UK academic general practice and primary care

The report of Higher Education England’s commission on the primary care workforce is timely and welcome.1 The UK has led the way in delivering high quality, effective, accessible, and equitable healthcare at modest cost.2 Getting the right workforce to deliver the strongest possible NHS primary care focus3 is critically important in times of financial constraint, healthcare innovation, and the changing population demographic characterised by complex care needs and multimorbidity. But in parallel, attention must be given to the importance of recruiting, retaining, and developing the primary care academic workforce—an agenda that was beyond the remit of the commission.

The UK’s 205 senior academic GPs comprise just 6.5% of all clinical academics, and a tiny fraction of the 64 923 GPs currently registered with the General Medical Council (32 628 established GP full time equivalents). The overall increase in GP academic capacity from 153 full time equivalents in 2000 to 205 in 2014 has been almost exclusively the result of an increase in the numbers of GP professors from 33 to 78; the static number of GP lecturer posts (40) over 15 years reflects reduced opportunity for career progression at this level (Medical Schools Council, personal communication).

The recent trend to move academics who mainly teach into central undergraduate teaching units4 has also fragmented university primary care departments (a consequence of the leadership of primary care academics in professionalising training and teaching roles) and reduced the already modest critical mass. Although the move towards centralisation of teaching may have some apparent advantages in terms of institutional management, it carries substantial risks. It may reduce academic capacity and separate undergraduate teaching in primary care from research in the discipline. Given that exposure to charismatic role models and observation of academic opportunities during rotations5 6 are important drivers of the career choices of medical students, such dislocation may reduce the number who consider general practice as a career.

Academic GPs make an essential contribution to the NHS through education, research, clinical practice, and service development, usually while continuing to provide direct patient care. It is academic GPs who lead the general practice and community based undergraduate teaching of all future doctors, including those considering general practice as a career. Around 15% of the clinical curriculum in UK medical schools is general practice based.4 However, since the only generalist discipline left in the NHS is general practice, it is essential that all future doctors have sufficient quantity and quality of exposure to primary care to ensure that they learn about undifferentiated symptoms, value longitudinal patient care, and understand modern NHS systems.

Academic GPs are increasingly involved in curriculum development, quality assurance, assessment, admissions, welfare, and senior educational leadership. Furthermore as local education and training boards and deaneries restructure, university departments are key players in the emerging models for integrated delivery of community based undergraduate, postgraduate, and non-medical clinical education.

Academic GPs are also research leaders, developing and overseeing high quality studies and building the evidence base around the organisation and delivery of clinical primary care. This discipline contributes disproportionately to major NHS research initiatives, supporting the work of the National Institute for Health Research, including leading the NIHR School of Primary Care Research. It contributes to leadership in primary care research education and training, research design and delivery, and to supporting the development of national research strategy.

International comparisons show UK primary care researchers outperform other countries in terms of the number of publications.7 Primary care research addresses NHS priority areas, including, for example, antibiotic stewardship in primary care,8 9 the management of patients with atrial fibrillation,10 diabetes,11 12 multimorbidity,13 14 serious illness,15 and risks arising from lifestyle.16 The organisation of care17 and informing new approaches to managing patients18 19 20 are examples of core themes in current primary care organisational research. UK based primary care research often has direct societal impact, influencing government policy and international clinical guidelines.21 22 23 This research is directly relevant to GPs—the research findings help guide their clinical practice, with reliable evidence derived from their own setting. Hosting research can provide GPs with a more varied role and wider colleague interaction, can generate extra capacity in practice if the research is adequately funded, and can stimulate future doctors and energise training GPs.

Although the challenges facing the NHS with respect to the general practice workforce are substantial, we believe in the need to secure a strong, critical mass of leaders in primary care research and education. Offering academic career development and training in conjunction with clinical service delivery is an important means of enhancing recruitment to, and retention of GPs.24 Much has been achieved in supporting the clinical academic training of academic GPs in the past 10 years through initiatives such as the national academic foundation programmes and a range of academic clinical fellowships. However, capacity within these programmes remains small, and opportunities for long term academic career development are limited. Overall, the capacity of clinical academic general practice needs to increase, and this requires the establishment of new mid-career GP lecturer or senior lecturer posts. It is vital that such efforts are further developed to ensure the continued visibility, core viability, and continued value of this discipline to the NHS.