The NHS has to train two GPs to produce one full-time family doctor because so many have started to work part-time, new research reveals.
The finding helps explain why GP surgeries are still struggling to give patients appointments as quickly as they would like, despite growing numbers of doctors training to become a GP.
The disclosure is contained in a report by the Nuffield Trust health thinktank that lays bare the large number of nurses, midwives and doctors who quit during their training or early in their careers.
“These high dropout rates are in nobody’s interest,” said Dr Billy Palmer, a senior fellow at the thinktank and co-author of the report. “They’re wasteful for the taxpayer, often distressing for the students and staff who leave, stressful for the staff left behind, and ultimately erode the NHS’s ability to deliver safe and high-quality care.”
In an appeal to ministers to consider “bold” solutions to the NHS’s staffing crisis, the Nuffield Trust urged the government to start writing off large amounts of student loans owed by nurses, midwives and other health professionals in a bid to encourage them to stay in the NHS.
For example, a nurse graduating with £48,000 of debt would see it cut by 30% after three years in the NHS, 70% after seven years and then written off completely 10 years after joining. Doing that for nurses, midwives and allied health professionals such as physiotherapists would cost £230m a year, and another £170m if it was applied to doctors too, but would help the NHS recruit and retain staff, Palmer said.
The report highlights that the recent rise in the number of young doctors choosing to train as a GP is not leading to an equivalent increase in the number of full-time GPs.
It says: “We estimate that every two filled training posts in general practice result in around one fully qualified, full-time equivalent GP joiner.
“This is partly because the proportion of fully qualified GP joiners working full-time has fallen, from three in four in 2016/17 to one in three in 2022/23.”
The loss of so many trainee GPs “comes at a significant cost”, the report adds, given trainee family doctors’ salaries, as well as their medical degrees and postgraduate training, are NHS funded.
Overall GP numbers are still falling because worrying numbers of would-be GPs drop out during their training either for financial reasons or because they find training difficult, Palmer added.
The Royal College of GPs has highlighted that there are 970 fewer fully qualified, full-time equivalent GPs working in England than there were in 2019.
Dr Victoria Tzortziou Brown, the college’s vice-chair, said: “There may be many reasons for GP trainees choosing to work part-time, or even leaving the profession, after qualifying, but we are extremely concerned that this is happening due to unsustainable workload pressures and need urgent action to halt this.”
The Nuffield Trust’s research also found that:
One in eight nursing students in England do not complete their degrees.
For every five students doing a nursing degree at university, the NHS only gets three full-time nurses.
One in five newly qualified nurses working in hospitals or community settings quit within two years.
The number of UK nurses joining the NHS fell by about a third in both 2020/21 and 2021/22 – “a new and worrying dynamic”.
The thinktank also voiced concern about high dropout rates among young medics. About one in four doctors leave within two years of completing foundation training, the stage in their careers between medical school and starting to train as a specialist.
In June the government and NHS England published a long-term workforce plan, which envisaged a doubling in the number of UK-trained doctors and 80% jump in the number of domestic nurses over the next 15 years.
However, Palmer warned that the ambitious plan risked being “enormously shortsighted” because it contains too few ideas for encouraging existing staff to keep working.
A government spokesperson said: “Office for Students data shows those on nursing, allied health and psychology courses have similar, and in some areas better, rates of attainment, completion and progression compared to other subjects.
“We’ve made significant progress in growing the workforce with record numbers of staff working in the NHS. The first ever NHS long term workforce plan, backed by over £2.4bn in government funding, will deliver the biggest expansion of staff training in NHS history, retain more talented people and harness cutting-edge technology.
“The current student finance system strikes the right balance between the interests of students and of taxpayers. We are working closely with NHS England to reduce student attrition rates and ensure they are supported whilst in training.”