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Fewer than half of trainee GPs go on to work full time for the NHS
High dropout rate has left health service increasingly reliant on foreign doctors to fill vacancies, report warns
By Michael Searles, Health Correspondent27 September 2023 • 11:59pmFewer than half of trainee GPs go on to work for the NHS full time, a new report has revealed.
The equivalent of 1,419 full-time GPs joined the health service in 2020 from a pool of 2,837 UK graduates who started training three years earlier, analysis by the Nuffield Trust has found.
Some of that number were made up of multiple doctors working part-time hours, meaning fewer than half were actually working full time.
The report said a “leaky pipeline” of undergraduate and foundation training had “failed significantly to provide the UK doctors needed to fill GP training posts”. And it warned the health service is increasingly reliant on foreign doctors to fill GP vacancies as the NHS battles record waiting lists.
The Health Foundation think tank estimates that there is a shortage of 4,200 GPs in England, which could double within ten years. It calculated that by adding together all the contracted hours of new GPs who worked full time and part time , they accumulated the equivalent full-time working hours of just 1,419 GPs.
A total of 2,267 doctors joined the General Medical Council’s GP register in 2020, which means their combined NHS output was just 63 per cent of what it would be if they all chose to work full time for the health service.
Around 600 trainees did not join the register at all, and while the think tank did not know why, it speculated that some may not have completed their training while others were working for “defence services” such as the army.
The NHS long-term workforce plan says it wants to up the number of training places for GPs by half.
However, Dr Billy Palmer, author of the report and health fellow at Nuffield Trust, likened the plan to “turning on the tap without filling in the holes”.
The report, titled Waste Not, Want Not, found that the number of new GPs joining the NHS was “unmoved” despite previous efforts to increase training places by a third in 2015.
While it said information was limited, it found fully qualified GPs who did not join the NHS were going to private companies such as Bupa or taking on other public sector roles, such as in the Ministry of Defence or the Armed Forces.
It said the number of GPs joining the register had fallen to its lowest rate since the data were made available in 2017.
“We have become increasingly reliant on doctors who went to medical school abroad to fill such positions – nearly one in five of GP training posts were filled by overseas doctors in 2017, which increased to around two in five in 2021,” the report revealed.
Incentives like £20,000 bonuses to work in “hard to recruit” areas had failed, it said.
‘Workforce crisis’
Prof Kamila Hawthorne, chair of the Royal College of GPs, said there were “952 fewer fully qualified full-time GPs than in 2019”.She added that there was a “workforce crisis” and said general practice was “withering on the vine after more than a decade of under investment”.
Nuffield’s analysis of NHS workforce data also found that one in four of all doctors leave the NHS within two years, while after three years one in three have left.
The think tank said “high dropout rates” among all staff, including doctors, nurses and other clinical professions, who were either still training or new to the NHS was “wasteful” and “ultimately erodes the NHS’s ability to deliver safe and high-quality care”.
Around one in eight nurses drop out of training, while one in five who start NHS work leave within two years, it said.
Dr Palmer said “ploughing more staff into training without thinking about why they leave” was “enormously short-sighted”.
“The NHS has outlined plans to double training places but if we don’t address students leaving courses there is going to be a lot of waste,” he said. “You can’t just turn on the tap and not fill in all the holes.”
‘Leaky’ pipeline
The report said: “Aside from the ability to fill training places, the GP speciality training is also a ‘leaky’ pipeline, in terms of the proportion who go on to complete training and participate in NHS services.”The think tank is proposing that student debt is written off in a phased way based on time spent working for the health service, particularly given that just 30 per cent of nurses will pay off their debt in full.
While its proposals look to improve the “unacceptable levels of attrition” among nurses and midwives in particular, it said similar schemes could be applied to doctors.
More than £5 billion a year is spent on medical and nursing training with half of this going on doctors.
“Our proposal to write off student debt is affordable, credible and could be implemented straight away,” Dr Palmer said.
A Government spokesman said: “We’ve made significant progress in growing the workforce with record numbers of staff working in the NHS. The first ever NHS Long Term Workforce Plan, backed by over £2.4 billion in government funding, will deliver the biggest expansion of staff training in NHS history, retain more talented people and harness cutting-edge technology.
“We are working closely with NHS England to reduce student attrition rates and ensure they are supported whilst in training. This includes a training grant for eligible nursing, midwifery and allied health profession students of at least £5,000 a year, alongside support for childcare and certain expenses.”
