Why is there a crisis in GP numbers?

#GPFUQ 149 What’s the big crisis in GP numbers? The recruitment problem is that not enough junior doctors want to train in general practice and not enough want to train in the under-doctored parts of the UK. The retirement problem is that too many GPs are aged over 50 and too many are deciding either to retire early or not continue working after the age of 60. The retention problem is in response to the changes in work that too many GPs are quitting careers in general practice too early.  The returner problem is that GPs who leave UK practice for more than 2 years but want to return have to have a period of low paid retraining. The regulation problem is that the bureaucracy of payments processes like the Quality Outcome Framework, and accreditation processes like the Care Quality Commission make GP work unpopular. It's clear that we have to challenge and change current recruitment, retention, retirement, returner and regulation practices if we want the NHS to continue with the primary care registered list that provides care for all patients and protects the secondary care from too many referred patients.

#GPFUQ 150 Why is there a crisis in GP numbers? The accumulation of past errors and current circumstances has created a perfect storm! These probably include the structural and process problems that allow the largest UK specialty (General Practice) to be relatively under-represented in all the organisations that influence the choice of medical careers; the rapid expansion in numbers of hospital specialists (possibly at the expense of general practice) with more sub-specialists who need more junior doctors to, the relative underfunding of primary care (compared to secondary care) at a time when workload is increasing, all the other portfolio jobs that can divert GPs away from clinical practice, the changes in GP workforce that necessitates more parental leave and more part-time working, the reduced pension cap that means many older GPs reduce how much they work to match their pension cap,  the burden of over regulation with revalidation and Care Quality Commission, the weekly onslaught of bad news about general practice in the media and the increasing demands that mean a GP’s day is often a busy 11-12 hour day.

#GPFUQ 151 How do you solve the crisis in GP recruitment? Hold the feet of the politicians, civil servants and medical speciality leaders to the fire on consequences of a NHS without effective primary care. Ensure each and everyone responsible is held accountable for their actions and inactions. Some suggestions include placing more medical students and Foundation doctors in the practices where they are most likely to be inspired to become GPs. Its not surprising that if medical students and Foundation doctors spend most of their time in hospitals, and have straight forward career paths in hospital they may be biased towards a career in hospital medicine. The status quo has failed to provide the balanced workforce we need.  A better way may be for medical students, Foundation doctors and GP trainees to spend at least 50% of their time in general practice learning medicine by following patients who have the specific health problems listed in their medical curriculum on their journeys though the health and social care services.  We must also promote Foundation and GP training in the under doctored areas otherwise the NHS will collapse in those areas. The NHS and Health Education England must use all the carrots and sticks at their disposal to get junior doctors working in the right numbers in the right specialities in the right areas.