Falling investment and rising demand has increased GPs’ workload, sparking a recruitment and retention crisis. Increasing numbers of practices are unable to recruit GPs, particularly in certain areas, with this having a knock-on effect both on the workload of GPs within these practices and, crucially, on patient care.
The potential future scale of the recruitment and retention crisis was clearly illustrated by our GP survey. It found that:
- Thirty-four per cent of GPs are hoping to retire from general practice in the next five years. Significantly, 36 per cent of GPs aged 50-54 – who currently make up 16 per cent of the GP workforce – hope to retire in the next five years.
- Twenty-eight per cent of GPs who are currently working full-time are hoping to move to working part-time in the next five years.
- Nine per cent of GPs are hoping to move abroad in the next five years. This includes 19 per cent of current GP trainees.
- Just under half of GPs (47 per cent) would recommend a career as a GP to an undergraduate or doctor in training, but one-third (35 per cent) would not do so.
The recruitment and retention crisis should be addressed on a number of levels. There needs to be a comprehensive strategy to boost the GP workforce; to reduce doctors’ workload; to provide new models of working for GPs who would rather not take on the responsibility of managing, or becoming a partner in, a practice; and, through a consolidated contract, to define the ‘core’ services which GPs are expected to deliver to their patients.
Boosting the GP workforce
More GPs are needed in order to meet the demand for GP services from patients. We have agreed a 10 point GP workforce plan with NHS England, Health Education England and the RCGP,22 intended to kickstart initiatives and funding to improve recruitment and retention within the GP workforce. This needs to be the start of a sustained programme of meaningful initiatives and funding for the GP workforce.
We believe the following steps could help to address the gap between the number of GPs we have and the number we need:
- Improve the image of general practice in medical schools. The visibility of GPs in medical schools should be increased by increasing the number of senior academic GPs teaching, mentoring and acting as role models to medical students. Universities need to be incentivised and encouraged to expand the number of academic GPs to bring them in line with the number of academics in the consultant workforce. Applications to general practice have varied by medical school. Research should be carried out to establish why this is and develop best practice in all medical schools.
- Significantly increased resources to grow the number of GP placements for foundation doctors. Many foundation doctors do not currently gain experience of general practice making it less likely that they will choose a career as a GP.
- Fully fund GP returner and retainer schemes in order to retain GPs who have already qualified within the workforce. A national induction and refresher scheme has been implemented as part of the 10 point workforce plan.23 While this is a welcome first step, it is likely that more funding will be needed for the scheme in order to fund further places and provide an adequate bursary for participants.
- Introduce an equitable and fair tariff for GP practice undergraduate placements – the funding for which currently varies across the country – to ensure that practices take on undergraduates for these placements.
- Be aware of what GPs find attractive about general practice. Working as a generalist was seen as the most attractive feature of general practice. This underlines the importance of emphasising the broad and holistic character of general practice and suggests that a move away from this, thus removing GPs from the frontline of general patient care, would be damaging to recruitment and retention. Developing relationships with patients over time was also rated highly. This indicates that any shift away from the current list-based model of general practice and of practices embedded in a defined community would also endanger recruitment and retention.
- Implement a sustained increase in resources to general practice to match demand for GP services. This would both address the acknowledged underfunding over the last decade and anticipate the increased activity required in the community in the coming years.
Quality first: managing workload to deliver safe patient care (PDF)
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