Ahead of May's General Election, a £10 million investment has been announced to 'kick start' what Baldrick might describe as a 'cunning plan' to expand the general practice workforce; NHS England will finance initiatives to recruit GPs, retain existing GPs and encourage former GPs to return:
- A drive to recruit newly trained doctors into general practice in areas that are struggling to recruit. There will be incentives to doctors to become GPs by offering a further year of training in a related clinical specialty of interest such as paediatrics, psychiatry, dermatology, emergency medicine and public health. In addition there will be a national marketing campaign aimed at graduate doctors to highlight the opportunities and benefits of a career in general practice. Pilot 'training hubs' based in GP practices will be established in areas with the greatest workforce needs to encourage doctors to train as GPs in these areas. They will also enable nurses and other primary care staff to gain new skills.
- A drive to retain GPs. The plan will include a scheme to encourage GPs who may be considering a career break or retirement to continue working on a part-time basis. It will enable practices to offer GPs the opportunity to work with a modified workload and will be piloted in areas which have found it more difficult to recruit. There will also be a review of the existing retainer schemes.
- A drive to encourage doctors to return to General Practice. Health Education England and NHS England will publish a new induction and returner scheme, recognising the different needs of those returning from work overseas or from a career break. Funding will be targeted to encourage GPs to return to work in areas of greatest need which will help with the costs of returning and the cost of employing these staff.
To coincide with this the RCGP have produced a rather glossy recruitment video outlining why it is the best time to become a GP.
From my visits to practices and from recent LMC surveys the reality is that a significant proportion of the profession is demoralised and overwhelmed due to excessive workload and underfunding and many would not recommend the career to friends or family. When I was a junior doctor I was looking for a degree of certainty (financial and job security) and career satisfaction (variety and work life balance). I'm sure this must be the case for most medical students and young doctors today. We need to give hope for the future to people interested in becoming GPs (as well as those already GPs).
In addition we need to be honest about the current realities of the job and the need to get the profession into a better place. New models of General Practice that develop will need to provide flexibility and variety for those working full-time or part-time, ensure a sustainable and safe workload and accept that many young doctors are not interested in partnerships and do not wish to commit to buying into practice premises.
For many GPs in busy practices the average working day and duty sessions are making the job unsafe - I fear this video rather glossed over this reality which could make many juniors mistrust its content and regard it as window dressing or mis-selling. A career as a family doctor providing holistic care with continuity from cradle to grave continues to be an attractive long-term proposition - though it is understandable that many medical graduates and current GPs are looking for this outside the UK. I think the RCGP may have balanced their video with a more detailed and honest explanation of the things that need to change - in particular to tackle needless bureaucracy, overwhelming demand and serious anxieties about dwindling income and under investment in General Practice.
In summary:
- People will be attracted to working as GPs when the morale of the profession is good - this needs meaningful commitment and effective action to tackle financial uncertainties, spiralling demand and to put an end to the time spent on activities with little or no proven benefit to patients most in need.
- Medical students and doctors in training will be attracted to specialities like General Practice and Accident and Emergency when they are seen as good options - they witness overwhelmed and demoralised doctors and nurses when they undertake stints in these areas. They are some of the brightest brains in the land and they will not be taken in by hard sell and glossy videos.
I will finish on a positive note - the £10 million initiative does at least acknowledge that there is a real and deep rooted problem with recruitment and retention. Clear leadership is needed to explain that 'cunning plans' to recruit and retain GPs and centrally designed new models of General Practice are not the solution - General Practitioners have always thrived when trusted to get on with doing a good job with reasonable funding and a supportive environment. This needs significant investment, scope to ration patient demand to prioritise those most in need and a dramatic reduction in bureaucracy and non-core activities.
The funding for this initiative may be a drop in the ocean - £10 million is equivalent to 18.5 pence per patient. Though a very small step at least it's in the right direction.
LLR LMC will be liaising with the local CCGs, Health Education East Midlands and NHS England to see how we can best bid for some of this funding for pilots in our region.
I'll keep you informed.
Best wishes,
Dr Chris Hewitt
Chief Executive
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