GP STARS – trainees’ views about entering the GP workforce

Problem

The decline in GP recruitment, retention and morale combined with increasing workloads has led to major concerns about the capacity of general practice to safely and effectively meet patients’ needs. Recruitment continues to fall short of the national target, with 10% training places left unfilled in 2016. This study provides the baseline for a five-year longitudinal study which will follow the career activities and experiences of a cohort of recently trained GPs throughout the ‘First Five’ period.

Approach

All West Midlands GP trainees within 3mths of CCT were invited by email to complete an online questionnaire. Paper versions were also available at the leaver’s conference and local VTS.

Questions addressed undergraduate experience, specialist training (including reasons for choice), career intentions over the next 5yrs and demographics using a mixture of rating scales and open-ended questions.

Qualitative data was analysed using a framework approach, while chi-square tests with adjusted standardised residuals and Pearson’s product moment correlation co-efficient were used to explore the quantitative data.

Findings

The response rate was 57.2% (178/311); those who provided demographic data were predominantly female, aged 25-34yrs, white and married.

Only 77.4% of respondents anticipated still being in GP six months later, falling to 72.3% at 3yrs and 67.8% at 5yrs. Three-quarters of these expect to be salaried GPs/locums at 6mths, falling to two-thirds at 3yrs; by 5yrs the majority expect to have entered a partnership.

Those who felt well-prepared by their vocational training aspired to be partners, whereas those who felt ill-prepared anticipated being locums at 3yrs (χ2=10.17, p=.04) and neutral responders still expected to be salaried GPs at 5yrs (χ2=13.61, p=.009).

Work-life balance problems and heavy practice workload during ST3 led many to consider other career options or working less than full-time. ST3 practice morale correlated highly with trainee morale (r=.684, p<.001) and career intentions (r=.735, p<.001), with trainees seeking to emulate positive examples.

Negative media and political commentary had a negative impact on 56.4% trainees.

Consequences

Workforce planning needs to account for the growing number of doctors who complete vocational training with the intention of either working less than full-time or leaving NHS general practice completely.

A number of modifiable career influences were identified: the importance of positive presentation within politics and in the media; thorough preparation for all aspects of GP during vocational training; adequate support and management of workload during ST3 and monitoring of training practices to ensure trainees are placed in positive, supportive environments.

Vocational training schemes should reflect the environment that trainees will be working in by supporting innovative training for portfolio careers and resilience training for all trainees.

Policy makers need to continue to build on the foundations of the Roland Report and GP Forward View to support initiatives addressing GP workload.