The Health
and Social Care Committee’s Inquiry into GP Workforce
Supplementary information from The Wales Deanery
Dr Phil Matthews
Head of GP Training School
Wales Deanery
6th February 2015
Dear Rhys
I am most grateful to my colleagues Mary Beech and Martin Sullivan for attending, in my unavoidable absence, the GP workforce inquiry session last Thursday. Having read the draft transcript of the discussions that took place, I know that the Committee will join me in thanking them both for providing a very useful supplement to the paper we originally submitted.
However, as Mary and Martin indicated in their evidence, they were not in a position to perhaps be completely familiar with the history of some issues. We are now grateful for the opportunity to be able to respond to The Committee’s request for additional information.
Your email of Jan
30th 2015 stated that
“It was noted during the meeting that there is a tight
turnaround associated with the output (i.e. the letter to the
Minister) for this inquiry. As such I would be extremely grateful
if the additional information could be provided as soon as
possible, and no later than 12.00 (noon) on Friday 6
February if at all possible please.”
As such, I have constructed this brief report so that this deadline can be met; and we will provide as much useful and pertinent information as we are able within this timeframe. However, if the Committee requires more detail, we will of course be delighted to expand where we can upon this further submission.
I am grateful to you for forwarding this letter and the report below to the Members of the Committee.
Yours sincerely
Phil
Matthews
Introduction
In your email, you outlined that the Committee has requested
· An outline of the costs associated with increasing the GP training recruitment target from 136 to a minimum of 200 (as recommended by the British Medical Association) or to a number that you feel would be realistic; and
· A breakdown of the areas and localities in Wales where spaces have not been filled over the past 3 years.
Further to conversations I have had with Mary, Martin and The RCGP this week, I would also be grateful to take this opportunity to clarify one or two other matters which we believe will aid The Committee in its work. This clarification largely relates to certain matters referred to in the draft transcript we have received between paragraphs 659 and 678 (inclusive)
· We would like to provide much needed clarification around the discussion (derived from the RCGP’s paper of evidence) that the RCGP have figures for numbers of GPs leaving Wales after GP training, and that for last year this number was 45.
· We would like to a) explain the outcome of various attempts to monitor the career progression of GPs once qualified both in Wales and elsewhere to date, and b) The opportunity we now have and are planning to seek ethical approval for in terms of using the Wales Medical Appraisal and Revalidation (MARS) tool which the Deanery has developed, to be able to achieve better results in future than we and our colleagues in other parts of the UK have managed to up till now.
Beneath the data requested regarding regional vacancies, I have also included two further tables which I am sure will be of help to the Committee. These two tables will enhance the Committee’s understanding, in numerical terms at least, of the current major problems we have in Wales (as in most of the rest of the UK) in terms of insufficient numbers of GPs entering the UK work force. These two tables show the total number of recruits to GP training over each of the last five years AND the number successfully emerging from GP training in Wales over each of the last five years. If having considered tables 2 and 3, the Committee would like further information as to the significant attrition and lag factors during GP training that further reduces output, I would be very happy to provide this information.
Finally, in this introduction, I would add that I sent Martin and Mary a draft of this report last night. They have advised me that, in addition to the information requested by email, the Committee also appeared to them to want information pertaining to a) costings for increasing the GP proportion of F2 placements up to the 55% UK average AND b) costings for increasing the GP specialty registrar training supplement to 65%. As I’m finishing off this paper just before heading off to do this morning’s surgery, I’m afraid I don’t have sufficient opportunity to include this data now. However, if this latter additional data is indeed required, I would be delighted to supply it to the Committee and should be able to get it to you next week.
Clarification
1.
Here we provide
very much ball park additional costings to the end of
this decade, if the current target of 136 entrants a year into GP
specialty training in Wales was expanded from August 2016
onwards and was fully recruited to.
For a 25% expansion (an increase to 170 entrants ) in
£ millions
2017
2018
2019
2020
£1.3
£3.9
£4
£4.1
For a 50% expansion (an increase to 204 entrants) in £
millions
2017
2018
2019
2020
£2.6
£7.8
£8
£8.2
With a few weeks’
notice,firmer costings and their
underpinning detail can be calculated and provided if requested by
The Committee for a particular percentage increase
2. A breakdown of the 12 district GP training schemes in Wales where spaces have not been filled over the past 3 years.
Please
N.B.
a)Target vacancies per year in
Wales = 136
b) Advertised vacancies per year in Wales = usually significantly
less than 136 (multiple posts needed by GP registrars due to return
from maternity leave)
One important caveat arising from a) and b) is thus that the
total number of recruits each year cannot be extrapolated by
simply subtracting the number of vacancies remaining from
136. The latter calculation would produce an inflated
recruitment figure for each year
Table 1.
Vacancies on GP
Training Schemes in Wales on completion of annual recruitment
|
District Training Scheme |
2012 Vacancies remaining |
2013 Vacancies remaining |
2014 Vacancies remaining |
|
Aberystwyth |
3 |
4 |
3 |
|
Bangor |
6 |
0 |
1 |
|
Bridgend |
0 |
0 |
0 |
|
Cardiff |
0 |
0 |
0 |
|
Carmarthen |
3 |
0 |
1 |
|
Dyffryn Clwyd |
2 |
0 |
0 |
|
Glamorgan Valleys |
1 |
0 |
0 |
|
Gwent |
1 |
0 |
0 |
|
Neath Port Talbot |
0 |
0 |
0 |
|
Pembrokeshire |
3 |
0 |
2 |
|
Swansea Bay |
1 |
0 |
0 |
|
Wrexham |
3 |
0 |
2 |
Table 2. Total number of recruits to GP specialty training programmes in Wales over each of the last five years
|
2010 |
123 |
|
2011 |
115 |
|
2012 |
105 |
|
2013 |
126 |
|
2014 |
114 |
Table 3. Total number of qualified GPs successfully emerging from GP training programmes in Wales over each of the last five years.
|
2010 |
108 |
|
2011 |
98 |
|
2012 |
93 |
|
2013 |
90 |
|
2014 |
101 |
3.
The RCGP has confirmed to me in
an email that they are not aware of the number or of any potential
source of figures relating to the number of GPs leaving Wales at
the end of their GP training programmes in Wales.
The quote in the RCGP’s paper submitted to the Committee that
was clearly interpreted as such in the Committee transcript is, we
were told by The RCGP, derived from a table on page 11 of The UK
Foundation School “F2 career destination report”.
This table, which we were fully aware of, has nothing to do with
exit from GP training. Successful exit from GP training occurs
more than 3 years years later in the career of any aspiring GP.
However, we can see why this data might easily have been
interpreted by any HSCC member as it appears to have been, given
the context of this inquiry i.e. GP workforce.
The F2 career destination report in question, does indeed have mounds of very useful information regarding short term career aspirations of Foundation doctors if its context is fully understood and explained to anyone unfamiliar with the issues involved; but the statistical rigour of the numerical quote and its pertinent interpretation on the part of the RCGP continues to puzzle us.
4. There have been attempts both in Wales and elsewhere to establish the career destinations of doctors who have finished their specialty training in the UK for various specialties including General Practice. These have largely proved to be of limited value because of the collective problems of tracking/contacting/gaining responses from senior doctors (i.e. GPs and consultants) as they move between jobs and locations both in the UK and abroad over time.
In Wales, the GP section of The Deanery is in
fact in the planning stage of an alternative approach to obtaining
the sort of information the Committee believed it had received from
the RCGP.
We are planning to explore the feasibility and ethical
acceptability of comparing lists of individual identifiers for a)
doctors who have successfully emerged from GP training in Wales in
recent years, with b) GPs on The All Wales “Medical Appraisal
and Revalidation Service”(MARS) Database, which was set up by
and is administered within the Wales Deanery. If this proposal,
when fully worked through, gains ethical approval, we would of
course only be able to report numerical rather than any
identifiable personal data; and we intend to produce a report on an
annual basis. Such a report would, we strongly believe, be able to
accurately demonstrate in future how many GP trainees from each
cohort qualifying every year in Wales are continuing to work as GPs
in Wales at a particular point in time. As we take this plan
forward it is very possible that other useful parameters will be
identified and researched.
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