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Experiences and career intentions of general practice registrars in Thames deaneries: postal survey

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7335.464 (Published 23 February 2002) Cite this as: BMJ 2002;324:464
  1. Isobel Bowler (isobel{at}gower.u-net.com), independent health service researchera,
  2. Neil Jackson, dean of postgraduate general practice educationb
  1. a 22 Marriott Road, London N4 3QL
  2. b London Department of Postgraduate Medical and Dental Education, London WC1N 1DZ
  1. Correspondence to: I Bowler
  • Accepted 27 October 2001

The national plan for the NHS in Britain has promised an additional 2000 general practitioners and 550 training places for general practice registrars by 2004.1 A study of the experiences and career intentions of general practice registrars was commissioned by the four deans of postgraduate general practice education responsible for south east England. These deaneries included a third of all registrars in general practice training in England.2

Methods and results

A postal questionnaire was developed, piloted, and sent to all 470 general practice registrars in the Thames deaneries in April 2000. Altogether 373 (79%) completed questionnaires were returned, 92% (330/358) by registrars in their final year of training. The proportion of female respondents (60%, 218/365) was similar to the national average2; the participants' median age was 30.0 years (mean 31.5 years). Most had trained in UK medical schools, but 29% (108/373) had qualified overseas (table). Doctors qualified overseas were older than UK graduates. Almost two thirds had chosen general practice after becoming a doctor, a median of three years after qualification.

Most registrars were satisfied with their training. Fifty eight per cent (213/366) would prefer the general practice component of training to be extended by six months, to 18 months. Seventy four per cent (272/369) would be interested in a salaried post combining clinical work with further training and development for 12 months, and 70% (257) would be interested in a programme of higher professional education for up to 12 months after completing training.

Altogether 94% (349/370) intended to work in general practice in the United Kingdom at some stage in their career, 1% (4) did not intend to do so, and 4% (17) were undecided. Four per cent (2/45) of doctors who had qualified in the European Union did not intend to work in the United Kingdom and 22% who had qualified in the United Kingdom (10) were undecided (P<0.0001, χ2 test). Graduates from medical schools outside the European Union had similar intentions to graduates from the United Kingdom.

Overall 74% (275/370) intended to take a general practice job immediately after training, but only 26% (96) a principalship. A significantly higher proportion of men than women intended to go straight into a principalship (37% (54/147) v 18% (39/218); P<0.001, χ2 test). Overall, 81% (301/373) intended to be a principal at some stage (14% (53) were undecided). Overall, 52% (194/370) anticipated becoming a principal within 12 months and a further 24% (89) within 24 months of finishing training.

Characteristics of general practice registrars participating in the survey. Where the difference by sex is significant, the results are given. Values are percentages (numbers) unless otherwise specified

View this table:

Of those intending to be principals, 48% (143/301) planned to work full time. Thirty per cent (51/171) of women and 75% (91/122) of men planned to work full time (P<0.0005, χ2 test). Overall, almost half (49%, 179/365) planned to work in general practice in the health authority in which they trained, 38% (138) as a principal.

Comment

Our study shows that the government's national plan may understimate the numbers of new doctors needed. Another study has estimated that 150 new entrants to general practice are required to replace 100 retiring principals, but this is a minimum figure.3 If the government's ambitious target of 2000 more general practitioners is to be met, then the 550 promised new training posts will not be enough. Qualified doctors currently in practice should be retained and encouraged to participate more in the workforce.

More than 10% of doctors training for general practice had attended medical school in other EU countries, and this group showed less commitment to working in general practice in the United Kingdom. Only half the registrars intended to stay in the health authority where they trained. Many expressed an interest in working part time, especially women registrars, who now make up more than half of doctors training for general practice.

Acknowledgments

NJ, Patrick Pietroni, Abdol Tavabie, and Ri Hornung (the four deans of postgraduate general practice for the former North and South Thames deaneries) had the idea for the survey and commissioned the work. They commented on the draft questionnaire, coordinated the mailout to the registrars in their deaneries, and commented on earlier drafts of this paper. NJ also arranged the piloting of the questionnaire and commented on the final draft of the paper. IB reviewed the literature, designed the questionnaire, analysed the data, and wrote this paper. Jackie Bradford entered the data. IB is the guarantor.

Footnotes

  • Funding The work was funded by the four Thames postgraduate general practice deaneries.

  • Competing interests None declared.

References

  1. 1.↵
    1. Secretary of State for Health
    . The NHS plan. A plan for investment. A plan for reform. London: Stationery Office, 2000.
  2. 2.↵
    1. NHS Executive
    . General and personal medical statistics England and Wales: 1 October 1999. Leeds: NHS Executive, 2000.
  3. 3.↵
    1. Royal College of General Practitioners
    . The primary care workforce. A descriptive analysis. London: RCGP, 1997.
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