The nature and prevalence of threats to medical student placement capacity in primary care: a survey of East of England GP practices

Background: GP practices deliver vital medical student teaching in the face of increasingly challenging circumstances. Aim: To understand the nature and scale of threats to medical student teaching capacity in primary care. Design & setting: An electronic survey of a predefined population of 120 East of England GP practices that host medical student placements. Method: The survey was completed on behalf of the practice by the GP lead for medical student teaching. They were asked to pick (from a list of 16) the four main challenges they faced delivering medical student teaching placements, then explain their selection and suggest solutions. Thematic analysis of free -text responses was undertaken from an activity theory perspective. Results: Responses were received from 114 of the 120 practices in the study population (95% response rate). The most commonly selected challenges to delivering placements were clinical/practice workload (picked by 92 practices), and lack of space in the practice (picked by 63 practices). Thematic analysis produced a model whereby a practice's decision to continue hosting students was influenced by level of motivation and burden of teaching, but only if a certain level of resource enablement is present. Analysis of free -text responses suggested that space pressures were perceived as being exacerbated by the need to accommodate more clinicians, especially advanced practitioners employed by primary care networks (PCNs) under the additional roles reimbursement scheme (ARRS). Conclusion: This study provides much-needed quantitative evidence to support the view that lack space in GP premises is a major threat to the future of undergraduate general practice.