Could 50 additional GP training places per year be enough to sustain primary care?

– Closing the GP Workforce gap (part 3)

The single biggest challenge in closing the GP workforce gap is the issue of supply. With numbers of qualified GPs effectively decreasing each year due to retirement, changes in working patterns and leavers, we need a strategy that will replenish our workforce faster than retirement rate. This needs a coordinated effort on two fronts: training and retention.

If you want to catch up on previous posts, click here: part 1, part 2.

Closing the 2032 GP workforce gap, aiming for 8.5 % vacancy
Number of GPs expressed as Full Time Equivalent (FTE)

Our forecast of GP workforce has suggested that by 2032 we will need 39,000 GPs FTE. With an already significant vacancy rate, GPs retiring, potential leavers and demand increasing, we will not be able to rely on the current 27,500 GPs to make up the majority of that figure. To prepare us for the future, we need a long-term strategy on training and on relieving system pressures where possible.

GP training has already seen some significant changes in the last few years – such as more time during training spent entirely in primary care and rising numbers of GP-training places being filled. These have resulted in a record-high 9,714 doctors in training in 2021/22, 45% of which are international medical graduates. The contribution of overseas doctors to the NHS is both admirable and invaluable, such as their support in the COVID pandemic, but we may question the sustainability of this approach. Foreign doctors often come from lower-income countries (NHS Digital) and there may be ethical issues in question when they leave in large numbers to sustain our health system. Addressing our static medical school numbers (OECD) will be a matter of priority to support a future sustainable workforce.

How much reliance will be placed on training new GPs to fill the workforce gap will depend on how far other factors can be addressed, such as demand drivers, retention and better use of the primary care MDT. In order to illustrate this challenge, we have created three scenarios, outlined below:

PMQ: primary medical qualification

We have added two moderating factors to our trainee scenarios in order to produce realistic figures: that up to 15% of trainees may not complete training, and that once qualified many will not work full-time in general practice, resulting in 75% as many FTE as headcount.

Strategy 1 – A multi-faceted approach to the future, focusing on reducing demand, retention and training

In a scenario where we address drivers of demand and focus on retaining the current workforce, a modest but sustained increase the number of GP trainees by 50 every year, effectively creating an additional 2,750 training spaces over the 10 years would provide 23,200 GPs to close the 2032 workforce gap.

This option would allow for the greatest proportion of UK-trained doctors as part of the GP-cohort, seeing medical schools slowly increasing their graduates to at least 13,000 – a figure that echoes the 2021 plea from the Medical Schools Council. It would bring the ratio of UK-trained vs international-trained doctors from the current 55%-45% split to 59%-41%, in line with secondary care figures.

Achieving this scenario, however, relies on effective retention planning and addressing the sources of demand, where possible, both through public health measures and innovative care strategies. The potential long-term benefit on the nation’s health is vast, and decisive effort should be placed on focusing on system sustainability, as the risk of relying exclusively on training high numbers is that if posts are unfilled, an even bigger gap awaits.

Strategy 2 – Efforts on addressing demand are not effective, but retention strategies bear fruit. The focus on training is increased

In this scenario, no decisive action is taken towards demand drivers and therefore demand continues to grow as projected. The 2,000 GPs we estimated could be saved from addressing demand drivers in part 2 of this series now need to be accounted for by supplementing training numbers. This requires GP training places to grow (and be taken up) by 210 a year, rather than 50. The 2032 cohort would be the largest, with 11,834 doctors in training – and approximately a third of them qualifying that year. This is 1,800 more than with our first scenario, meaning that we will need robust infrastructure in place to sustain this number of trainees, including support for GP practices, adequate training facilities and opportunities and chances for all trainees to be exposed to varied practice and patient settings.

In order for this strategy to work, significant efforts need to be placed on retaining the current workforce, as well as on increasing the attractiveness of general practice to medical students. We estimate that currently only 17% of medical school graduates choose GP training and without increasing the medical school places to at least 15,000 – rather than the 13,000 needed in scenario 1 -, or increasing the proportion of students who take up GP as a specialty, we will not be able to reduce our reliance on international-trained doctors.

Strategy 3 – Demand drivers are not addressed and retention strategies are not effective in preventing GPs to leave their posts. Future workforce is mainly supplemented by training

The requirement for FTE GPs that need to be produced solely through training now is 27,690 – it includes both the 2,000 that could be averted by addressing demand as well as the 2,500 GPs part of the potential leavers cohort we hoped we could retain (more on this next week).

This increases our training requirement to an extra 425 places year on year – this means that by 2032 we need to be able to support 13,964 doctors in GP training at any one time, compared to the 9,714 of 2022. As there are currently 6,495 GP practices in England, a 20% drop since 2013 (GP online), that would equate to 2 trainees per every GP practice across England. Currently, only 3,422 practices support trainees as they must be able to meet a number of criteria to provide training; we can expect that the added training pressure on practices would represent a significant challenge in this scenario.

This option also has the biggest potential to have unfilled training posts over time. We would need much higher proportions of the medical student cohort to take up primary care as a specialty, as our current university infrastructure would not be able to educate high enough numbers of students. To mitigate for this, we would need international doctors to make up nearly 60% of the GP training cohort, with 7,938 overseas doctors in training by 2032.

These scenarios reinforce that a cohesive future strategy will be needed to address the GP workforce gap over the next 10 years. Retention will play a key part in this plan – join us next week to hear more about this.