of their GP trainee recruitment campaign.

The issues raised in our survey were in keeping with the national GP worklife survey suggesting that not only do these issues discourage current trainees from embarking on full-time NHS general practice work, but they push current GPs out of full-time work. Our findings suggest that the trend towards more part-time or portfolio-working is being driven by a push away from general practice by the unattractive aspects of the job rather than a pull towards alternative options.

Although NHS England and the government are working to combat the workforce crisis in general practice, simply recruiting more trainees will not be enough. General practice will need prolonged investment and will have to find innovative ways of working to enable staff to provide person-centred, holistic, pro-active care within a better working environment. Enabling staff to provide appropriate care in a less stressful environment could make general practice a more attractive career and may increase recruitment and retention.