HEE GP training report is well-intentioned but skirts around key pressures, says BMA

Press release from the BMA

Location: England
Published: Friday 17 March 2023
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Responding to the ‘Training the Future GP - Enhancing delivery of GP Specialty Training’ report from Health Education England, Dr David Smith, BMA GP trainees committee chair, said:

“This report contains some well-intentioned ideas and initiatives, some of which will be cautiously well received by GP trainees, but overall it still skirts around some of the key pressures impacting training and general practice more widely.

“For years the BMA’s GP committee and trainees committee has been saying that to fully-qualify as GPs, trainees need as much experience as possible in the practice, so while the fairly recent move to two years in a GP setting is positive, it’s incredibly frustrating to hear HEE itself admit that to increase this further is being blocked by lack of capacity and funding. The answer here is therefore clear: invest more in practices so they have the space and resources to do this.

“The focus on mental health is positive, as all GP trainees have seen an increase in the number of patients coming in who are struggling with theirs. However, secondments or placements in other settings must not take trainees away from learning in general practice.

“Trainees, like all GPs, care deeply about not only helping their patients get better when they’re sick, but being and staying healthy, so the impetus on population health, environmental health and addressing health inequalities will be warmly received by current trainees – and many will be interested in knowing more about the combined CCT in general practice and public health.

“But these changes and suggestions must not be used to shift demand from other services that are themselves running over-capacity – in these cases psychiatry and public health teams.

“Meanwhile mentions of frailty and long-term condition management – which make up a huge amount of day-to-day patient care – are notably absent.

“We know our international colleagues and those from ethnic minority backgrounds continue to face barriers and face disproportionate challenges during training, so the commitment to addressing differential attainment is positive. The test will be whether this results in meaningful change that allows the brightest, best and willing to fulfil their potential in general practice, regardless of their background.

“Technological innovation has a lot to offer both patients and GP staff, and so it makes sense to have GPs of the future at the forefront of developments in this area. But it is no silver bullet to fixing the huge workload demands on practices, and access to new platforms should not come at a cost to trainees – while we know that practices still desperately need investment in their basic IT infrastructure.

“Every day we look with trepidation at our futures as senior colleagues wrestle with soaring demand, mounting bureaucracy and for partners, huge financial pressures, so it’s no wonder newly-qualified GPs are increasingly choosing portfolio careers and turning away from partnerships. More leadership training is all well and good, but without addressing these core issues eroding the appeal of full-time general practice, it is unlikely to change trainees’ minds. You cannot fix GP training without fixing the crisis impacting the whole of general practice.

“There is disappointingly nothing in this paper for GP trainers – our senior colleagues who put time aside to foster the skills of the future workforce – nor improving estates so there is space for learning in a clinical setting.

“And aside from a very short mention, there is nothing of substance on trainee wellbeing or improving morale that continues to plummet – much like our pay. Alongside all junior doctors, GP trainees wages continue to fall in real-terms – and without restoring pay to 2008 levels, trainees will continue to struggle with the cost of living and training and the NHS will continue to struggle to keep them.”


Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.