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School ‘tribalism’ discouraging medical students from general practice, report finds

Medical students are being discouraged from working as GPs because of negative attitudes about the profession and funding difficulties, according to a new report from Health Education England (HEE) and the Medical Schools Council (MSC).

The report, based on evidence from experts and staff and students within medical schools, said that “tribalism” within medical schools was encouraging students to see general practice as “lower status”.

Students who carried out work placements in general practice also faced “negativism”, including GPs directly discouraging them from working in the field.

Professor Wendy Reid, director of education and quality at HEE, said: “There needs to be a system-wide approach to changing long held views about general practice being a poor relation to working in a hospital and working with partners to improve the image of general practice.”

The Royal College of GPs predicts that there could be a shortage of 9,440 full-time GPs across the UK by 2020, leading to almost 600 practices closing as older doctors retired.

NHS England has now developed the GP Forward View to try to help GPs cope with a population with increasingly complex needs by addressing problems including funding and recruitment shortages, doctors leaving general practice, workplace stress and outdated premises.

HEE and the MSC also argued it was “absolutely crucial” to address the lack of reimbursement for undergraduate teaching in different medical settings.

The report said that HEE and the Department of Health should “rapidly progress” their current review of funding arrangements to ensure that GPs are compensated for teaching medical students and can do so without distracting from patient care.

It also recommended that medical schools reach out to primary and secondary schools to promote a positive understanding of general practice; improve students’ access to GP work experience; ensure that GPs are involved in the selection process and feature as role models in schools; and work to counteract negative ideas about general practice.

And upon graduating, students should be encouraged to make career decisions without “feeling pressured by market forces” and to consider portfolio careers.

Dr Katie Petty-Saphon, chief executive of the MSC, commented: “Medical schools are committed to becoming the catalyst for change recommended in the report.

“General practice is an extremely intellectually challenging specialty and medical schools will do all they can to prepare students to support patients in the community in increasing numbers.”

The report added that medical schools should revise their undergraduate curricula, and that the General Medical Council should review its outcomes for graduates, in order to ensure that the curriculum reflects the patient’s journey through different healthcare settings.

Lastly, it said NHS England should review the current structure and support of academic training opportunities in primary care, ensure there are enough available, and actively promote them within medical schools.

Professor Val Wass OBE, who chaired the task force which produced the report, argued it was “a great opportunity” for general practice to raise its profile and status.

Harrison Carter, co-chair of the BMA medical school committee, said it was encouraging that the report recommended addressing the prominence of general practice in medical school.

“However, it is also right not hide the fact that one of the solutions to this problem is to address the funding crisis which many GPs say is having a real impact on the service that they can provide for their patients,” he added.

“A comprehensive approach to solving the current crisis is the only way that more medical graduates will be encouraged into general practice."

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