This thesis explores access, experience, and outcomes from GP Higher Specialist Training (GPHST), the largest UK speciality training programme, among diverse groups through equalities lenses solely and intersectionally: age, sex, socioeconomic status, ethnicity, disability, religion, sexual orientation. Three
quantitative cohort studies are presented using UK Medical Education Database (UKMED) data relating to trainees who applied for GPHST on the national ORIEL application system over a three-quarter decade period (2013-2020) and who had lived in England when they applied to medical school (earliest date 2007)
with trainee-level longitudinal data relating to their socioeconomic, demographic, geographical and academic metrics from pre-undergraduate through to postgraduate education (from classroom to clinic).

Study one, which explored access to GPHST, found increased diversity in applications during the study period. Sole application to GPHST was more likely among white trainees, standard entry medicine (SEM) trainees, female trainees and trainees with a disability comparative to their counterparts. Trainees who
lived pre-medical school in the most deprived quintiles for IMD, LE, Indoor LE, Outdoor LE, Income, Employment and Crime deprivation were more likely to apply to GPHST in combination with other specialities comparative to trainees who lived pre-medical school in the least deprived quintiles and all
other quintiles. Direct application to GPHST was less likely among white trainees and those from most deprived quintiles for IMD, LE, indoor LE, Outdoor LE, Income, Employment, Health and Disability, Crime and Education comparative to the least deprived quintiles but not comparative to all other quintiles.
Trainees were more likely to be given an offer for a GPHST National Training Number if they were female and applied for SEM although there was no statistically significant difference in offers of a GPHST national training number by level 1 ethnicity. Decision tree analyses provide a nuanced understanding of
intersectional factors influencing access.

Study two, which explored experience during GPHST, found that observed variations in AKT and CSA performance through each of the equalities lenses were not inequitable (AKTGini and CSAGini <0.15). Multivariate analyses demonstrated that when modelling is adjusted for level 1 and level 2 ethnicity,
ethnicity is no longer a predictor of performance but rather socioeconomic factors emerge as predictors of performance in the AKT and CSA. The magnitude of the attainment gap increases during UG and PG training among trainees who lived pre-medical school in the most deprived quintiles for IMD, Income
Deprivation, Employment Deprivation, trainees who were on Income Support and free school meals. The magnitude of the attainment gap also increases during UG training among ethnic minorities, trainees who lived pre-medical school in the most deprived quintile for adult skills deprivation (v all other quintiles) and those with a religious belief although there were no changes in the attainment gap for these characteristics during PG training. The magnitude of CYP deprivation gap narrows during UG training but widens during PG training.

Study three, which investigated outcomes from GPHST, found that non-standard ARCP Outcomes were more likely among trainees who were male, black/mixed and those who lived pre-medical school in the most deprived quintile for Income deprivation v the least deprived quintile or all other quintiles. Trainees were less likely to complete CCT timely if they were: female, white, disabled or Christian. Trainees who were more likely to complete CCT timely included Asian and Indian trainees as well as those who lived pre-medical school in the most deprived quintiles for Income, Employment, Education, CYP and Adult Skills deprivation in comparison to the least deprived quintiles or all other quintiles.

This thesis offers significant insights into the extent of equity in the GP training pathway from end to end in cohorts over a three-quarter decade period. This thesis contributes significant knowledge to the literature and to practice across access, experience and outcomes from GPHST with implications for
informing policy and driving efforts towards a more equitable GP workforce that represents the diverse population it serves. Of particular significance, the introduction of Gini coefficients as a measure of the degree to which there is equity in educational attainment among diverse groups provides a novel
contribution to the field, offering a reproducible methodology across medical education.