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Only one in five GP trainees plan to work full-time

Proportion drops to one in 20 ten years after qualifying, King’s Fund poll shows

Caroline White

Friday, 17 August 2018

Only one in five GP trainees plan to work full-time one year after qualifying, reveal the results of a poll carried out by health think tank The King’s Fund. And this proportion falls further to one in 20, 10 years after qualifying, the responses show.

The NHS is struggling to retain GPs. NHS Digital figures* show that the number of full-time equivalent (FTE) GPs fell by 2.2 per cent to 33,062 in September 2017 compared to September 2016. And a recent GP survey found that 39 per cent of respondents (62 per cent of respondents aged 50+) planned to leave “direct patient care” by 2022.

The King’s Fund surveyed GP trainees in 2016 in a bid to understand the pressures in general practice. This second survey looked at trainees’ career plans once they qualify: 729 responses were received.

The responses show that only 21.7 per cent planned to work in full-time clinical general practice one year after qualifying. This fell to 5.4 per cent planning to do so 10 years after qualifying.

Around one in 10 (nine per cent) in the first year after qualifying intended to work part-time as a GP, with many wanting to undertake other responsibilities and have portfolio careers: this option was increasingly popular the longer they had qualified.

Over half (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 the working day.”

The principal reasons suggested for rising workload were “increased patient demand”, “increasing and ageing population” and “insufficient staff in general practice.”

Only just over a third (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 putting trainees off.

Many of the respondents felt portfolio-working was a necessity, with one commenting that this was the only way to manage the unreasonable workload in direct clinical care delivery.

“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,” comments GP Dr Mike Nosa-Ehima, who worked on the survey for The King’s Fund.

“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,” he continues.

The issues raised in the survey chime with the findings of the national GP Worklife Survey, and suggest 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, he adds.

“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,” he says.

“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,” he concludes.

Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners (RCGP), said: "It's not a surprise to see that more GP trainees are planning to either work part-time, or opt for portfolio careers – meaning that they undertake work in other areas of healthcare, as well as clinical work. The intense resource and workforce pressures facing general practice at the moment, mean that full-time working as a GP is often regarded as untenable.”

Rising demand amid underinvestment combined to produce working conditions that were “simply not acceptable for our trainees, or existing GPs trying to guide and nurture those new to the profession – and it isn't safe for our patients,” she said.

And she emphasised: "It would be misguided and unhelpful for people to criticise the decision of GP trainees not to work full-time, and suggest that this is contributing to workforce pressures – it is actually the flexibility that a career in general practice offers that makes it a sustainable career choice.”

She added: "We urgently need to see existing promises of investment for general practice, 5,000 more GPs, and 5,000 more members of the wider practice team delivered in full – but the RCGP is also calling for an additional £2.5bn a year, as part of the upcoming long-term plan for the NHS, to ensure that GPs and their teams are given the support and resources they need to deliver high-quality patient care both now and in the future."

*General and Personal Medical Services, England As at 30 September 2017, Final Experimental statistics. NHS Digital, February 2018.
**Innovative models of general practice. The King's Fund, June 2018.

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