To ask why we can't train more doctors?

[Turmerictolly]

The NHS is desperately short of GP's and other doctors and the system is at breaking point. I look on the regular threads on here about not being able to physically see a GP any longer and my own experience of having cancelled hospital appts which are leading to worsening health. I then look at the Medicine threads where there seem to be so many bright and promising young people willing to train but not enough spaces on the courses.

It seems like some sort of dystopian catch 22. How on earth is this going to be fixed?

There's a breakdown at assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/600835/Medical_expansion_rev_A.pdf#page=22

But, yes, it's a misleading figure.

Have you got the link to this thread?

I'm a hospital consultant. The problem is not that simple. It is more about retaining doctors who are already here than more into med school..All doctors come out of medical school & do a 2 year period of 'foundation training'. This is usually a combination of hospital & community posts and these posts are generally plentiful & full of doctors. It's persuading these doctors to stay in the NHS/UK that is the problem. Do you remember the strike & the new contract? As predicted it's had very significant adverse effects on staffing & working hours. Junior doctors now have random days off in the week to cover weekends (this was the Hunt agenda: '7 day NHS with no more staff to cover 7 days') thus much more antisocial hours & much less continuity of care, this reduces them to 'doing jobs' on the ward rather than building relationships with & following the recovery of patients 'like in the old days'. Most of them spend these years unable to attend weekend events with friends and families & being posted randomly to hospitals in wide geographical areas making things like relationships & sending kids to school or childcare very challenging. Rotas are changed at the last minute, locum pay for filling in these at the last minute is inadequate & generally conditions make working life pretty challenging..They earn around 30k, I don't know enough about other postgrad jobs with simillar hours to know how this compares. When they finish these 2 years , continuing in the NHS to train as a GP does not look very appealing, particularly when you consider the difficulty in looking after patients without secondary care input due to covid related delays & the incredible amount of abuse they face from the general public, generated partly due to their understandable frustration with a broken system too & partly due to the media spin on what is actually happening in surgeries.
There are many other problems eg Brexit meaning less well trained European doctors who come in at a senior level, these docs used to fill gaps at the senior level but no longer feel welcome & years & years of government cuts making provision of care more & more challenging. I feel very reluctant indeed to allow my children to go into a career in medicine in these circumstances even though I love being a hospital consultant & feel very privileged to be here. Bottom line is that we need to vote for a more socialist government who cares about provision of high quality health care for all regardless of their means. Then we need to focus on addressing the problems that make medical training so challenging so that more doctors stay.

That's a really interesting woody. Going further back, I think a lot of the dissatisfaction began with the introduction of the EWTD (under the old contract). It fundamentally changed patient care. Shift work became the norm and firm structures were destroyed at a stroke.

Doctors, especially the most junior, never saw the team they were part of, didn't see patients through their care pathway and couldn't get feedback from consultants they hardly saw because of the working patterns. Annual leave began to be allocated in advance to avoid falling foul of the regulations, which is dissatisfying and demotivating.

Retention is the main problem. Medical schools are recruiting smart, empathic, top grade students, med students are spending £45,000, just to train for 5 years, then work very long hours, in an unpleasant situation, with inadequate supplies and structure. Funnily enough, a huge number of docs at the age of 30-40 get disillusioned. Most tradesmen are on a better hourly rate than mid band doctors!

I’ve not read the full thread, but one thing I’ve noted - when I moved into my town in 2001 it had a population of 103,000. In 2022 it now us a population of 130,000 (as of 2018). In the last 20 years, there have been numerous housing developments expanding the town in every direction, thousands upon thousands of new homes. Yet not one of these new developments has a GP surgery on it. Not one. There are the same number of GP surgeries having to serve an extra 30,000+ people. No wonder they are struggling to see everyone, the infrastructure just isn’t there.
Shockingly, we have more nail bars then GPs 🤷‍♀️

An I ask for opinions on the idea of pharmacists providing fit notes to free up appointments. My local pharmacy has long opening hours and is incredibly busy at all times of day. I cannot see how they could accommodate that?

However the idea of midwives/physios/surgeons being able to provide notes for patients already under their care seems sensible

100% agree! Nothing bothers me more than when people say GPs are hiding away. I just did a GP rotation and it was 1000x worse than the hospital. You work 8-6:30, with way less days off. You work mon-fri plus out of hours clinics. You see way more patients and make way more decisions in shorter amount of time. You get a lot of abuse for things not in your control. How is it my fault 200 patients rang today for 20 appointments. And that they arent more GPs. literally people booked appointments just to tell me off that gps aren’t working. Wht a waste of an appointment!

people saying we do nothing because if we are worried we send patients to hospital. Well thats the whole point. Its emergency care for urgent testing! We dont have those facilities in GP as its not the purpose of a GP. If we did, we would basically be an a&e and we woulsnt be able to see anywhere near as many ptients and wait times would suffer further. Gp is for minor non life threatening illnesses, not requiring hospital admission, that can be treated from home. As well as management of chronic conditions. Not emergencies

We all work from within the practise itself. No one works from home unless a very good reason for it.

GPs are responsible for running their own practise and have a given budget. Then you have to pay whatever the expected wage is for a partner/nurse/doctor/manager/receptionist/admin etc. and ensure they have enough for supplies and bills and council tax. They also have to make sure they meet minimums and see certain patients yearly as needed. For example patients with copd or diabetes etc. 10% of patients take up 90% of a GPs time. All this extra work is done during your own time. You have to make sure staff meet training requirements unlike in hospital where you can focus on the medicine mostly and someone else takes care of all the extra running. Almost everyday my supervisor was doing all this extra work at home after surgery was over.

I don't mind GPs working part time if it means they avoid burn out, or breakdown.

That said, my current gp is pt and is on long term sick leave.
I've also contacted a consultant for a private consultation and they are also on medical leave until the new year.

Its a stressful job and its bound to take its toll.

Our village pharmacy struggles to get a pharmacist at all, they've not had a "permanent" one for a couple of years now, and rely on locums every day. Probably 1 or 2 days per week on average, they can't get a locum, so it has to stay closed. It's not just GPs that we're short of now, there is apparently a shortage of pharmacists too!

Apparently, they can't issue prescriptions without a pharmacist present, even if a pharmacist has already prepared/signed off the prescription, so there's no point in them opening! The other staff continue to "pick" and label the drugs for prescriptions in the absence of a pharmacist, making huge stacks of "baskets" for a pharmacist to sign off when they get one!

Because of this, our pharmacy stopped doing things like flu and covid jabs as when they get a locum for the day, they're busy catching up with issuing the prescriptions backlog from previous days without a pharmacist, so don't have time for jabs etc.

So, we need to train more pharmacists too!

So, we need to train more pharmacists too!

Universities train more than enough pharmacists. Again, there's a bottleneck post graduation (the pre-registration year), and many pharmacists fairly quickly realise it's a crap job for those who don't rise to senior & management positions and they therefore leave to do something else.