The changing shape of Northern Ireland’s medical workforce

Good morning and thank you for the opportunity to be here.

We're going to talk today about the picture of primary care in Northern Ireland, and what workforce trends mean for patients and the profession.

We'd also like to touch on the role of regulation, and the part we see the GMC playing in tackling the challenges facing the health system.

GP wellbeing in Northern Ireland

Amongst the most pressing concerns is the record demand for care.  

As GPs, you’re at the sharp end of this. And as practice closures and financial constraints compound pressures, it’s clear the system is experiencing substantial and sustained strain. 

We can see the impact of this in our own data.

Our latest report on workplace experiences shows that, compared to their peers in other specialties, GPs in Northern Ireland are at significantly higher risk of burnout.

This is perhaps not surprising when you consider that they are struggling with workload to a far greater degree.

80% of GPs in Northern Ireland found it difficult to provide sufficient patient care at least once a week, compared to 54% across other doctor groups. The vast majority of GPs in Northern Ireland – 92% – are also working beyond their rostered hours at least once a week, compared to 73% of doctors in the country overall.

Workforce trends in Northern Ireland  

A sustainable workforce is crucial to stabilising this fraught picture. But Northern Ireland – along with Scotland and Wales – is struggling to keep hold of its medical talent. 

This is particularly acute in the early part of doctors’ careers. Data we’ll publish shortly shows significant proportions of doctors leaving Northern Ireland after graduation to take up their first foundation posts elsewhere. 

While 81% of doctors who graduated in 2019 from English medical schools were still working in England in 2024, the figure in Northern Ireland was only 44%. 

Attracting talent to general practice is a particular issue across the UK. With lower-than-average homegrown applicants, we’ve instead seen significant numbers of international graduates take up training posts. In 2024, half of all first-year trainees in general practice qualified outside the UK. 

Across the workforce as a whole in Northern Ireland, we’ve also seen this trend replicated, with a 35% increase in the number of non-UK graduates between 2020-4.

The GP workforce in Northern Ireland, however, has bucked this trend. Currently, only 9% of GPs in Northern Ireland come from outside the UK. 
This, however, looks set to change.

While only 3% of first year GP trainees in Northern Ireland came from outside the UK 10 years ago, that proportion shot up to 45% in 2024. 

That suggests a significant shift is on the horizon, with Northern Ireland’s future GP leaders a much more diverse cohort than their predecessors. 

Whether or not they have long, fulfilling careers here depends in no small part on the reception they receive, and the degree to which they are made to feel they belong.

Doctors cannot perform at their best in circumstances where they are unsupported, unincluded and undermined. For all doctors, no matter their background, the workplace environment has a huge influence on the care they provide. For doctors new to Northern Ireland, it is absolutely decisive.

These are doctors who, while contending with the complexities of practising in a new country at a time of acute pressure, are also getting to grips with the basics of finding accommodation and setting up bank accounts. In short, people who are themselves in need of support.

So providing support and good induction is crucially important to protect the wellbeing and morale of the doctors we rely on to deliver care. But the point I really want to emphasise is that this isn’t just an ethical issue. It’s a patient safety issue too, as the workplace environment and support that doctors receive have a direct influence on the quality of care that they provide.

The role of doctors 

Having a compassionate workplace culture in place becomes all the more critical when the service is under severe pressure, as it is now. 

With more patients, who are sicker and in need of more complex care, the high stakes judgements we make as doctors are even more consequential and scrutinised. That upping of the ante can easily create tension.

Recognising this, we've published on our website resources on how to apply our guidance in times of high service demand.

And I know other health and social care organisations are looking at how to support good care and the wellbeing of staff during this difficult period.
Such interventions are welcome and important. But ultimately culture comes down to individuals, not initiatives

The way we as doctors conduct ourselves has a material impact on those around us – our patients, but also our colleagues. What we see, hear and experience every day fundamentally influences what we do and how we do it. 

Simply put, if you work in an atmosphere that feels hostile and closed, you are less likely to ask questions, raise issues or escalate concerns. So the task of fostering healthy workplace cultures starts with us.

It was this understanding that led us to recently formalise a bystander duty in the updated version of Good medical practice. This makes clear that if we, as doctors, witness unprofessional and pernicious behaviour, we have a responsibility to speak up.

Doing so is in our interests – in terms of promoting the sort of environments we want to work in – but also in the interests of the patients in our care.

The role of the GMC 

We at the GMC believe that we have a role to play here too.

Prevention is the first line of defence. And by tackling poor behaviour head on, we believe we can prevent issues from crystalising and thus reduce the number of cases that come to us.

This will allow us to spend more of our time and effort on the most serious cases, those that can’t be resolved at a local level.

One of the ways we're doing this is through our outreach teams. They operate across the UK, offering free training to put our standards and guidance into practice and providing support around ethical and professional challenges.

Through our Professional Behaviours and Patient Safety (PBPS) programme, for example, we’re giving doctors practical skills to promote healthy workplaces and challenge poor behaviour. 

This year, we also launched a workshop for GP trainers, amongst others, on how to give constructive and supportive feedback to colleagues. And we developed a workshop specifically for final year GP trainees, which focuses on how to tackle unprofessional behaviours.

Our aim is that these workshops help to minimise the chances of misconduct occurring at all. 

Induction is another key focus for us, and has grown in importance as the number of international doctors in the workforce has increased

Our 2019 Fair to refer research found that internationally qualified doctors were two and a half times more likely to be referred to the GMC by their employer than their UK-trained colleagues. By equipping these doctors with the knowledge and confidence they need to thrive in our health services, we believe we can reduce this disproportionality.

So we developed an induction workshop called Welcome to UK Practice, which we’ve been rolling out across the UK. In 2024, 66% of newly employed internationally qualified doctors in Northern Ireland attended one of these sessions, and we hope to reach even more doctors in the coming years.

Conclusion

General practice is under severe strain across the UK, and in Northern Ireland these challenges are particularly acute.

There’s no silver bullet that will resolve these issues overnight. But there are things that we – both profession and regulator – can do to improve the picture.

That starts with creating working environments that are conducive to good care – where all doctors, no matter their background, feel supported and included. That is vital for them and their wellbeing but, most importantly, the patients they treat. 

Thank you