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- Page navigation anchor for RE: Why doesn't anyone want to be a GP?RE: Why doesn't anyone want to be a GP?I feel that the correspondence from Alexander, Chaudry and Majeed and also the paper by Abbt and Alderson have failed to address the key factors influencing doctors who might choose general practice.Over the 39 years since I entered medical school the status of the GP has fallen, largely because of the growth of a consumer society. Individuals are no longer defined by their occupations but by their lifestyle choices. My senior colleagues and peers were revered for their dedication and willingness to be accessed at all hours. Now this is deemed to be part of the job.Society does not recognize professional attitudes as creditworthy, placing higher value on appearance on television or other media. Additionally, politicians have repeatedly sought to demonise our profession.If these were not disincentives enough we have the CQC fiasco. Not only was inaccurate data published but many practices who would have built or improved premises have been repeatedly refused permission to do so by the same government who now criticizes their out of date facilities.Finally, to compound our misery, we are paid on the dubious basis of patient satisfaction. Having taken over failing practices, built new premises, increased services and staffing exponentially it was galling to find it impossible to raise the satisfaction score of patients whose questionnaire...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Why doesn't anybody want to be a GP?RE: Why doesn't anybody want to be a GP?The recent media spotlight on the low levels of recruitment and retention to general practice training has generated much debate and discussion regarding the underlying causes behind these current trends. Although I agree with Abbt & Alderson's article in Nov 2014 issue of the BJGP1 regarding the concerns of foundation doctors considering a career in GP, I believe that there is much that can be done to promote the positive attributes that already exist within the system in order to entice trainees to apply.As a GPST2 trainee in the South West of England I have experienced a highly organised and well administrated training programme that treats trainee doctors with respect and works from a basis of patient centred holistic care. We regularly consider the underlying issue or hidden agenda that has brought the patient to the consultation and continue to develop our communication skills in order to be able to illicit this invaluable information. Although this may be perceived as a “soft skill” it is actually crucial to all types of consultation, hospital or community based, if success is to be achieved in the realms of diagnosis, treatment compliance and patient satisfaction.GP training prepares us for competent independent medical practice with a broad knowledge base and clinical skills that transfer beautifully to many environments particularly those with minimal technology...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Women in medicineRE: Women in medicineIn the November edition, Naomi Abbt and Trisha Greenhalgh both discussed the falling numbers of GPs, the new recruits and the old hands respectively. I would argue that the growing numbers of middle-aged female GPs who want to work part-time but who are electing not to work at all is a more pressing issue. In my small training practice two out of the three GPs, both in their 30s with children, resigned soon after I finished; neither was going to another job. If this is a general trend and 60% of the GP workforce is female then it should be raising alarm bells amongst partners about the sorts of jobs they are offering. When you have an already expensively trained and often highly skilled and ambitious workforce why aren’t you employing them? Insisting on full time working when many women and increasing numbers of men want to work part-time will not fill posts. Only advertising salaried posts often in very uninspiring ways, will not work either. What professional equal really wants to work for less pay, less holiday, less influence and no prospect of progression? General practice has to become much less conservative and much more flexible if it is going to meet the increasing pressures effectively. Ignoring large chunks of the workforce who also happen to be mothers is not an option. More part-time partnerships with shared personal lists or salaried jobs with a more creative approach to working using bonuses or responsibility allowances should be made available. CC...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Why doesn't anyone want to be a GP anymore and what can we do about it?RE: Why doesn't anyone want to be a GP anymore and what can we do about it?Abbt and Alderson offer a refreshing perspective on why the UK is struggling to recruit enough doctors to GP Specialty training.1 She identifies the lack of perceived achievement in academia in general practice as being one of the factors influencing career choices.The UK does in fact have a good track record in primary care research, generally coordinated by academic departments within universities.2 However these departments have a low profile during the Foundation programme and Specialty training as this training has been delivered by organisations based within the NHS. Doctors qualifying as GPs may have little knowledge of the research activity occurring locally or the important role that primary care based research plays in ensuring the information that leads to the guidelines we use in daily practice is derived from patients within primary care.Participation in research is not mandatory in UK specialty training programmes except for a small number of academic trainees. In this respect we appear to be out of step with our colleagues in Europe, a recent survey by the European Academy of Teachers in GP/FM[EURACT] found that 17 of 27 responding countries require participation in a research module and in many cases the involvement in a research project as a mandatory part of their specialty training programmes.3 Perhaps now that the College is considering what sh...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Why doesn’t anyone want to be a GP: and what can we do about it?RE: Why doesn’t anyone want to be a GP: and what can we do about it?The difficulty in recruiting to general practice is a further unintended consequence of the restrictive career pathways imposed upon junior doctors by the modernising medical careers reforms. In order to ensure the smooth progression through the strata of medical training, junior doctors have to commit to a career pathway, be it medical, surgical or general practice, within three or four months of finishing their first foundation year.The days of sampling a number of Senior House Officer jobs before deciding upon a career are long gone and it is only natural that, as the authors point out, junior doctors choose from the limited number of training pathways with which they are familiar, usually to the exclusion of general practice.Once established on a career pathway it is difficult to switch to an alternative without a substantial loss of status and career progression, for example the years spent as a medical, surgical or paediatric trainee are usually counted for nothing if and when a trainee decides to transfer into general practice.In the past general practice recruited greatly from, and benefited greatly from the experience of, those who had sampled several areas of medicine and then decided that they wanted to remain general in their interests. In my opinion the current crisis in GP recruitment would be substantially mitigated if medical careers were made more flex...Show MoreCompeting Interests: None declared.
- Page navigation anchor for RE: Why doesn’t anyone want to be a GP: and what can we do about it?RE: Why doesn’t anyone want to be a GP: and what can we do about it?Abbt and Alderson offer explanations for the decline in applications for general practice training from foundation doctors.1 We acknowledge the severity of the current situation, yet question some of the authors’ speculations about the reasons underlying this recruitment crisis.The authors remark “how little time we spend in general practice...perhaps 8 weeks over an entire degree” but at Imperial College London and probably at most other medical schools, this represents greater time allotted than for many other specialties. We suggest the focus in medical schools should shift towards improving the quality of general practice placements and promoting the integration of primary care and specialist teaching, rather than consuming more time in an already overstretched curricula.Hospital medicine appears “the career-choice norm” because most specialties are hospital-based, thus recently, increased recruitment is greater for hospital-based than for general practice posts. Considering general practice uses knowledge gained within specialty placements (e.g. paediatrics), which are often now integrated with primary care teaching, the two should not be seen as mutually exclusive.We feel that prestige has never been the main incentive for pursuing a specialty. Our own experience is that many medical students are attracted to a career in g...Show MoreCompeting Interests: None declared.
- Page navigation anchor for Re Why doesn’t anyone want to be a GP: and what can we do about it?Re Why doesn’t anyone want to be a GP: and what can we do about it?
The public have two misconceptions about GPs:
- They are fabulously overpaid
- They do nothing much
The deluge of negativity from the press and politicians regarding GP pay means that there is unlikely to be any investment into primary care in at least one generation without it appearing to be backtracking from either the press or the politicians. The concept of a cradle to grave health care model provided by a single GP is 20th century. Other professionals provide much, often most, of this care, often cheaper.1 A box-ticking quality and outcomes framework can easily be run through a well-trained nursing and administration team. Therefore, UK-trained GPs do not have any specific skills other than for their niche market in the UK health service. In a global economy, it is important that junior doctors are empowered with the skills to hold their own anywhere they end up or whoever presents to them. A solution would then be to reduce the urgency to recruit more and more reluctant young doctors into general practice but instead invest in a public-health led primary care service that is staffed by nurses, pharmacists and health care assistants, with support from RCGP and NICE. This investment would not appear to be a pay-rise for GPs and be more palatable to the media and the public. The second tier of this system would be a service of specialists with a community slant working in tandem with A&E services to investigate, tr...
Show MoreCompeting Interests: None declared.