GMC plans to expand the range of doctors able to work in general practice

The General Medical Council (GMC) is calling for a relaxation of NHS rules to allow skilled doctors in non-training roles to practice in primary care.

The move would allow specialty and associate specialist (SAS) and locally employed (LE) doctors to undertake a wider range of work, thus helping to address some of the pressures felt across the health service.

The primary care workforce has had the lowest growth of all register types in the last five years

A recently published report, The state of medical education and practice in the UK: The workforce report 2022, found that these groups of doctors are growing the most, whereas the GP workforce has had the lowest growth of all register types in the last five years.

However, SAS and LE doctors, many of whom come to the UK after qualifying in medicine abroad, are more likely to leave after relatively short spells working in the NHS.

The GMC say that a significant number of these doctors want wider opportunities, and they hope that by offering them the opportunity to work in primary care, there will be better retention across the board.

Charlie Massey, GMC Chief Executive, says: “The UK’s health services are yet to properly understand how to make the most of these talented and able doctors. At a time when patients face unprecedented waits for care, now is the time to discard dated ideas and to tap into the skills and experience these doctors provide.”

GMC must provide more detailed proposals

However, the British Medical Association (BMA) has called for greater clarity about what the GMC is proposing, and to ensure that these doctors are treated and paid fairly, and not just used to “plug staffing gaps”.

As Dr Ujjwala Mohite, BMA UK SAS committee (SASC UK) chair, explains: “There are many unknowns about this proposal from the GMC, which will need some serious discussion among the profession to determine whether it is something that SAS doctors could back. It’s unclear what roles SAS doctors would be expected to fulfil, what training they would need to undergo, what support and inductions would be provided, and what terms and conditions they would be working under.

“The NHS has a staffing crisis across the board, with nowhere near enough doctors to meet demand in both primary and secondary care. But such a plan should not be a case of employing largely international medical graduates cheaply and on poor terms to plug staffing gaps, as we see with many locally employed doctors.”

Expanding the wider practice team “must not be seen in isolation as a solution to the chronic shortage of GPs”

The Royal College of GPs (RCGP) has made similar calls, and says the GMC will need to put forward “more detailed proposals about how SAS-grade doctors could work in general practice and integrate with existing teams”.

“What is clear is that SAS-grade doctors, like other members of the wider practice team, must not be seen as a replacement for GPs who are expert medical generalists and have completed their three-year training programme and have been assessed on their specialist clinical and communication skills required to practise independently as a GP in the UK,” says Professor Martin Marshall, Chair of the RCGP.

He warns that the expansion of the wider practice team must not be seen in isolation as a solution to the chronic shortage of GPs, and the government must develop a new recruitment and retention strategy that goes beyond the target of 6,000 GPs pledged in their election manifesto.

A culture shift

Suzie Bailey, Director of Leadership and Organisational Development at The King’s Fund agrees that the plan offers a valuable way of enabling skilled doctors to take up a wider range of work.

However, she warns that this will require “much more than just a relaxation of the rules, including a culture shift to embed change and adequate support for these staff to work to their full potential.”