Only 33% of trainee GPs plan
to work in NHS general practice
A new study by the University of
Warwick indicates that only 2 in 3 doctors who are completing their training to
become GPs plan to work in NHS general practice. Of those intending to remain in
the NHS most propose working as locums or salaried GPs rather than entering a GP
partnership. The study Factors influencing career intentions on completion of
general practice vocational training in England, a cross sectional study was conducted
by a team led by Professor Jeremy Dale at the University's Warwick Medical
School and is published in BMJ Open. An online survey was completed by 178 GP
trainees employed in the West Midlands who were within 3 months of achieving
their certificate of completion of training (CCT).
The quality of general practice experience during all training (including
student years) was reported as influencing personal career plans, and in
particular perceptions about workload pressure and morale within training
Professor Dale said:- "The study highlighted a number of potentially
modifiable factors related to GP training programs that are detrimentally
influencing the career plans of newly trained GPs. Many of these relate to how
general practice had been experienced across undergraduate, foundation and
vocational training, and in particular perceptions about workload pressure and
morale within practice placements.
The negative portrayal of general practice by politicians and the media was
experienced as having had a detrimental effect on personal career intentions.
Also sociodemographic factors, such as age, gender, and having children,
influenced career plans indicating a need for these to be considered within
workforce planning. A sizeable proportion of individuals did not describe
their future career plans, perhaps expressing ambiguity about career direction."
62.8% of respondents, stated that they expected to be working in 6 months as a
salaried, locum or other non principal NHS GP, dropping to 33.9% at 5 years.
Conversely, the proportion expecting to become a GP principal increased from
less than 5% at 6 months to 33.9% at 5 years.
As well as experience during training the study found three other factors that
were influencing respondents' career plans for the following 5 years. These were
the:- GP workload and work / life balance; practice morale; and media and political
The survey results are published in the face of increasing practice workloads,
declining GP recruitment, retention and morale. There are major concerns about
the capaCity of general practice in the UK to safely and effectively meet
patients' needs. National policy has set a target for ½ of UK medical school
graduates to enter general practice training but recruitment continues to fall
short with 10% of GP training places in England unfilled in 2016. The
attractiveness to recently qualified doctors of general practice as a career is
at an all-time low, with workload, uncertainty about the future of General
Practice and lack of respect for GPs often identified as important factors.
The research team found that there was an association between participants'
rating of how well their specialist training had prepared them for a career in
general practice and intended career plans for the next 3 years. Those who felt
well prepared were more likely to plan to become partners (28.0% compared to
12.5% who did not feel well prepared). Those who felt ill prepared were more
likely to anticipate becoming locums (37.5% compared to 10.0% of those who felt
In terms of 5 year intentions, those who felt their GP training had prepared
them well were more likely to aspire to becoming a GP partner (59.8% compared to
7.7% of those who didn't indicate either way) whereas those who responded
neutrally about how well prepared they felt were more likely to anticipate being
a salaried GP in 5 years (84.6% compared to 38.1% who were well prepared)
Those who had experienced work/life balance problems were more likely to agree
that their experience of practice workload was influencing career plans. 54.5%
of participants reported having experienced work/life balance problems during
their final year of GP training (ST3) and the majority of respondents agreed or
strongly agreed that the workload in their final year in practice has influenced
their career intentions.
Experience of heavy practice workload discouraged respondents from considering
applying for partnerships. Instead it encouraged respondents to seek the
flexibility of locums or salaried positions, part-time work and employment
opportunities that were outside standard clinical sessions, such as teaching,
developing special interests and gaining diplomas, CCG work and out of hours
56.4% felt that the current political and media comment about general practice
was having a negative influence on their career intentions. Those who were
negatively affected by the media's portrayal of general practice were more
likely to report their morale as low and this was exacerbating their
disillusionment with general practice as a career.
Professor Dale added:- "General practice is experiencing a growing crisis
with the numbers of doctors who are training and then entering the profession in
the UK failing to keep pace with workforce needs. With ever increasing workload
in general practice, there is an urgent need to understand and where possible
address these issues at national and local level."