Denigration of general practice rife in medical training, warns RCGP report

Medical students are being put off GP careers because more than three quarters hear senior clinicians, trainers or academics expressing negative views about general practice before their final year at medical school, a report has warned.

Professor Helen Stokes-Lampard: no excuse for talking down GP careers (Photo: Pete Hill)
Professor Helen Stokes-Lampard: no excuse for talking down GP careers (Photo: Pete Hill)

A total of 76% of medical students reported hearing clinicians, trainers or academics making negative remarks about general practice by their fifth year at university, according to a report published by the RCGP and the Medical Schools Council (MSC).

Seven out of 10 heard derogatory comments about general practice while on clinical placements, and 37% heard negative comments in medical schools.

The findings of the report, called Destination GP, echo those of research presented at the 2016 RCGP conference in Harrogate. Bristol research led by GP Dr Simon Thornton said that up to a third of medical students were put off GP careers because 'GP bashing' and derogatory institutional slang about general practice was widely accepted in medical schools.

Talking down general practice

Students from medical schools across the UK - 3,680 students in total - took part in research for Destination GP, with some reporting that even introductory lectures at medical school were dismissive of general practice and that this theme continued throughout their university careers.

The RCGP has warned that unless serial talking down of general practice is addressed, the GP workforce crisis will continue. GPonline reported last week that despite the government's pledge to boost GP numbers by 5,000 by 2020/21, the full-time equivalent GP workforce fell by almost 1,300 in the two years to September 2017.

The report found that the attitudes of peers and trainers at medical school strongly influenced students' choice of specialty. It found that 91% of medical students felt their fellow students had negative views of general practice, and that by the end of their third year 84% think doctors and staff on clinical placements have 'negative associations with general practice'.

Examples of how general practice is talked down included claims that doctors choosing GP careers lacked ambition, that it was easy, complaints about referrals and derogatory comments about GPs' status compared with other doctors.

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RCGP chair Professor Helen Stokes-Lampard said: 'These archaic perceptions about general practice that appear to be held by a number of colleagues throughout the NHS need to change, and fast.

'It's so frustrating because being a GP can be the best job in the world when we are given the time and resources to do it properly – it is challenging, intellectually stimulating and full of variety.

'We are consultants in general practice, just like consultants in any other medical specialty and we must all work together, across medicine, to break down any perceived hierarchies that exist. Alongside the joint publication of this report, I'm delighted to acknowledge the commitment of medical schools in seeking to address the issues highlighted, and to MSC for working so constructively with the college.

"Dedicated GPs are the bedrock of the NHS and without them, our health service would fall apart. But we just don't have enough GPs, we need thousands more, and there is no excuse for some of the negative attitudes our medical students are being subjected to.'

Professor Jenny Higham, Chair of the Medical Schools Council, said: "We have been privileged to work together with the RCGP on the vital area of recruitment into the specialty of general practice. Our joint publications and meetings have identified a number of important strategies and we enthusiastically support medical students choosing a GP career.

Dr Sophie Lanaghan, Chair of the RCGP Associates in Training Committee, said: 'We need our best and brightest in general practice – our service is the backbone of the NHS. I'm saddened that so many students and junior doctors are being put off a career in general practice and feel that any narrow-minded views that do exist need to be challenged.'

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