We've never needed family doctors more: new figures show that the UK has hit “chronic” GP shortages, with each family doctor now responsible for an average of 2,200 patients – rising to 3,000 patients in the worst affected areas. More than 800 doctors said they had cancelled all routine appointments over the past year, such is the “unsafe” workload. With patient numbers up and the number of trained GPs dropping – one in seven job posts remains unfilled and early retirement is at an all-time high – unless the Government makes good on its promise to hire an extra 6,000 medics within two years, the health service will be unable to weather the storm.
Bogged down by the pandemic backlog and facing heavy criticism from patients and politicians, who would be a GP now? For some following the career path, the pandemic has provided a motivation. Indya-Jane Wardle, then 17, was volunteering at East Sussex District General hospital when the Covid 19 pandemic began. The place was transformed within weeks; PPE donned, non-urgent patients cleared.
But inadvertently landing on the frontline of a health crisis “wasn’t off-putting”, she says. Far from it: her time pushed her to apply for a medical degree, of which she is about to complete her first year. Wardle, who studies at King’s College London, is a proud member of the inaugural Covid medical cohort – the teenagers who, after seeing health workers’ efforts in the pandemic, were inspired to join the frontline themselves.
“All of us are very aware” of the current GP crisis, Wardle says, and doctors do paint a daunting picture of life in a busy surgery. She says doctors taking on extra phone appointments, a lack of in-person interaction with patients and more people turning to their GPs with late stage health problems that should have been treated in hospital during the pandemic are fast leading to burn-out.
Caps on medical school places are contributing to Britain’s recruitment stasis. A record 20 per cent more students applied for the 9,500 annual medical school places in 2020 and there are currently around three times as many hopefuls as openings; Exeter University offered applicants £10,000 and free accommodation if they deferred the course for a year, such was the interest when Covid struck. In October, the Medical Schools Council suggested adding 5,000 more places per year to bridge the gap; the following month, former health secretary Jeremy Hunt added his voice to calls for more training, pointing out that the cost – around £200,000 per student – could be clawed back by cutting down on locums, who run up a £6 billion NHS bill each year. Wardle warns that more trainee places risks creating a “bottleneck” among her fellow students, however, where no one can progress to senior doctor or consultant level because NHS funding hasn’t been raised accordingly.
Many enter medicine for the people, she adds – and the shift to online interactions has left many finding it “difficult to see the upside”. Most King’s first-years have spent the past 12 months sifting through around eight hours of pre-recorded lectures each week (compared to the five or so spent on campus in tutorials). Other medical schools’ early years remain entirely digital; at the University of East Anglia, all students have been given a virtual reality headset in order to be given a “nuanced and holistic” experience of clinical life. Much of her first academic year had constituted “a weird sort of limbo” where teenagers – who had their final years of school and exams cancelled – are “just being expected to get on with it as if nothing’s happened”.
Professor Martin Marshall, chair of the Royal College of GPs (RCGPs) notes that this “will have been a very challenging time for people to start a career in medicine”. Social distancing requirements meant students couldn’t look in patients’ mouths during training, for instance – even resuscitation skills have, during various lockdowns, been taught from metres away.
It’s all a far cry from the training 21-year-old Josh Kimberling’s GP father went through three decades ago – and “things were certainly different in my day”, Dr Daniel Kimberling agrees. Seeing his dad join the vaccination effort last year was to the first year Hull York medical student “a demonstration of the constantly changing, evolving nature of medicine and just trying to keep up with the needs of an also changing population”. For Josh, Covid has been an eye-opener to “how much medicine changes”. “Not too long ago, people were in the hospital wearing no masks – now they probably will be for a long time… medicine is a career in which you have to be constantly learning, because our understanding of the body is constantly improving. I find that quite exciting, actually; that we’re striving towards better care,” he said.
Dr Kimberling, GP partner at Haxby Group, medical director of Nimbuscare and clinical lead at the West, Outer and North East York Primary Care Network in York, warns a note of caution that: “As medics, we may be playing catch up for some time, I fear… but [the NHS] is still full of hope. Its future is full of enthusiastic people – young students like my son – and even the current stretched staff will bounce back, the nation can count on it.”
Some have a more personal reason for choosing a career in the NHS. Rachel Ohene-Adjei, 39, began embarking on a nursing career less than a year ago, following her husband’s death from Covid. Eric, 46, spent almost two months in intensive care after contracting the virus, with his children, aged 12, nine and eight, unable to visit. Her own trip to say goodbye offered a kind of clarity, she says. The consultant “explained everything they did over the seven weeks to try and save him, and he held my hand and walked me into the room” where Eric lay; staff had moved her husband to one side “so that I could lay on the bed with him, so I was holding him when they turned the machines off”.
Losing him like this was agony, she reflects. And yet “everything was just made so beautiful and dignified” thanks to those who cared for him. “I would just like to be able to hold someone else's hand and give comfort to somebody else, and be able to care for somebody the way they cared for my husband. It just inspired me so much, to want to do that for someone else.”
During Eric’s time at University Hospital Wales, Cardiff, Ohene-Adjei, who left school at 16 with no qualifications, had wondered what it might be like if she could join the ranks of staff who were “so stressed, the doctors and nurses were so exhausted”. Just a few hours after her husband’s funeral, the stay-at-home mother “started reflecting on everything”, logged on to her computer and applied to a pre-access to nursing course (a requirement for those who have not undertaken GCSEs). Come September, she’ll begin a one-year access course, before a three-year nursing degree at university.
Ohene-Adjei never imagined herself here, she explains; “I was comfortable, I didn’t really think I needed anything else.” Yet the shock of Eric’s death felt “like a lightbulb went off”; age gap between her and her fellow students be damned, Ohene-Adjei knows she's on the right track. “Anything I wanted to do, he’d say go for it, go on, you can do it. He was so confident in my abilities; where I didn’t have the confidence, he did,” she says. “He would be so so proud.”