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Workload issues affecting GP trainees’ plans for their future careers

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    Kristina Bergman

For the fifth time since 2016, The King’s Fund has surveyed GP trainees on their plans for their own careers and on the future of general practice more generally. Each time we ask questions about trainees’ intended future working patterns, one year, five years and ten years after completing their qualifications. This year’s survey of GP trainees shows excessive workload and intensity is having a significant impact on how trainees plan to work in future.

The survey was distributed via the GP Vocational Training Scheme in England and we received 318 responses from people at different stages of their training. This year less than a third of trainees said they intended to work full-time (defined as eight or more half-day sessions per week) a year after qualifying, dropping to less than five per cent ten years after qualifying, which largely mirrors previous years’ survey results. The most popular option for working hours at every future point in time was five to six clinical sessions per week.

The most common reason selected for not wanting to work more sessions was ‘intensity of the working day’ (78 per cent of respondents not wanting to work full-time selected this option). In previous years ‘family commitments’ has been the second most common reason for wanting to work less than full-time, but this year, the second, third and fourth most selected options were all related to workload, including the volume of administrative work; work-related stress and long working hours.

GP time is counted in half-day sessions but after each clinical session GPs also have to complete all the administrative work that each encounter generates. This might include interpreting investigation results, communicating with hospital specialists or carrying out urgent clinical assessments, such as home visits. This means that a half-day session, in reality, lasts much longer than four hours and so six half-days a week can easily equal 37 hours or more, which is why so few trainees feel a ‘full-time’ workload of eight sessions is sustainable:

“General practice is a brilliant job, but will always be too intense to do for more than five or six clinical sessions per week.”

Author: GP survey participant

Taking on a portfolio career is the most popular option for GP trainees at both five and ten years after qualifying. As in recent years, the most common plans for GPs working in portfolio careers are to work for other NHS services (such as sexual health, urgent care or palliative care) and in medical education, both of which will bring specialist knowledge, skills and training opportunities into primary care. For me, the portfolio way of working at both a GP practice and at The King’s Fund increases my job satisfaction, and each role compliments the other: I can apply policy and systems thinking I gain at the Fund to my general practice, and bring a frontline primary care perspective to work I am involved in at The King’s Fund.

The trend away from wanting to take on partnership continues, with being a salaried GP the most popular option for one and five years after qualification. The most commonly selected reason for not wanting to become a GP partner was the ‘responsibility for practice workload’. Despite this, at 10 years after qualification, 35 per cent of trainees intend to be a GP partner (down from 45 per cent in 2016).

Compared to previous years, more people suggested that they were unsure about what hours they might work in the future or whether they would continue in general practice at all, reflecting the uncertainty and doubts described by some trainees about the long-term sustainability of a career in general practice due to workload and demands.

This year, we also included questions on the GP trainees’ views on the integration of additional roles in primary care, and whether they think it will improve patient care and/or their own working lives. The majority of trainees were very positive about working in teams with other professionals such as pharmacists and community link workers and saw clear benefits for their own work and for patients, but they were worried about unclear boundaries between different staff roles.

Most GP trainees were still positive about their future in general practice, drawn by the opportunity to offer continuity and holistic care, which makes a career in primary care exciting, challenging and unique. The ability to work flexibility means it can remain a manageable job, but this will mean that more staff will be needed in future to meet the workload demands.