GPs entering the workforce are facing a future with no fixed job.
The lack of salaried and partner positions this year and a glut of locums are pushing some newly qualified GPs back to the parental home and others abroad. Some GPs compete with 100 others for a salaried post.
'There are many registrars from the most recent batch who do not have jobs,' said Dr Amit Tiwari, a GP in Colchester, Essex.
It used to be shocking when only one new GP out of 30 from a vocational training scheme gained a partnership.
This year, there are schemes where only one new GP has any fixed employment. The rest are making do with locums, out-of-hours shifts or going abroad.
'I have no contract and no stability and could be without work tomorrow,' says newly qualified GP and locum Dr Adrian Haslam. 'I do not have the permanent partnership I have always wanted and am finding work where I can.'
Job downturn
A rapid drop in partnerships and salaried posts locally two years ago had a domino effect, said Dr Jess Martin, a south London GP.
'Where once our out-of-hours cooperative would struggle to fill certain shifts, it suddenly started turning doctors away.'
You do not have to search far for reasons for the jobs downturn. As deaneries expand GP training (by 400 places next year in England alone), practices focusing on profits prefer quality framework-focused nurses.
'It is much cheaper to employ a practice nurse than a newly qualified GP,' said south Manchester locum Dr Rangan Chatterjee.
Practices are also replacing partners with salaried doctors. This summer Dr Alan Young's Hull practice replaced its out-going senior partner with two salaried part-timers.
'Mainly, we felt that as our income has not gone up in three years and staff costs are increasing, we could not commit to a partner at present,' he said.
Now in their third year of profits and income squeeze, some practices are unwilling even to risk employing a salaried GP.
Others are dropping pay rates for new salaried GPs and making salaried GPs redundant. GP has been told of a practice switching contracts to fixed term.
Forty-four per cent of GP's panel of young GPs under 35 said they had difficulty finding work over the past five years. Everyone who contacted us told us the outlook this year is worse than when they qualified.
But it is true that the jobs crisis is patchy. One young GP told us that this year more partnerships are being advertised in Scotland.
RCGP chairman Professor Steve Field said the jobs were not always where GPs wanted.
Long-term concerns
Dr Simon Plint, vice chairman of the Committee of General Practice Education Directors, said that a project in Milton Keynes offering new GPs a job for a year did not get enough applicants.
For those who end up freelancing, 'there is definitely no shortage of work', said Dr Anna Cumisky, a new GP.
Long term, too, work beckons. Dr Plint said: 'It is impossible to get away from two essential facts. First, demand for GPs is going to increase and the future model of care for the NHS will require thousands more GPs. Second, supply of doctors is going to fall short.'
Professor Field agreed: 'Longer term, the workforce predictions show a great shortage of GPs.'
The worry is that, meanwhile, the downward pressure on conditions will drive young GPs out.
East London GP Dr Osman Bhatti said: 'If this is not acted on soon, these will be the GPs collaborating with other providers.'
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What do the GP 35 think
"Salaried GP wages have stayed the same for the past three years. Some surgeries can only afford to employ GPs part time and so there are fewer full-time positions."
— Dr Grace Adedapo, GP, south London
"The London deanery survey revealed that of the 50 per cent of GPs coming off training schemes who responded, only 53 per cent got a job after GP training, including locums."
— Dr Osman Bhatti, GP, east London
"With the government trying to get money off practices along with a pay freeze (in reality, a pay cut) it is a tightrope walk for a lot of practices and financially damaging to employ more doctors."
— Dr Kamal Sidhu, GP, Newcastle.
