Medical training must give equal status to general practice, warns landmark report

The DH must urgently review medical school funding to improve training in primary care and tackle the perception of general practice being a 'less valued' career option, according to a landmark report.

The By choice – not by chance report - released by Health Education England (HEE) and the Medical Schools Council – identified three negative forces driving against GP recruitment - 'tribalism, negativism and finance'.

The report said there was 'profound professional "tribalism"' dividing primary and secondary care. It said 'a powerful, unacceptable, deeply ingrained professional disparagement, often in jest, exists between specialties', adding that this led students to view primary care to be 'of lower status' than secondary care.

It said that students also met negativity about careers in general practice from 'disillusioned' GPs while on placements, with some students reporting they had been actively encouraged to pursue a career in secondary care.

The report called for a system-wide approach to bring GP work experience opportunities more in line with those available for secondary care.

The report warns that recruitment into general practice has ‘become a major issue’, coming at a time when GPs are facing huge pressures.

Undergraduate teaching under the current model 'is not working' and it must adapt to better reflect the future of healthcare delivery, which will see a greater emphasis on treating patients in the community.

Flexible careers

In a raft of recommendations, the report said increased awareness of, and support for, portfolio careers in general practice was crucial.

It added that the GMC should work with medical schools to overhaul undergraduate curricula in order to ensure they ‘develop to reflect the patient journey through different healthcare settings’, with a more integrated and less speciality organised approach.

This will better prepare students for the more flexible careers available in the future of health and care delivery, it said.

Students should also be taught to recognise the ‘breadth and complexity of general practice care and be stimulated by the complex intellectual challenge’. This should include emphasising the business elements and career options within general practice.

The report also urged medical schools to identify ‘positive and enthusiastic’ GP role models to work as educators and assessors with students.

‘Above all, the tensions around financing undergraduate (UG) education need resolution,’ the report said. ‘Addressing the lack of equity of reimbursement for UG education teaching across the different health care settings is absolutely fundamental.

‘The DH, with HEE, should rapidly progress the current review of funding models, to ensure that, as patients are cared for increasingly in the community, students can follow them and learn. The current model is not working. Appropriate funds must be available to release general practitioners to teach without compromising patients.

‘Adequate funding structures, with equitable transparent accountability, must be urgently achieved to educate students in different NHS contexts outside secondary care. Without this they exist with little understanding of current, let alone future, health care delivery.’

'Great opportunity'

Professor Val Wass, who chaired the taskforce behind the report, said: ‘The challenge has been to seek practical feasible recommendations, which hold strong, positive commitment to deliver and contribute to solving the current crisis. Our aim has not been to blame but to catalyse change.

‘Our recommendations are made acknowledging the complexity of the student experience not only within the university campus but across their clinical placements in hospital trusts, general practice and community organisations.

‘General practice now has a great opportunity to raise its profile and status.’

RCGP chair Professor Maureen Baker said: ‘The denigration of general practice in medical schools – often dismissed as harmless "banter" – has a very real, very tangible impact on the GP workforce, as research has shown that it puts people off choosing to train as family doctors.

‘This comprehensive report echoes the college's concerns about how general practice is viewed compared to other medical specialities, and draws much-needed attention to the fact that negative perceptions amongst medical students are often fostered in medical schools.

‘This is totally unacceptable, particularly at a time when we have a severe shortage of GPs across the UK and should be doing everything in our power to promote general practice.

‘It is imperative that we change the misconception that general practice is somehow run of the mill and has a lower status compared to hospital specialties. If implemented effectively, the recommendations made by Professor Wass today will go a long way to setting the record straight. As a former GP she knows what she’s talking about.’

Harry Carter, BMA medical student co-chair, said: ‘A key problem is that general practice is not given adequate prominence in the medical curriculum and it is encouraging that this report recommends that this problem is addressed.

‘However, it is also right not hide the fact that one of the solutions to this problem is to address the funding crisis which many GPs say is having a real impact on the service that they can provide for their patients. A comprehensive approach to solving the current crisis is the only way that more medical graduates will be encouraged into general practice.’

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