Releasing the potential of Academic General Practice in addressing the GP workforce crisis: how we could, why we must.

What is Academic General Practice?

Academic GPs are a core part of the discipline of Academic Primary Care. We teach, research and help formulate policy with colleagues from a wide range of scientific and professional groups to drive improvements in primary care provision through education and research.

Academic Primary Care is central to building, sustaining and developing quality primary care. It works to provide a deeper understanding of primary health care and to develop and evaluate primary care policy and practice. Its rigorous academic approach is essential for the provision of critical commentary and research evidence on how wider policy and practice impacts on the provision of primary care within the National Health Service.

Academic GPs design, deliver and oversee all undergraduate teaching in General Practice and around 15% of the total undergraduate medical curriculum in UK medical schools. We are the only academic medical generalists, and lead the development of innovative training and research in expert generalist practice.

Academic GPs lead health service research that drives improvement in policy and practice in NHS priority areas such as managing acute infection and antibiotic resistance, diabetes, managing acute infections, cardiovascular disease, diabetes, and addressing musculoskeletal related disability (Avery et al 2010).

Academic GPs also provide the evidence which tackles the distinct problems of new policy challenges for the NHS and primary care, including the challenges of GP workload, new service models for care of the acutely ill, telephone triaging, payment for performance models (QOF), managing multimorbidity, the diversity of community mental health needs, the growing prevalence of the phenomenon of medically unexplained symptoms , and continuity of care.

How does Academic General Practice already support GP workforce issues?

We deliver the next generation of GPs and generalists: providing all of UG teaching in generalist community based medicine and significant contribution to PG training including of GPs with Special Interests (GPwSI), future leaders and innovators
We recruit people in to General Practice: through providing role models to doctors and GPs at all stages of their career
We support retention of doctors within General Practice through providing and supporting portfolio career choices; and through re-engaging GPs with core professional values)
We provide students and early career doctors with experience of the intellectual interest and challenge of General Practice. (Lack of intellectual stimulation is a key barrier to pursuing a GP career

How could Academic General Practice do more?

Academic General Practice delivers a powerful contribution to current and future General Practice far beyond its visible presence. As with the wider discipline, we need to invest in Academic General Practice if we are to unlock its potential to contribute further to driving improvement in future primary care. But we also need to innovate – more of the same will not be enough. Key recommendations are given below:

We must recognise Academic General Practice is an intellectual discipline with its own distinct scholarship

In order to address a key barrier to recruitment and retention in GP - namely, a perception of General Practice as a technical role delivering the outputs from others' intellectual effort
To be achieved by: all medical schools being required to have a visible Academic Primary Care grouping; all universities being encouraged to develop Academic GP groups supporting local communities

We must recognise the existing intellectual contribution of the whole GP community to driving improvement through scholarship

In order to tackle a missed opportunity to enhance the retention of GPs through supporting existing/developing new portfolio career options. The significant contribution of a large cohort of GPs engaged in driving quality improvement through education and research is currently under-recognised in the form of visible career paths and support.
To be achieved by: NHSE to join the work being undertaken by SAPC and RCGP to describe and develop the career pathway of GPs with extended roles that include education and research

We must ensure that performance metrics for academic GPs (those with a university contract) reflect the full range of academic activity undertaken/needed to support GP workforce development

In order that support for academic activity reflects the required diversity of practice needed to maximise the potential of academic General Practice (including education, innovation and co-production of practice-based evidence)
To be achieved by: we propose that NHSE, SAPC and RCGP co-host a one day symposium on what should the future academic GP look like – which will also consider organisational structures and performance metrics to support this

We must ensure payments to general practices providing vital medical student placements adequately reflect the cost of teaching.

In order to address inequity: reimbursement has been static for 10 years; and is typically only 40% of the payment for secondary care undergraduate placements. Capacity for undergraduate GP placements is now a serious challenge for many medical schools. Without sufficient exposure to high quality community based teaching medical students are unlikely to consider GP as a career choice.
To be achieved by: ensuring that DH/HEE urgently renew negotiation around the undergraduate primary care Tariff – and ensure that the new Tariff is realistically costed in order to re-provide service when staff are engaged in student supervision and teaching.

Further details and full references can be found here.

Dr Joanne Reeve (SAPC Chair), Dr Joe Rosenthal (Chair, Heads of Teaching), Prof Richard Hobbs (Head of NIHR School for Primary Care Research) on behalf of SAPC December 2016