You go into GP training with your eyes wide shut; an exploration of prominent factors which influence the success of transitions from GP training to GP work

Problem

It is widely agreed that in many parts of the UK there are insufficient general practitioners (GPs) to cope with increasing workloads. Despite efforts to boost recruitment, each year, fewer new GPs join the UK GP workforce than complete GP training programmes. In the absence of robust research to determine the reasons they do not progress to settle in general practice, it is difficult to propose strategies which could improve this situation. The purpose of the study behind this paper is therefore to explore the preferences, incidents and experiences which influence new GPs before and during their period of transition from GP training to settling into substantive GP careers.

Approach

The participants in this study are doctors who have been recruited during the final year of general practice training and within 5 years of completion of training. We have conducted a qualitative study using individual interviews and focus groups to gather narrative accounts of their perspectives on multiple influential experiences. Our ongoing analysis has identified several prominent influential themes including; the extent to which they feel properly prepared for GP work, their preferred working patterns and how they see their future GP careers.

Findings

Doctors have described the strengths and limitations of GP training programmes; they describe it as 'world-class' training but also recognise knowledge gaps and a range of difficulties encountered when working in hospital posts. Having expected general practice would be less onerous than hospital work, they have witnessed GPs coping with heavy workloads and begun to plan more sustainable working schedules and a healthy work-life balance for themselves. Many voiced concerns about how the roles expected of future GPs may differ from their preferred patterns of work and some have been preoccupied by an uncertain mixture of hoping and fearing that things will change.

Consequences

The NHS needs a succession of new GPs who are skilled, knowledgeable, well-resourced and committed to the long-term delivery of primary care. General practice training has been the most highly rated of UK specialist training programmes but the apparent attrition rate from training to practice adds to concern for the future of primary care delivery. For as long as a significant proportion of these new GPs are not retained within general practice, it is likely that a resolution of the continuing GP workforce crisis will remain difficult. Insights gained from this study therefore provide a timely and valuable source of information about how improvement may be achieved and are relevant for policy makers, educators and practising GPs.