Are junior doctors turning their backs on general practice?

It certainly looks that way. Such has been the drop in the number of young doctors choosing to train as GPs that one in five training slots in Scotland has been left empty this summer. That figure is likely to improve later in the year when health boards attempt to fill up any remaining vacancies, but the message seems clear: large numbers of junior doctors do not want to become GPs.

There are a number of reasons this might be so. The first is the nature of the job itself - being a GP is essentially a solitary affair and there is pressure to get through a large number of patients, with only a few minutes allocated to each one. On top of this, the nature of the job has changed in recent years with doctors dealing with many more elderly and frail patients with ongoing, complicated problems. Working as a GP can also be a fairly invisible job and there is certainly none of the prestige that surrounds the role of consultant. Faced with all of this, perhaps it is no wonder so many junior doctors are saying no thanks.

The obvious response might be to say that GPs have never had it so good and point to the UK contract that exempted them from working at weekends; by any comparison, GPs are also now paid very well. But the now infamous contract was negotiated more than 10 years ago and while it may have helped to make becoming a GP more attractive and alleviate the shortage of new recruits in the short-term, the problem has returned with a vengeance.

The landscape has also changed dramatically in the last ten years. There may be a huge, new hospital on the south side of Glasgow, but the vision at the heart of the modern NHS now is to help people avoid hospital and to live longer, healthier lives in their own homes. But if this vision of care in the community is to work, GPs will have to play a central part in it - and they can only do so if there are enough of them, and the job is attracting new recruits.

We now know that the opposite is happening. Three years ago, 96 per cent of GP training positions were taken, but by last year this had dropped to 89 per cent and this year it is 78 per cent. There are a number of complex factors contributing to this trend, but it does not help that junior doctors do not routinely spend time in a GP's surgery as part of their training. Requiring them to do so would obviously mean junior doctors spending less time on another area of training, but it would at least give trainees direct experience of general practice. If a proportion then decided general practice was for them, it could help deal with the shortage of new recruits.

As part of a plan for community care that is properly funded, GPs also need a clear definition of what their role will be in a very different NHS. There is no reason why junior doctors cannot be tempted back to the GP's surgery, but it will only happen if they know that instead of taking on a highly stressful, over-burdened job, they can expect a valued role with sensible working hours, proper support, and space for training and development. Caring for patients more in the community rather than hospital wards is a perfectly valid strategy for a health service with limited resources, but it will only work if the community has the doctors it needs.