Unsustainable workload, part-time working and portfolio careers: results of the GP trainee survey
)
Since 2016 The King’s Fund has surveyed GP trainees on their future career plans. The 2022 survey identified that workload issues were affecting trainees’ plans and the 2023 survey results amplified those findings. In 2023 340 trainees responded to our survey, which included some new questions about retention. This is a not a representative sample, but it does shed light on the career plans of the next generation of GPs.
While many respondents reported a positive experience of training, what they saw in practice was making them very concerned about their workloads when they qualified. One key theme was trainees’ concerns about an unsustainable workload after completing training. Many respondents said, even as trainees, they often had to work beyond contracted hours to keep on top of their workload.
'Being a GP trainee is very different to being a qualified GP. Our hours and workloads are much more protected as a GP trainee.'
'Trainees are shielded from the heavy workload that partners and full-time GPs undertake.'
'I enjoy the support as a trainee but I fear the workload of a fully qualified GP.'
The top three concerns were the intensity of the working day (82 per cent of respondents), volume of administrative work (75 per cent) and work-related stress (65 per cent). These concerns are understandable given that GPs in the UK report the highest stress levels and lowest job satisfaction of GPs across 10 high-income countries. Trainees’ career choices appeared to reflect these concerns, with many respondents planning to reduce the number of clinical half-day sessions they work when they qualify.
'I can imagine myself getting burnt out so would likely be doing less sessions as time passes post-CCT [certification of completion of training].'
Between our surveys in 2022 and 2023 there was a 10 percentage point increase in the number of trainees planning to do no clinical work or still being unsure of their plans five years after qualifying. These findings suggest that unless action is taken to improve retention of GPs the number of full-time equivalent GPs may continue to fall. Respondents identified the top three priorities to improve retention as better pay, improved workload and longer appointment slots.
'I would work more clinical sessions in a practice which had 15 minute appointments as standard, limited admin and support such as care co-ordinators but the risk of burnout is too high with the more typical NHS work.'
When asked about their career plans one year after qualifying, the most common response (41 per cent) was an intention to work five to six clinical sessions (out of a possible 10) per week possibly because the workload means that in reality these part-time hours are often actually full time because of the significant number of additional unpaid hours of work required.
'I might decrease to one to two sessions after 10 years or so to focus on my academic career if the work pressure remains similar to how it is at present.'
'In the current climate, I think I would become ill if doing any more sessions in GP.'
Respondents who planned to work outside NHS general practice most commonly planned to work in other NHS settings, such as hospitals, undertake out-of-hours work or private clinical work, move abroad or work in medical education. Of the 311 respondents who answered this question, a higher percentage compared to the 2022 survey plan to move abroad to work (43 per cent of those intending to work outside NHS general practice in 2023 compared to 30 per cent in 2022) or undertake private work (40 per cent in 2023 compared to 33 per cent in 2022).
'Not really sure how long I will be able to work as an NHS GP because of the high workload and not enough income based on the workload.'
More trainees were planning to work as a locum (23 per cent in 2023 compared to 22 per cent in 2022) or ‘other’ (10 per cent in 2023 compared to 4 per cent in 2023) five years after qualifying compared to previous years, and there was a notable decrease in the number intending to work as a GP partner or salaried GP (from 57 per cent to 47 per cent).
'I would like to locum as it is better than being salaried in terms of workload, work hours and pay. After five to 10 years, I imagine I might be abroad, in private practice or have moved into a non-clinical role.'
The most common reason for choosing to not be a partner was responsibility for practice workload, which echoes findings in 2022.
The NHS Long Term Workforce Plan aims to increase the number of medical school and GP training places, but there is little point in increasing places if fully qualified GPs are not retained over the long term. Solving the GP workforce crisis will require a break in the vicious cycle of clinicians leaving the workforce due to workload pressures, which in turn increases the pressures on those GPs who remain. While many trainees who responded to the survey had positive experiences of training, they highlighted significant concerns for the future after qualification. Listening to the voices of the workforce and addressing the issues raised by those voices could influence trainees' future career choices and improve retention.