Huge variation in time and money for GP-based teaching in medical schools

UK medical schools are allocating vastly different amounts of time and money to GP-focused teaching, undermining recruitment to the profession and incentives for practices to take on students, a survey shows.

Medical schools short on GP teaching (sshepard/Getty Images)

Analysis of 36 UK medical schools by the Society for Academic Primary Care (SAPC) found significant gaps between institutions in the overall amount of GP teaching in their curricula.

In the medical school with the greatest focus on GP teaching, 19% of teaching overall was within general practice or by GPs, compared with just 3.9% in the medical school with the lowest proportion of GP teaching. On average, 9.2% of medical schools' teaching was GP-based.

A near five-fold variation was seen in the average number of sessions assigned to GP teaching per student in curricula at different medical schools. GP-based sessions per student ranged from 65.3 to 313 - equivalent to 6.5 weeks to 31.3 weeks.

GP teaching

Meanwhile, the average payment per session for clinical GP teaching was £58.74 per student per session, but payment varied from £32.21 to £120.00 across the UK.

Three quarters of medical schools experienced difficulty in recruiting GP teaching practices, citing poor pay for clinicians, difficulty where placements were not in blocks, or where students had excessive travel.

Two medical schools' curricula were found to include none of a list of key topics recommended by Health Education England (HEE) to encourage doctors into general practice. Just 14% said they delivered sessions on all recommended topics from the HEE list.

The findings follow a BJGP study last month, which revealed that the actual cost of teaching undergraduate medical students in general practice was almost double what practices receive for placements.

Medical students

The SAPC report, which examined the exposure of undergraduate medical students in the UK to general practice, found that the number of GP teaching sessions in undergraduate schools has plateaued since 2002. This was despite perceptions among educators that GP sessions had increased over the past five years.

Medical schools established before the start of the 21st century had a significantly lower percentage of GP teaching than the percentage in newer medical schools: 8.3% vs 12.9%, the report found. While, the number of compulsory sessions of practice-based GP teaching varied between schools, varied between 248 and 27.

Dr Hugh Alberti, who is sub dean for primary and community care at the University of Newcastle, said variation in the amount of time given to GP teaching was down to both cultural and historical reasons, with hospitals traditionally seen as the natural learning arena for medical graduates.

But he said it was important that attitudes changed if more students were to be attracted into working in general practice.

‘The arguments for having more students in general practice are very simple; it’s good for the students because they get high quality teaching and it’s good for general practice because more students are likely to become GPs because they’ve had more time in that area.

‘If we don’t get more students into practices, we’re not going to get more students becoming GPs and we’re just going to continue the recruitment problem.'

He added that practices were currently 'making a loss on average' from training students. 'If it costs them £110 [to train a student]  and we’re paying them on average £55, then practices are potentially making a loss,' he said. ‘Until we make it cost neutral for them, then it’s always going to be a challenge.'

Health secretary Matt Hancock announced last month that more than 3,500 doctors had been recruited to GP specialty training this year. But the RCGP has warned that the NHS needs to train 5,000 GPs a year to keep patients safe.

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