What are the views of GPs working in deprived areas on GP training?

Problem

In Scotland, practices in affluent areas are more likely to undertake GP speciality training: the average deprivation score of training practices is significantly lower (more affluent) than the average deprivation score of non-training practices. Trainees are more likely to stay where they train, and experience in GP training can affect future career choice. Unequal distribution of training practices across the social gradient may affect recruitment in these areas, and may mean some trainees are less exposed to issues associated with deprivation. There is no literature reporting/examining the views of GPs working in deprived areas on speciality training, in particular the major influencers on the decision to undertake trainingThe aim of the study was to explore the views of GPs who work in training, and non-training practices, in deprived areas regarding benefits and barriers to training

Approach

Ten in-depth interviews were carried out over a wide range of localities covering all four training regions in the NES Scotland deanery, using a schedule covering GPs views on the experience of working in deprived areas and their views on training. GPs from training and non-training practices were interviewed. Data were audiotaped, transcribed verbatim, and then analysed using thematic analysis.

Findings

Key ThemesWell Rounded GPs: • All GPs felt strongly training should produce “well-rounded GPs” able to work anywhere in Scotland, some experience in areas of deprivation was important for thisBenefits of training:• Generic issues relevant to all practices included the trainer/trainee relationship, enhancing CPD and inspiring the next generation• Particular relevance to training in deprived areas: workforce planning, extra pair of hands, break from clinical work• Specific to deprived areas: value of exposure for traineeBarriers to training: • Academic/Organisational eg.MRCGP, application process – seen as surmountable• Time/workload: insurmountable and main barrier to training• Challenge of exposure for trainee: specific to deprived areas, the value of exposure was felt to outweigh this

Consequences

GPs in deprived areas reported that training should produce “well rounded GPs” through exposure to a variety of environments, including deprivation. GPs in deprived areas see benefits to their own practice and to GPSTs in undertaking speciality training. There are specific GP skills to be gained undertaking at least some time in a placement in a deprived area and national education bodies should consider this in GP training rotations.The key barrier to training was identified to be increased workload and lack of time.