Rationing, planned undercapacity and recruitment from inner city students (the best) leads to perverse outcomes,

David Millett reports in GPonline 4th April: Growth in GP training posts has exacerbated brain drain to London, warns HEE – Creating more GP trainee places has exacerbated workforce shortages in parts of England by allowing more trainees from underdoctored areas to opt for newly-available places in London instead, Health Education England’s (HEE) chief executive has said.

Prolonger rationing of places at Medical School, in GP training,  and planned undercapacity by manpower, and recruitment from inner city students (the best schools) leads to perverse outcomes, Graduate entry to dispersed and geographic medical schools with distance learning, will help, as will giving places to rural schools.


HEE has expanded the number of GP trainee places over the last four years but has failed to recruit new doctors at the same rate, its chief executive Professor Ian Cumming said.

His comments – made to MPs earlier this year – were revealed in board papers published by HEE.

The gap between available places and demand has allowed desirable locations such as London and Kent to offer more places and lure trainees away from understaffed parts of the country in the north and east of England, he added.

Speaking at a Public Accounts Committee (PAC) meeting, Professor Cumming said that fill-rates for London have remained consistently close to 100% as those further north have dropped.

The problems mean some areas of England have been left struggling to fill even two thirds of their GP trainee posts.

GP recruitment

GPonline revealed in December that areas such as the North East and East Midlands were being hit particularly hard by shortages.

By the end of three rounds of recruitment, the North East deanery filled just 62% of places, while the East Midlands filled 69%.

In contrast, the Thames Valley, South West, East of England and Kent, Surrey and Sussex deaneries filled 100% of places. London filled 99%.

The comments from Professor Cumming emerged as HEE and the RCGP celebrated GP recruitment figures for round one this year, which showed 148 more GP trainees were accepted into places than by the same time last year.

The GP National Recruitment Office (GPNRO) website, which advertises the remaining number of GP trainee places, suggests that 100% of London’s 458 places have already been filled. Thames Valley deanery is only advertising 10 places out of an original 126.

But the North East is still advertising for 100 places, over half (52%) of its original 192. East Midlands, North West, Yorkshire and West Midlands all have over 100 places remaining.

Junior doctors

Professor Cumming said at the meeting: ‘On an annual basis, on average for the past five years, we have attracted 2,700 junior doctors into GP training. In each of the past four years, we have increased the number of GP training slots, but we have still attracted, on average, 2,000 junior doctors into GP training every year.

‘So the number of slots has grown, but the number of applicants has remained broadly consistent. However, what we’ve continued to see in that time period is every training slot in London being filled. In London, Kent, Surrey and Sussex, for example, we have got 100% fill of all our GP training slots, and because the number of slots has gone up, those people have had to come from somewhere else.

‘By and large, the further north and east you go, the numbers have therefore gone down as a percentage of fill-rate, because people have been attracted more towards London. So, in the case of GP training, London is very attractive.’


This entry was posted in A Personal View, Perverse Incentives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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