Can new blood from state schools cure GP crisis?

A trip to the hospital for an operation on a shattered knee is the kind of experience that will stay ingrained in the mind of your average 13-year-old. But for hockey-loving Callum Cruickshank, a ruptured anterior cruciate ligament (ACL) led to '¨a meeting with a surgeon that would '¨put him on the path to medicine and propel him to set up a charity devoted to helping state school pupils become doctors.

Callum Cruickshank, whose eyes were opened to a rewarding career by a knee injury. Photograph: Toby Williams

Cruickshank couldn’t wait to get back into hospital after his ACL epiphany made him realise how big a difference he could make by becoming a medical professional.

The final year medical student, who is due to start work as a junior doctor in two months’ time, now finds himself providing a crucial lifeline to a profession reeling from crisis to crisis, leading one senior doctor to state that “general practice in Scotland is indeed on the precipice”.

A myriad of problems including an ageing population requiring more time with their doctor, and a system that continues to haemorrhage GPs, coupled with concerns over Brexit and ongoing calls to increase funding have conspired to make the profession far less attractive to the clever kids.

Throw in the recent cyber attack, which hit 11 of the country’s health boards and the Scottish Ambulance Service last week, and a picture emerges of a health service close to breaking point.

Key to Cruickshank’s thinking when he set up You Can Be A Doctor was a need to provide a pathway to medical school for less privileged state school pupils who feel that the profession is out of their reach. Cruickshank says that breaking into medicine is difficult and one of the most competitive higher education courses. He describes the application process as being “quite opaque” to navigate without help.

According to a Selecting for Excellence study carried out by the Medical School Council in 2013, while 7 per cent of children in the UK are educated in the independent sector, 31 per cent of trainees in year one of the foundation programme, which forms the bridge between medical school and general practice training, were identified as having attended an independent or fee-paying school.

The need to widen access to the medical schools programme to attract more pupils from a state school background is a view that is echoed by two of the country’s most senior practitioners. Dr Miles Mack, chair of the Royal College of General Practitioners (Scotland) and Dr Alan McDevitt, chair of the Scottish General Practitioners Committee at the BMA, both recognise the importance of recruiting GPs who can identify strongly with the local communities in the areas in which they practise.

This comes on the back of serious recruitment concerns, with a projected deficit of 828 GPs in Scotland by 2021 and calls for all political parties to guarantee protection for GPs in Scotland who came to the country from the European Union.

The predicted loss of what amounts to an additional 4 per cent of Scotland’s GP workforce could negatively impact on the wellbeing of over 226,000 people, according to the RCGP (Scotland).

A lack of medical professionals in key areas of secondary hospital care like psychiatry, anaesthetists and specialist doctors for A&E compounds the recruitment problems.

The RCGP (Scotland) is demanding the general practice service receives 11 per cent of NHS Scotland spending instead of the current 7.2 per cent allocated, which it describes as “clearly inadequate”.

Mack said: “We are seeing a serious shortage of GPs and this is going to have a serious impact on general practice and a huge knock-on effect to the wider NHS. We are very keen to see that reverse and everything done to boost GP numbers.

“We’ve got really clear evidence from the work we’ve been doing in rural areas that doctors do have a tendency to return to their place of residence before they went to university.

“So this is particularly important, that we manage to get doctors from Scotland into medical school and from the areas which are hard to doctor.

“The problems we’ve got with health inequalities in Scotland and the problems we’ve got with covering remote rural areas is the reason why we need to be able to widen access.

“People struggle to get into medical school from deprived areas because they may not have the access to some of the work experience and coaching that others will get and doctors in remote rural areas will struggle because they find it very difficult to get clinical experience. This is because of the small size of their own local community and worries around consent and confidentiality.”

At present one GP practice is now closing or returning its contract every month in Scotland, mainly because of staff shortages.

Another factor is creeping repair bills for Scotland’s doctors’ surgeries which can leave GPs with serious money worries. Long-term leases, some signed under Thatcher-era privatisation, are now coming to an end, with some surgeries in poor condition.

Despite this, optimism remains in some quarters that a move towards a new GP contract next year coupled with plans to shift certain tasks on to other professionals will free up more time for doctors to see patients who genuinely need their services – with the hope that it becomes easier to get an appointment.

McDevitt believes these steps could see an end to the exodus, and allow doctors to face the next big challenge, which is caring for an ageing population.

He said: “We are faced with not having enough GPs for quite some time, so that’s a challenge for us to maintain services to patients.

“Part of the way we’re doing that is by making sure GPs only see patients who need a doctor.

“So, if somebody else can do something you need – a pharmacist, or a nurse who could help with blood pressure or things like diabetes, for example – then you see them. If we know what people need and we can direct them to the right professional then if you really need a GP you’ll be able to see one.

“A lot of time the GP is sorting out medication issues and a pharmacist can do that in conjunction with the GP working in a team.

“There are things that GPs have just ended up doing, like repeat prescriptions in a practice. Once the doctor decided you needed this medication then every month or two months after it’s been prescribed a GP has to double check and countersign it.”

He added: “The other issue we have is that as the population gets older, we need to manage more things at home, particularly the elderly people approaching end of life, and if we’re planning to look after more people and more complex medical things at home we need to spend longer with those patients.”

The Scottish Government has responded to calls for action from beleaguered GPs by giving them an extra £71.6 million to be spent directly on general practice, including recruitment and retention.

Back at University of Edinburgh Medical School, and Cruickshank is posing for pictures among the medical simulation mannequins and the fake blood bags full of vegetable dye.

His passion for the job is evident and he considers his lifelong calling an “enormous privilege”.

The 23-year-old former North Berwick High School pupil, who wants to work in dementia care, spent two years employed in a local care home in Gullane before he came to study medicine.

He set up You Can Be A Doctor after receiving help from the Pathways to the Professions initiative run by Edinburgh University. The charity visits schools and runs events such as an introduction to anatomy, where pupils from 4th year and above get the experience of working in a laboratory setting.

At present those wanting to study medicine need to do biology and chemistry as well as either maths or physics, but Cruickshank says that realistically five As in Higher subjects is the target for anyone wishing to study medicine.

He said: “I think that it’s incredibly rewarding, and one of the most rewarding things is following people through from 4th year school pupils when they first come in to seeing them progress to making an application to medical school and coming to lots of our different events.

“Part of the problem that I identified was that there wasn’t anyone who was able to guide me. I had a careers adviser who was really helpful and pushed me towards medicine and made me really believe I could do it – but he didn’t know much about the application process.

“And nor did anyone I knew – so I found out more about it through Pathways to the Professions.

“That was one of the things that was so difficult – I just didn’t know how to go about it.

“If you go to a private school and your parents are doctors there’s already some experience of the process, so it’s a lot easier in terms of logistically making an application.

“That’s one of the aims of the website, to provide all the information you need to make an application in the one place – that’s what we think is so important, even in the depths of the Highlands. You can log on and get that information, aimed directly at Scottish state school pupils, so there’s no talk of GCSEs or A-levels, it’s all about the Highers that you need to be doing.”

Although facing up to life as a junior doctor and all that entails, Cruickshank appreciates the need for balance.

“Personally, I think it’s really important that you have friends both in medicine and outwith medicine. You need to understand where your patients are coming from and you need to have a social life that doesn’t revolve around being a doctor. But equally there are some things that only other medical students and doctors will understand and it’s important to have people you can rely on to deal with those situations as well. I think you absolutely need a mix.”

Mick Burns was Cruickshank’s Skills Development Scotland careers adviser during his time at North Berwick High School.

He said: “Callum is already a role model for the pupils of North Berwick High School, having returned since beginning his studies to talk about his experiences, and it’s exciting to see that he and his colleagues will now be reaching even more young people across Scotland through this website.

“Skills Development Scotland careers advisers work hard every day to open young people’s eyes to the possibilities and opportunities of their future. It’s great to see that message being echoed by Callum and this venture.”