GP crisis over longer hours and fewer staff

Doctors' leaders yesterday warned of a looming crisis in general practice, the so-called "jewel in the crown" of the NHS, with a 15 per cent fall in the number of GP trainees since 1988.

Disillusioned older GPs are also quitting early, while more newly-qualified doctors are rejecting life in general practice for hospital careers, according to a report from the British Medical Association.

Recruitment problems are so severe in some areas that GP training schemes cannot attract any candidates, while others rely on doctors from European countries who, once qualified, return home to practice.

Among newly-qualified GPs who have completed their training, many are opting for other medical or non-medical careers. Others take time out to travel or have a family. Women make up 50 per cent of medical school intake and are increasingly seeking careers as GPs.

The report, Medical Workforce, compiled by the BMA's General Medical Services Committee, points to an increasing workload, unsocial hours and low morale for the failure to attract and to keep GPs as health services shift towards primary care.

Dr Ian Bogle, chairman of the BMA's GPs Committee, said: "When you have people not coming into practice; when you have people trying to get out of it prematurely, then you have a crisis ... a breakdown of the family doctor service. There would be fewer GPs, under intense pressure, to deal with patients, he warned. Dr Bogle accused the Government of ignoring the crisis, and said that the transfer of additional health care activities from secondary (hospital) services must stop until more funding is made available to GPs.

He also criticised the pay review two weeks ago which gave GPs 3.8 per cent. "The Government spends 364 days a year talking about general practice being the jewel in the crown of the NHS, but when it sits in front of the review body, all such talk goes out of the window," Dr Bogle said.

Between 1988 and 1994, the number of trainee GPs entering general practice fell from 2,165 to 1,840, while the GP's average working week has increased from 39 hours in 1985-1986 to 43.5 hours in 1992-1993.

The report highlights dependency of general practice on overseas doctors, and warns that following immigration rules changes in 1985, their numbers fell and will continue to decline as many retire. It also points out a "significant reduction" in the number of GPs wanting to work beyond the age of 60, and an increase in the number seeking a reduced time commitment.

Hospitals are taking an increasing proportion of the medical school output with an increase in career grade staff of 26 per cent between 1988 and 1994, compared with a 4.9 per cent increase in GP principals.

Dr John Toby, chairman of the Council of the Royal College of General Practitioners, said that more places at medical school were needed, extra- resources to fund them, and greater emphasis on primary care in medical education.