Would changing the selection process for GP trainees stem the workforce crisis? A cohort study using multiple-imputation and simulation

Abstract

BackgroundThere is currently a shortage of qualified GPs in the UK and not all of the training posts available each year are filled. Changing the way in which GP trainees are selected could help increase the training post fill rate and the number of new entrants to the GP Register. The aim of this study was to model the impact of changing the selection process for GP training on the number of trainees obtaining GP Registration, either with or without extensions.MethodThis was a cohort study using UK applications for GP training in 2011–14. Application data were linked using GMC numbers to training outcome data where available, and imputed using multiple imputation where missing. The number of trainees appointed and GP Registrations within three and five years’ full-time-equivalent were estimated for four different selection processes.ResultsThe cut scores used in the actual 2015 selection process makes it impossible to fill all training posts. Random selection is the worst option, but the difference between this and other processes modelled falls as more trainees are selected. There are large marginal effects on outcomes: those with the highest selection scores are more likely to obtain GP Registration than those with the lowest scores.ConclusionsChanging the selection process alone would have a small impact on the number of GP Registrations; reducing/removing cut scores would have a much larger impact. This would also increase the number of trainees requiring extensions and being released from training which would have adverse consequences for the profession.

Exploring UK medical school differences: the MedDifs study of selection, teaching, student and F1 perceptions, postgraduate outcomes and fitness to practise

“…Of course, nearly doubling the amount of GP teaching nationally, from 339 to 600 h, would not be easy, as GPs and GP teaching are finite resources, which are already overloaded [101]. Whether increasing the number of GP trainees by 5 percentage points (25%) would be sufficient to ameliorate the current shortage of GPs requires further modelling, particularly if other teaching were to decrease, perhaps with unintended consequences, and also were there to be more GP trainees failing MRCGP examinations or having ARCP or FtP issues [102] (although such outcomes can be modelled [19,103]). Greater exposure to general practice could also merely confirm for many students that they definitely have no intention of a career in general practice [104].…”

Using recruitment and selection to build a primary care workforce for the future

“…(13) However, in terms of maximising CHW performance, such involvement can be detrimental if nepotism influences decision-making. (14) The use of Stage 2 scores only to select GP trainees involves a very different trade-off as there is evidence that this approach is cost-effective, with no impact on training outcomes (15), but acceptability could be low because of the high face validity of the relatively expensive faceto-face Stage 3 selection centres.…”

The professional resilience of mid-career GPs in the UK: a qualitative study

“…General Practice in the UK is facing a crisis. [1][2][3][4][5][6][7][8] While patients remain highly satisfied with the care they receive, satisfaction with access to GPs has steadily declined. 9 The number of full-time equivalent GPs per head of population is falling 2,5, 8, 10 .…”