Increase GP trainees by 450 a year to avoid crisis, says taskforce

The general practice workforce in England is shrinking, while people’s healthcare needs continue to grow—a situation that “must be addressed immediately” to avoid a crisis, a task force has concluded.

It would take only a small shift of patients away from primary to secondary care because of limited access to GPs to “put the whole healthcare system under unmanageable pressure,” it said.

The GP Taskforce was commissioned by the government to recommend how numbers of GPs could be increased, with a target set for 3250 trainees to enter GP training in England each year by 2015. Recruitment to GP training has stayed below target for the past four years at about 2700 trainees a year.

The report also found “disturbing” evidence that the GP workforce was shrinking. The number of GPs per 100 000 people across England fell from 62 in 2009 to 59.5 in 2012. Also of concern was the unequal distribution of GPs across the country, with fewer GPs per person in areas of high deprivation, areas that typically have greater healthcare needs.

The taskforce, whose report was published on 22 July, said that urgent action was needed “even to sustain the present role of general practice in the NHS, let alone enable it to expand and meet the growing healthcare needs of our population, irrespective of future models of care.”1

The report looked at the “blocks to progress” in meeting the target increase and other key factors affecting the overall size of the GP workforce, namely retention and retirement rates. The cumulative shortfall has been compounded by rising numbers of trained GPs leaving the workforce, including those approaching retirement and, “more worryingly,” women in their 30s.

The report said that patients had increasing trouble accessing GPs. A disproportionate number of GPs were nearing retirement in more densely populated urban areas where unmet health needs were “already a national concern,” it said.

The taskforce said that there were several reasons why the longstanding targeted expansion of GP training numbers was not being met. These included difficulty attracting graduates into general practice, a lack of training capacity, and financial pressures. It said that a “professional marketing strategy” was needed to promote general practice as a positive career choice, starting in schools.

It also said that GP trainee numbers would not be expanded without a corresponding fall in the numbers of medical students entering hospital specialty training, because the overall applicant pool was “not big enough.” It said that the 3250 target could be reached by 2015 by putting 450 more people into the first level of GP training in two stages and cutting hospital specialty training numbers by the same amount.

The taskforce said that major gaps in workforce information had to be filled, and the GP workload survey should be recommissioned, along with a more effective vacancy survey. Also, the Department of Health should consider “incentivising” medical schools to increase the proportion of their graduates selecting general practice.

The taskforce recommended that research be undertaken to identify why doctors leave general practice early and what prevents their return to it. It said that NHS England and Health Education England should work together to provide and fund a GP returner programme, prioritising funding for GP returners to train in areas with relatively fewer doctors.

Simon Plint, who chaired the taskforce, said in the report that its recommendations were “essential to secure the future GP workforce supply upon which the sustainability of our NHS depends.”

He wrote, “Many of the recommendations will be welcomed by Health Education England and NHS England, but some are very challenging and will need very serious evaluation and then concerted and co-ordinated commitment to implement.”

Richard Vautrey, deputy chairman of the BMA’s General Practitioners Committee, welcomed the report. He said, “We have reached a serious crisis point where not enough GPs are being recruited and too many are retiring early. There is no longer any time to waste, and the government needs to implement the findings of this report in full and begin a programme of sustained, long term investment in the GP workforce, as the BMA has called for in the Your GP Cares campaign.”