This study is seeking to establish the factors influencing foundation doctors' decision-making when applying for speciality training. A questionnaire was sent to all foundation doctors in Scotland (n = 1602, response rate 34%) asking them about their career intention in relation to General Practice, whether they received career advice and the extent to which certain factors influenced their career choice. For the majority of trainees, General Practice was not their first choice but just under half were considering it as a career. There were significant differences in career choices between the four Scottish regions and between the medical schools, with a greater proportion of those who studied in Aberdeen and Dundee Medical Schools opting for a career in General Practice. Undergraduate GP placement was reported as the strongest influence in favour of a career in General Practice followed by discussion with family and friends and discussion with speciality trainees. There were differences between medical schools in the way hospital placements, General Practice placements and role models influenced career choices. Career advice on General Practice was reported to be less available and more difficult to find.

We were able to demonstrate that the fCSA can be used to identify those trainees likely to fail the RCGP CSA. Contrary to reservations about the potential to demoralise trainees, the fCSA was viewed as a useful and a positive experience by both trainees and trainers. In addition, we suggest that feedback from fCSA was useful in triggering appropriate educational interventions. Early intervention with trainees who are predicted to fail the CSA has the potential to reduce deaneries overall fail rate. Preventing one trainee failure could save over £30 000.

Background Variation in general practice (GP) referral rates to outpatient services is well described however variance in rates of referral to acute medical units is lacking. Objective To investigate variance in GP referral rate for acute medical assessment and subsequent need for hospital admission. Methods A retrospective cohort study of acute medical referrals from 88 GPs in Lothian, Scotland between 2017 and 2020 was performed using practice population size, age, deprivation, care home residence, and distance from hospital as explanatory variables. Patient-level analysis of demography, deprivation, comorbidity, and acuity markers was subsequently performed on referred and clinically assessed acute medical patients (n = 42,424) to examine how practice referral behaviour reflects clinical need for inpatient hospital care. Results Variance in GP referral rates for acute medical assessment was high (2.53-fold variation 1st vs. 4th quartile) and incompletely explained by increasing age and deprivation (adjusted R2 0.67, P < 0.001) such that significant variance remained after correction for confounders (2.15-fold). Patients from the highest referring quartile were significantly less likely to require hospital admission than those from the third, second, or lowest referring quartiles (adjusted odds ratio 1.28 [1.21–1.36, P < 0.001]; 1.30 [1.23–1.37, P < 0.001]; 1.53 [1.42–1.65, P < 0.001]). Conclusions High variation in GP practice referral rate for acute medical assessment is incompletely explained by practice population socioeconomic factors and negatively associates with need for urgent inpatient care. Identifying modifiable factors influencing referral rate may provide opportunities to facilitate community-based care and reduce congestion on acute unscheduled care pathways.