GP training needs reform: the status quo isn't working for anyone

by Euan Strachan-Orr

A recent BMA survey has shown a shocking level of unacceptable behaviour towards trainees 

Location: UK
Published: Wednesday 11 May 2022
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It can feel like we are bombarded with surveys as GP trainees. Surveys about our training, surveys about our teaching, even surveys about surveys. I want to thank the 652 GP trainees across the UK who took the time and completed the BMA GP training survey last November. We need to know what is happening across the country, and hear actual experiences, to help shape the work and priorities of the BMA to improve GP trainees' working lives.

Our survey was delivered at a hugely turbulent time for GP trainees and the wider GP profession; with training programmes disrupted by COVID-19, trainees learning to consult in completely different circumstances to our seniors, while the profession was under hostile press attacks it seemed day after day.

As trainees we are the future of the profession, and we wanted to hear about GP trainee plans for when they enter the GP workforce. Our findings provide significant food for thought, both requiring action now, and in the long term.

Our experiences

Doctors should not go to work expecting to be abused, bullied, or harassed. This is a simple, basic expectation. Unfortunately our survey revealed a shocking level of unacceptable behaviour towards trainees. Of the GP trainees who responded:

  • 44% reported bullying in hospital placements – most commonly from senior hospital colleagues
  • 36% reported bullying in GP practice settings – but most commonly from patients in this setting
  • 44% experienced sexism in hospital posts, compared to 29% in GP posts
  • 34% experienced racism in hospital posts, compared to 20% in GP posts.

These statistics are truly disgraceful and unacceptable. We don’t know whether these GP Trainees even felt able to report their concerns. Clearly a radical review of training environments is required, to encourage reporting of such experiences, support for trainees in such situations, and to stamp out such unacceptable events.

The BMA provides confidential free counselling and peer support to any doctor, regardless of BMA membership. If you need support – please raise your concerns and experiences – we can help, do not suffer in silence.

As GP trainees – we support our patients with their mental health. It’s clear the GP Training journey has become more turbulent over the past two years. Our mental health has also been affected, as has our wellbeing during the working day. Of the GP trainees who responded:

  • 75% have experienced symptoms of burnout, stress, depression or anxiety
  • 42% say they cannot take breaks at work
  • 59% say they start work early due to the demands of the job, while 61% leave late.

How can we look after our patients if we cannot look after ourselves day to day in the workplace? And qualified GPs are also feeling the strain.

84% of GPs have experienced anxiety, stress, or depression in the last year in a similar recent survey, highlighted by Rebuild General Practice. Tired GPs make mistakes. Our patients will inevitably suffer.

Our future

And if we are burning out ourselves at this stage of our career – what do we want to do long term? We asked GP Trainees about their future career plans.

It’s clear that with mounting pressures and increasing patient numbers for GPs, the government’s failure to deliver the 6,000 more GPs they promised us, and increasing medical complexity – the job is undoubtably tougher than it was even 10 years ago.

Given this, our findings won’t be surprising but are still staggering. Of the GP Trainees who responded regarding their post-CCT career plan:

  • 55% stated their plan includes becoming a salaried GP at some point
  • 27% stated their plan includes becoming a locum GP at some point
  • 23% stared their plan includes becoming a GP Partner at some point.

With regards to number of sessions worked post-CCT:

  • 32% stated they would work 6 clinical sessions post-CCT, 21% stated 5 clinical sessions, 20% stated 4 clinical sessions
  • 16% stated they would work 7 or more clinical sessions post-CCT
  • Only 6% stated they would work ‘full-time’ their entire career

And regarding other post-CCT workforce aspects:

94% stated they wish to work flexibly at some point in their career, with 78% stating this was to support their physical or mental health

13% indicated they do not expect to work as a GP in the future.

Is more flexibility why salaried is now proving the more popular post-CCT job choice? Are we, as trainees, being adequately trained in the ‘non-clinical’ side of general practice, to help guide our post CCT career choices? How can we make partnership more attractive, alongside improving other GP career choices? These are the questions senior GP leaders will need to consider – to provide security and stability for the future of our profession.

What is also clear is that six clinical sessions are what GP trainees want to work post-CCT. This is ‘part-time’ – but what isconsidered part-time working is now equivalent to what was considered full-time working.

The pressure and stress of working late, working through lunch, even taking work home, is the reality we are seeing as trainees. A 6-session week now feels like full time. Is this why that 13% are walking away from the profession? If extrapolated – this represents a loss of 433 potential GPs in England alone, before they even start working. These are GPs our patients need.

The government has admitted it has failed to train their promised 6000 GPs. We are working in environments more challenging and stressful than ever. The profession is changing.

The future workforce is changing. This is a critical juncture. Unless we improve our training, recruit even more GPs, and provide the facilities, support, and resources to train those GPs – there will be one big loser – our patients.

GP Trainees are the future of the profession. Now is the time for change and reform – to ensure we can be there as GPs for our patients when they need us most.

Euan Strachan-Orr is chair of the BMA GP trainees committee and a specialty trainee 3 in Mersey