Chantal Simon and colleagues write perceptively about Generation Y1 but can we blame medical graduates for being cautious about committing themselves to general practice? Trying to see things through their eyes I spot three big hazards for potential GPs.
Specialist medicine is growing very fast. The number of hospital medical staff has grown substantially from 87 000 in 2004 to 113 500 in March 2017. Within that figure, the number of hospital consultants has risen by more than half — up from 30 650 in 2004 to 47 816 in March 2017. This contrasts with the slow erosion of the GP workforce and the rapid reduction in district nursing. The scientific developments on the near horizon — ‘precision’ medicine, AI datamining, bacteriophage therapies, biome modification, and so on — are emerging within specialist disciplines. General practice might have much to teach about integration of health and social care, but we are not promoting it as the contribution of our discipline to medicine’s further development. The gravitational pull of hospital-based specialisms seems likely to increase.
The collectivisation of general practice seems likely to create many salaried posts but future fewer partnership jobs. Being a locum or opting only for salaried posts make sense in such an unstable environment, especially when there is a buyers’ market and some locums can command high salaries. The highest I have seen so far was £200 000 for a year’s commitment to eight surgeries a week. And of course part-time sessional work is flexible, eases childcare arrangements, and promises work–life balance.
As a discipline we do not always help this situation. Matthew Dunnigan argued cogently that the repeated exaggeration of GP consultation rates by RCGP leaders, starting in 2014, may have created a disincentive for new graduates to enter general practice.2 The estimated consultation rates are no longer discussed in public, but general practice is described as being under pressure, stressed, challenged, and close to collapse. GP workload is described by the BMA as ‘so unmanageable it is affecting the delivery of safe patient care’.3 Medical graduates may well ask why they should join a discipline that is presented in such a light by its own leaders.
- © British Journal of General Practice 2019