'A dynamic, rewarding career at the forefront of healthcare': reimagining general practice

The numbers paint a stark picture. In 2015, a mere 17.4% of Foundation Year 2 doctors were appointed to GP training in the UK. This falls woefully short of the Department of Health's ambitious target of retaining 50% of medical graduates in general practice.  

Research I conducted as part of my DPhil in the Health Economics Group at the NDPCHS, using the UK Medical Education Database (UKMED), reveals intriguing patterns in career preferences among medical students. My analysis found that women and students from more socioeconomically disadvantaged backgrounds are more likely to consider a career in general practice. Conversely, my research highlighted that medical students who attended private schools tend to view general practice with less enthusiasm. 

Geographically, it's a postcode lottery. Some institutions, such as the Universities of Lancaster and Swansea, consistently produce higher percentages of students intending to become GPs. In contrast, and notably, the Universities of Oxford and Cambridge show markedly lower rates of students pursuing general practice. So why are medical graduates increasingly opting out of what has long been considered the cornerstone of British healthcare? 

The answer, it seems, is a combination of cultural, educational, and economic factors. 

First, there's the issue of "tribalism" within medical education. Hospital specialties are often portrayed as more prestigious and intellectually stimulating, with greater  long-term financial incentives . This hierarchical view skews the perception of general practice to a  less desirable status, a sentiment that permeates medical school halls and clinical placements alike. By their fifth year, a staggering 76% of medical students report encountering negative attitudes towards general practice from academics, clinicians, or educational trainers. This subtle (and sometimes not-so-subtle) denigration shapes students' perceptions at various formative junctures in their career decision-making processes. 

Then there's the question of exposure. Despite calls for more community-focused curricula, the proportion of teaching being delivered in general practice has plateaued at a paltry 13% since 2008. More alarmingly, the average amount of clinical contact in GP settings has actually decreased. This limited exposure denies students the opportunity to fully appreciate the intellectual challenges and rewards of primary care, including the value of community-facing care, the importance of care coordination across multiple health services, and the significant role GPs play in systems management and resource stratification within the broader healthcare landscape. It's a classic case of "out of sight, out of mind" – how can we expect students to choose a career path they've scarcely experienced? 

But perhaps most concerning is the perceived state of general practice itself. Students witness first-hand the pressures facing GPs – overwhelming workloads, bureaucratic burdens, and the relentless hard work of 10-minute consultations. The spectre of burnout looms large, deterring even those who might otherwise be drawn to the diverse challenges of primary care. 

So, what's to be done? The solution, like the problem, is multifaceted. 

Medical schools must take a hard look at their curricula and culture. Increasing exposure to general practice is crucial, but it's not just about quantity – it's about quality. We need to showcase the intellectual rigour of primary care, highlighting its role in managing complex, multimorbid patients and addressing population health challenges. GP placements should offer meaningful engagement. 

We must also address the hidden curriculum that undermines general practice. This requires active efforts to combat negative stereotypes and elevate the status of primary care within medical education. GP tutors and student-led GP societies can play a pivotal role here, as research shows they have a strongly positive influence on students' perceptions. 

Financial incentives need recalibration. This includes not only addressing the pay gap but also revising the funding model for undergraduate teaching in general practice. The current system, where GP practices often receive less for teaching than hospitals, is unsustainable and sends the wrong message about the value we place on primary care education. 

Finally, we must confront the systemic issues plaguing general practice. Improving working conditions, reducing bureaucratic burdens, and fostering a more sustainable work-life balance are essential not only for current GPs but also for attracting the next generation. 

The stakes could not be higher. A robust primary care system is the bedrock of an effective, equitable healthcare system. If we fail to reverse this crisis, we risk a future where access to high-quality, community-based care becomes a luxury rather than a right. 

As researchers, medical educators, policymakers, and healthcare leaders, we have a responsibility to turn the tide. It's time to reimagine general practice not as a last resort medical specialty, but as a dynamic and rewarding career at the forefront of healthcare. Only then can we hope to inspire a new generation of doctors to choose this vital path.