UK academic general practice and primary care.

Abstract

The report of Higher Education England’s commission on the primary care workforce is timely and welcome. The UK has led the way in delivering high quality, effective, accessible, and equitable healthcare at modest cost.Getting the right workforce to deliver the strongest possible NHS primary care focus is critically important in times of financial constraint, healthcare innovation, and the changing population demographic characterised by complex care needs and multimorbidity. But in parallel, attention must be given to the importance of recruiting, retaining, and developing the primary care academic workforce—an agenda that was beyond the remit of the commission. The UK’s 205 senior academic GPs comprise just 6.5% of all clinical academics, and a tiny fraction of the 64 923 GPs currently registered with the General Medical Council (32 628 established GP full time equivalents). The overall increase in GP academic capacity from 153 full time equivalents in 2000 to 205 in 2014 has been almost exclusively the result of an increase in the numbers of GP professors from 33 to 78; the static number of GP lecturer posts (40) over 15 years reflects reduced opportunity for career progression at this level (Medical Schools Council, personal communication). The recent trend to move academics who mainly teach into central undergraduate teaching units has also fragmented university primary care departments (a consequence of the leadership of primary care academics in professionalising training and teaching roles) and reduced the already modest critical mass. Although the move towards centralisation of teaching may have some apparent advantages in terms of institutional management, it carries substantial risks. It may reduce academic capacity and separate undergraduate teaching in primary care from research in the discipline. Given that exposure to charismatic rolemodels and observation of academic opportunities during rotations 6 are important drivers of the career choices of medical students, such dislocation may reduce the number who consider general practice as a career. Academic GPs make an essential contribution to the NHS through education, research, clinical practice, and service development, usually while continuing to provide direct patient care. It is academic GPs who lead the general practice and community based undergraduate teaching of all future doctors, including those considering general practice as a career. Around 15% of the clinical curriculum in UKmedical schools is general practice based. However, since the only generalist discipline left in the NHS is general practice, it is essential that all future doctors have sufficient quantity and quality of exposure to primary care to ensure that they learn about undifferentiated symptoms, value longitudinal patient care, and understand modern NHS systems. Academic GPs are increasingly involved in curriculum development, quality assurance, assessment, admissions, welfare, and senior educational leadership. Furthermore as local education and training boards and deaneries restructure, university departments are key players in the emerging models for integrated delivery of community based undergraduate, postgraduate, and non-medical clinical education. Academic GPs are also research leaders, developing and overseeing high quality studies and building the evidence base around the organisation and delivery of clinical primary care. This discipline contributes disproportionately to major NHS research initiatives, supporting the work of the National Institute for Health Research, including leading the NIHR School of Primary Care Research. It contributes to leadership in primary care research education and training, research design and delivery, and to supporting the development of national research strategy. International comparisons show UK primary care researchers outperform other countries in terms of the number of publications. Primary care research addresses NHS priority areas, including, for example, antibiotic stewardship in primary care, 9 the management of patients with atrial fibrillation, diabetes, 12 multimorbidity, 14 serious illness, and risks arising from lifestyle. The organisation of care and informing

DOI: 10.1136/bmj.h4164

Cite this paper

@article{Campbell2015UKAG, title={UK academic general practice and primary care.}, author={John Campbell and F D Richard Hobbs and Bill Irish and S Nicholson and Mike Pringle and Joanne Reeve and Joe Rosenthal}, journal={BMJ}, year={2015}, volume={351}, pages={h4164} }