Fire the Medical Schools Council if you want more GPs

Recruitment websites

Why are medical schools attracting so few would-be GPs? I reviewed the recruitment websites of all 33 publicly funded UK undergraduate medical schools. These noted in general terms the variety of career opportunities, the generic need for particular skills (empathy and listening were commonly mentioned), and the importance of medical schools in providing role models for their students. These sites attested their research and general rankings by the often selective use of various league tables, and none referred to the only hard published measures of graduate quality—the performance data on the membership exams for the Royal Colleges of Physicians of the United Kingdom9 and the Royal College of General Practitioners.10

Many of the websites offered positive commentaries by students or had worthy initiatives to widen access. Most of the schools provided videos specific to medicine, and almost all attested to the social attractions of the institution, referred to the (sometimes “famous”) hospital and its “wards,” and offered the possibility of “research.” A few mentioned general practice, though not at length—except the Brighton and Sussex website, which includes a video on the interaction between one practice and the school.11

More typically, a slogan would assert “superb teaching and research facilities,” with a picture of a surgeon in an operating theatre. I received no general impression that half of all medical students would end up becoming GPs. Indeed, I saw this only in the small print on one school’s website, which said that “approximately half of all UK medical graduates work in general practice.”

Who directs these medical schools’ policies? All 33 publicly funded schools are part of an independent parent university and notionally determine their own policies on recruitment, education, and assessment. However, their activities must respond to the requirements of the regulator, the General Medical Council, and the NHS.

On its own website, the Medical Schools Council says that it “represents the interests and ambitions of UK medical schools as they relate to the generation of national health, wealth and knowledge acquisition through biomedical research and the profession of medicine.”12 One of its aims is to “explore proactively the role of the doctor in the future and to pursue educational solutions for workforce requirements involving doctors.”

Just two are GPs

So, who makes up the Medical Schools Council? Of 33 members representing undergraduate medical schools just two are GPs, the rest mostly clinician scientists. One is pictured on the council’s website wearing blue scrubs. These people are conflicted: they are responsible for delivering appropriate medical graduates to the NHS, but they also have responsibilities (and loyalty) to their own—largely hospital specialist—disciplines and colleges. How can a representative body comprising only 6% GPs be entrusted with directing undergraduate medical education, and selection into it, when the country needs 50% of doctors to enter general practice?

In their GP Taskforce report Simon Plint and colleagues recommended a “professionally led marketing strategy to target a wide range of audiences, including the general public, to promote an accurate and positive image of general practice.”3 This should include “the promotion, central coordination and funding of provision of work experience in general practice for secondary school students.”

Radical solutions to the workforce problem must include considering retention as well as recruitment—and the inevitable reform of the undergraduate curriculum. Certainly, primary care should take up more curriculum time than it does now, although necessary breadth will mean that medical students inevitably encounter far more scientists and hospital clinicians than GPs in their training. This should not mean that schools should be directed by members of these groups, however—or that arrangements for recruiting students should be devised to their gratification. Without a complete reorganisation of student recruitment, patients will be left badly served by medical schools that will continue to produce too many graduates inclined to hospital specialties and research.

Medical schools must act, and the Medical Schools Council’s membership requires obliterative change. This is urgent because of the training time lag. If the NHS is to survive, we need creative recruitment whereby at least half of new medical students—not an eighth—want to become the GPs of the future.