Medical Education Capacity in General Practice in Scotland Working Group: interim report

2. Background

General Practice services in Scotland are operating within an increasingly complex system environment, characterised by an ageing population, rising multimorbidity, widening health inequalities and a continued policy shift toward delivering more care in community settings (1-4). These system pressures have direct implications for medical education capacity, as they influence the availability of time, space and supervisory resource required to support high-quality teaching and training.

Developing capability in medical generalism irrespective of doctors’ eventual career destinations is integral to the transformation of Scotland’s health and care system (5,6). Exposure to the principles of generalism equips all future doctors to deliver coordinated, person-centred, and sustainable care, balancing clinical breadth with continuity and system efficiency (7). Training the next generation of GPs remains central to achieving national ambitions for accessible, high-quality care as set out in the Service Renewal Framework (8). The Scottish Government’s ten-year commitment to increase the number of GPs by 800 by 2027 remains a key strategic driver. Since 2017, GP numbers have increased by 526, bringing the total to 5,423 as of September 2025 (including GP Registrars in practices) and whole-time equivalent (WTE) GP numbers of 3,657.1 (excluding GP Registrars), an increase of 3.7% between 2024 and 2025, the first substantive increase in several years (9). In October this year, the Scottish Government and British Medical Association (BMA) announced a £531 million investment over three years to support workforce growth and service sustainability (10).

Despite this progress, educational capacity in General Practice is constrained by a range of factors including workforce challenges, physical space, and time available for teaching. A structural distinction between primary and secondary care is relevant: while hospital staff are predominantly employed by Health Boards, the majority of General Practices operate as independent contractors. Consequently, Boards do not have direct levers to mandate educational participation or infrastructure within primary care settings. Engagement in training is voluntary and dependent on contractual opt-in, making it essential to understand the factors that enable or inhibit practices from hosting learners.

Meeting current and future medical education demand requires a coordinated, whole-system approach. This includes aligning workforce supply, infrastructure planning, educational funding mechanisms and service delivery pressures (11-13). It also requires recognition that pressures within General Practice directly affect the capacity to provide the stable, high-quality learning environments necessary to train Scotland’s future workforce. These challenges are consistent with trends observed across the UK and internationally (14-18).

2.1 Drivers impacting Scottish General Practice training capacity

Growth in demand for General Practice training capacity

Scotland is training more learners in General Practice than ever before, therefore increasing the demand on General Practice training capacity. Medical school intakes have expanded, with a greater emphasis on learning in primary care; the number of Foundation doctors is rising alongside a national expectation that a larger proportion undertake General Practice placements; and General Practice Specialty Training (GPST) numbers continue to grow. Collectively, these trends strengthen the future workforce pipeline but also substantially increase demand for General Practice placements, supervision and educational infrastructure.

Within GPST, recent NHS Education for Scotland (NES) data shows that Scotland has approximately 1250 GP Registrars^[1], (excluding those who are out of programme), with 100 additional GPST posts introduced since 2023 and fill rates having improved from 74% in 2017 to 99% in 2024 (19). A significant proportion of the current GPST cohort are International Medical Graduates (IMGs), now accounting for over one-third of GP Registrars. IMGs make a vital contribution to Scotland’s workforce and bring valuable clinical and cultural experience; however, some may require enhanced support during the early stages of training or when transitioning to new healthcare environments (20,21). This can increase supervisory intensity and has implications for both practice-level and Board-level education capacity.

Since 2017, more than 5,000 additional WTE staff have been employed by Boards in multidisciplinary team (MDT) roles across primary care, including pharmacists, physiotherapists, mental health practitioners, and Health Care Assistants. The MDT contributes positively to patient care and interdisciplinary collaboration (22,23). There are however challenges in coordination of space within practices, and coordination and supervisory responsibilities for GPs, increasing the demand for training and supervisory capacity (24). While a detailed analysis of MDT training requirements is beyond the scope of this report, it is important to recognise their growing influence on the learning environment within practices.

Challenges to the supply of General Practice training capacity

Against the growing demand, there are challenges to the supply of General Practice training capacity. Rising service pressures, driven by an ageing population, multimorbidity, increasing clinical complexity, and expanding administrative and organisational tasks, directly affect the time and energy practices can devote to education. These pressures are well-documented and continue to shape the daily working environment of General Practice (4, 25-30).

Workforce growth also remains a challenge (31,32). Sustained increases in GP numbers are essential not only for patient care but for ensuring a stable foundation for supervision and educational capacity across the training pipeline. The expansion of Less Than Full Time (LTFT) working impacts educational capacity through both supply and demand factors. On the supply side, higher rates of LTFT working among established GPs reduces the number of contracted sessions available for supervision and educational activities. This is compounded by 'hidden' workload; RCGP data (2024) from England indicates that while LTFT GPs are contracted for an average of 28.4 hours, they typically work 39.5 hours, leaving limited scope to absorb additional educational responsibilities (30,33-37)

These factors form the context in which medical education is delivered. They directly influence the time, space and supervisory resource available for teaching in General Practice (38,39). Understanding these dynamics is essential, as medical education capacity cannot be expanded or sustained independently of the wider workforce and service environment. Continued partnership across NES, universities, Health Boards, the Scottish Government and the profession will be critical to translating this understanding into sustainable capacity growth.