Radical solutions are needed to meet the challenge of medical student placement capacity in primary care

The authors’ presentation of Must/Should (MoSCoW prioritisation tool) for making placements compulsory occurs in stark contrast with the perceived wisdom of examinations of the GP workforce crisis such as Jefferson and Holmes’s BJGP leader,¹ which highlights the importance of autonomy and the ability to assert control over one’s work environment for a profession in existential distress.

Imposing a compulsory diktat is liable to be counterproductive in accelerating a loss of GPs from the profession, adversely impacting on learning climate through introducing anxiety and eliciting psychological defence in many of the most vulnerable GPs, and potentially exposing our learners to significant risks. Those working to deliver primary care undergraduate placements will be familiar with the tensions created by the need to generate capacity while quality assuring placements safely. Any increase in undergraduate primary care capacity needs to be matched with the resources to manage the complications the intervention might provoke. I believe this is a ‘could’ proposal for that reason.

The authors highlight their proposal as radical but, in essence, it’s an expedient and first-order intervention to resolve tension created by an unrealistic ask. By contrast, the proven value of longitudinal contact in primary care, as highlighted by the authors, affords the opportunity to realise some efficiencies in intensity and process while rewarding teachers and students with enhanced experience. The challenge for educationalists is to revisit educational design and strategy, and create anew. We have educational research and know-how at our disposal to bring to bear on this essential redesign but the unrealistic nature of the task, asserted ironically on a background of the conspicuous long-term neglect of workforce planning, should implore us to prioritise sustainability over immediate gratification of want. I believe the challenge needs to be met within this context, not shared with the most distressed and vulnerable among our profession who might reasonably expect advocacy not imposition.