Table 2.

Summary of evidence to support GP recruitment and retention, using a framework adapted from the 10-point plan from Building the Workforce — the New Deal for General Practice document.15

10-point planEvidence from GP literature
Recruitment1. Promoting general practiceNo clear evidence
  • Enhancing the status, contribution, career advancement, and rewards of primary care practitioners

  • Role models

  • Medical environment important

2. Improving the breadth of training (for candidates seeking to work in geographies where it is hard to recruit trainees)Some evidence both for candidates seeking to work in geographies where it is hard to recruit trainees, and for GP trainees seeking to work everywhereExposure to general practice:
  • Early exposure/pre-registration house officer scheme

  • Workplace experience and interaction with members of the profession

  • Length of time spent in general practice rotation

  • Ensuring that the rotations are of high quality, with dedicated generalists’ faculty

Curricula modifications:
  • Effective medical school curricula in primary care

  • Establish primary care honours or scholars’ tracks

  • Develop or expand primary care fast-track programmes

  • Subspecialisation, portfolio careers, and profile of new skills

  • Modification of selection criteria

3. Training hubsSome evidence in the rural training and context literatureRural training, rural context literature:
  • Familiarity with community health resources, sociocultural awareness in patient care, community participation and assimilation, and identifying and intervening in the community’s health problems

4. Targeted supportSome evidence in the rural training and context literature, but no clear evidence in general practice
  • Link choice of career in primary care to loan forgiveness

  • Funding in primary care research

  • Increase and assure funding for fellowship training in primary care

  • Direct training funds to schools with track records of producing graduates in primary care

OtherDeterminant factors in specialisation choice:
  • Fit between skills and attributes with intellectual content and demands of the specialisation

  • Stimulating and interesting

  • Lifestyle factors (flexibility, work–life balance, or quality of life)

  • Social orientation and desire for a varied scope of practice

  • Significant experience in the primary care setting

Retention5. Investment in retainer schemesNo clear evidenceWidening the scope of remuneration and contract conditions:
  • Reduce the income differential between general practice and hospital work

  • Remove the disincentives for less than full-time employment, widening of the employment mechanisms open to GPs, such as authority-organised salaried schemes

6. Improving the training capacity in general practiceNo clear evidenceSubspecialisation and portfolio careers where doctors might gain skills in a range of specialties and practices, some or all of them at any one time
7. Incentives to remain in practiceNo clear evidence
8. New ways of workingNo clear evidenceVarying time commitment across the working day and week:
  • Part time, job share, temporary, and short time available, GP’s employment status and career stage

Offering a wider choice of long-term career paths:
  • Locum and associate positions equal to full-time principal posts

  • Activities such as research and training in management skills

  • A part-time educational post or hospital attachment

  • Job mobility as a way to progress (a more positive vision of mobility)

OtherEvidenceIncreased satisfaction (factors):
  • Job autonomy/diversity/variety

  • Social support, relationship and collaboration with colleagues/patients

  • Academic hospital and centres/teaching medical students and advanced students

Decreased satisfaction (factors):
  • Too many working hours, low income/compensation/workload/not enough time/high demands/lot of paperwork/little free time

  • Lack of support/lack of colleagues

  • Lack of recognition

  • Bureaucracy/practice administration