A hole in the bucket? exploring England's retention rates of recently qualified GPs.

Abstract

Background: As the senior medics within primary care services, general practitioners (GPs) have a pivotal role within the National Health Service (NHS). Despite several commitments made by government to increase the number of GPs in England, the level has consistently fallen. Much attention has been paid to recruitment of trainee GPs and overall retention, whereas this study sought to examine the specific transition from ending training to joining the NHS.

Methods: The study used aggregated, published administrative data to examine rates at which 14,302 doctors leaving their third year of specialty training (GP ST3s) became fully qualified GPs in NHS practices between 2018 and 2023. We separately analysed average levels of part-time working of those joining the NHS from 21,293 fully qualified joiners in England between 2017 and 2023. We calculated joiner and participation rates and used generalised linear mixed-effects models to explore possible demographic, period and cohort effects.

Results: Of those doctors leaving their third year of training since 2018, around a third (34.3%) were recorded as having taken up a fully qualified GP role in NHS general practices 6 months after finishing training, rising to 47.5% within 1 year, and 62.2% within 2 years. Average estimated participation rates of joiners seemed to remain consistent at about 65-69% of a full-time contract between 2017 and 2023. Joiner rates were lower for doctors with a primary medical qualification from outside the UK and, over a 2-year timeframe, both UK and non-UK trained male GP ST3s. Our statistical modelling suggests that there is a significant 'period effect' in connection to the recent Covid-19 pandemic, with apparent differences in the likelihood of GP ST3s joining the NHS in a fully qualified role at certain points in time, and an effect among some cohorts, with doctors who left specialty training in specific periods having significantly different joiner rates.

Conclusion: The GP pipeline is expanding, but we find no evidence that retention of newly trained GPs is improving. We discuss possible factors for such attrition, from barriers to hiring new doctors, to their diminishing interest in joining the NHS. The data do not capture all destinations of GP ST3s, and more work is needed to further explore the changing career behaviours of subsequent cohorts and demographics of doctors completing GP training.