GP trainers warn of doctor shortages

Health crisis: Avalanche of paperwork, poor working conditions and climate of uncertainty blamed for shortfalls in recruitment
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The NHS is facing a serious shortage of GPs, as hundreds of jobs for trainee family doctors remain unfilled.

In some areas, half the vacancies are empty, according to an audit carried out by the senior doctors who are responsible for training the UK's future GPs. They have warned the Department of Health that the NHS is facing a crisis.

High levels of paperwork created by NHS reforms, increasing workloads, and long hours are among the reasons why young doctors are shunning careers in general practice.

The doctors have also warned that the shortages are leading to falling standards - two trainee GPs have had their contracts terminated because of incompetence.

In Yorkshire, where 78 out of 300 training posts remain empty, 20 German and Dutch doctors have been hired to fill some of the jobs. In Wales, 40 out of 80 posts remain empty, and in the West of Scotland there are 27 vacancies.

Dr Jamie Bahrami, regional adviser for GP training in Yorkshire, and secretary of the UK conference of postgraduate advisers, which carried out the audit of vacancies, said: "We are faced with a serious crisis in recruitment for GP training. In 1989, we had 30 applications for every vacancy, by 1992, that had dropped to five applications. Now in Yorkshire we have an acute shortage of applications for training schemes with 78 out of 300 vacant.

"We are having to rely heavily on doctors from the European Community. In Yorkshire we have 20 European trainees at present. There are also indications that the quality of trainees is not as good as it was five years ago. We have for example, had to terminate the contracts of employment of two doctors from the EU on the grounds of incompetence.

"Not only are we faced with a recruitment crisis, but people are being appointed to schemes who a few years ago would not have got a job. There are therefore long-term implications for the quality of training. If the situation is allowed to continue we are going to be left with a serious shortage of GPs."

He said that figures from the audit were being passed to the Department of Health with a warning of an impending crisis.

Dr Simon Smail, sub-dean for GP vocational training in Wales, said the principality needed about 100 new GPs a year to fill vacancies. "We advertised around 80 vacancies and only half have been taken up. The 50 per cent uptake is replicated in north of England, the north Midlands, East Anglia and the West Country. The Oxford region for the first time is having problems."

Dr Smail said there were a number of possible reasons for the difficulties in recruiting. "I am very concerned about the situation. It may be that young doctors are quitting medicine altogether.

"It may have something to do with terms and conditions of general practice. There is concern too about the speed of change in NHS, which has had an impact on some doctors. Doctors were not trained as business managers. They find change very stressful and increase in workloads has been stressful. Administrative workloads have gone up by 50 per cent since new contracts came in in 1990."

Professor Stuart Murray, regional adviser for the west of Scotland, said: "We have 27 vacancies out of 155 and that is serious. I think there are a number of issues causing the problems ... financial and a drop in morale, as a result of new contracts making general practice not as attractive."

A Department of Health spokesman said, "There are some valid concerns about GP recruitment. There has been a decline in the number of trainees in recent years, However there were 1,400 trainees throughout England in April 1995, a significantly higher number than is needed to sustain the numbers of GPs.

"We accept that there are real workforce issues which need to be addressed in the medium and longer term."