Palmer William L, Rolewicz Lucina, Tzortziou Brown Victoria, Russo Giuliano
Nuffield Trust, London, UK.
Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Hum Resour Health. 2025 Mar 3;23(1):14. doi: 10.1186/s12960-025-00980-x.
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.
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.
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.
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.
作为基层医疗服务中的资深医务人员，全科医生（GPs）在国民医疗服务体系（NHS）中发挥着关键作用。尽管政府多次承诺增加英格兰全科医生的数量，但这一数量却持续下降。人们对实习全科医生的招募和整体留用给予了诸多关注，而本研究旨在考察从培训结束到加入NHS这一特定的过渡阶段。
本研究使用汇总的已发表行政数据，考察了2018年至2023年间14302名结束第三年专科培训（全科医生ST3）的医生在NHS医疗机构中成为完全合格全科医生的比例。我们分别分析了2017年至2023年间英格兰21293名完全合格入职者中加入NHS者的平均兼职水平。我们计算了入职率和参与率，并使用广义线性混合效应模型来探究可能的人口统计学、时期和队列效应。
自2018年结束第三年培训的医生中，约三分之一（34.3%）在完成培训6个月后被记录为在NHS全科医疗中担任完全合格的全科医生角色，1年内升至47.5%，2年内升至62.2%。2017年至2023年间，入职者的平均估计参与率似乎保持在全职合同的65 - 69%左右。来自英国以外地区且拥有初级医学资格的医生以及在两年时间范围内，接受英国和非英国培训的男性全科医生ST3的入职率较低。我们的统计模型表明，与近期的新冠疫情相关存在显著的“时期效应”，在特定时间点，全科医生ST3以完全合格的身份加入NHS的可能性存在明显差异，并且在一些队列中也存在效应，即在特定时期结束专科培训的医生入职率有显著不同。
全科医生人才储备在扩大，但我们没有发现新培训的全科医生留用情况有所改善的证据。我们讨论了造成这种人员流失的可能因素，从招聘新医生的障碍到他们加入NHS的兴趣降低。这些数据并未涵盖全科医生ST3的所有去向，需要开展更多工作以进一步探究后续队列的职业行为变化以及完成全科医生培训的医生的人口统计学特征。
