The problem starts at undergraduate level when medical schools demand only the top grades in exams and minimal assessment, and therefore gather a narrow selection of students from our society.
The problem starts at undergraduate level when medical schools demand only the top grades in exams and minimal assessment, and therefore gather a narrow selection of students from our society.
Once at medical school, typically only 11% of training takes place in primary care. After qualifying as a doctor, the number that choose general practice from particular schools varies enormously, as does the number of academics in primary care. Primary care has less than 6% of the professorial body. The culture in medical schools, as can be seen by the statistics, is biased against primary care. We need a modernisation of student recruitment and training to match the needs of patients.
We need accountability of schools to a body that will ensure this is delivered. We also need an expansion of places so we never face a shortage of doctors again. Most of all, the training needs to address the needs of patients. With the internet, the skills needed of a GP now are very different from those needed by my generation. And we need to attract back those hundreds of UK students training abroad, for example, in Bulgaria.
The junior doctors’ dispute might be technically over, but half of the doctors are not choosing to go into specialist or GP training, so the ‘peace’ has not been won. Junior doctors feel unsupported, have to change jobs and homes every few months and are increasingly attracted to well paid locum posts.
At one time, training as a GP, you could choose your six-month posts and have them validated. Your trainer chose you and you chose them. This flexibility needs to return and an option should be given to doctors to spend five years training in general practice after qualification. Why have we allowed training of GPs to be four years in hospital and one year in primary care and would our hospital colleagues accept the reverse?
Ten years ago it was not unusual to see GPs continuing into their 70s. Now many are retiring or part retiring in their 50s. The reasons for this include the pension changes, the workload, the spiraling costs of indemnity, the burden of regulation, the instability of funding, short-term primary care contracts and rent reviews. And repeated surveys show minimal interest in a career of GP partnership.
Indemnity needs to be a shared risk again. Remember when we shared the costs equally. These were based on the total national payout every year. Why did we allow this to change?
Resources put into regulation must be rebalanced to expand the offering of developmental quality improvement (QI). Yes, we need to deal with unacceptable poor standards but often the biggest improvements come from the science of QI. The pension rules must be changed so the incentive is to stay. And we must end 24-hour retirement with a maximum of 16 hours a week in the following month, a guarantee to make you aware of all the benefits of not continuing to work full time as a GP. Most of all, we need to incentivise again a lifetime commitment to a population and community.
Dr Sam Everington is chair of Tower Hamlets clinical commissioning group, NHS England’s adviser on new care models and chair of the Healthcare Leader editorial board
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