Migration and the medical workforce

Charlie Massey's speech to the NHS Providers conference in Liverpool, 16 November 2022

Last year, nearly 10,000 doctors gave up their licence to practise. This represents a huge loss – to their employers, their colleagues and most importantly their patients.

So why are so many medics leaving?

For some, it’s the pull of new opportunities and adventure abroad. Medicine is an internationally mobile profession and we would naturally expect some movement.

But there’s more to it than that.

New GMC data show that poor working conditions and wellbeing issues are pushing practitioners out. Indeed, the research found that overwork and poor work-life balance were a factor in almost all migration decisions.

That means that doctors, who may otherwise have had long careers in this country, are voting with their feet. And it’s draining the system of talent it can precious afford to lose.

Our data paint a picture of these doctors and some of the concerns that are driving them out of the service.

While many doctors mentioned burnout, this was a particularly pronounced issue for many GPs. Strikingly, most respondents in this group had trained in the UK and initially had no intention to permanently migrate. It was their working conditions, and the impact on their wellbeing, that propelled them to leave.

The research also profiles ‘disillusioned doctors’, mostly UK-trained medics in their mid to late career. Frustrated with the health system, they cite the desire for a better work/life balance as a key trigger for leaving.

And then there are SAS and LE doctors who feel their careers are being curtailed. Confronted with barriers that prevent their progression, this group seek recognition and see more opportunity for achieving that abroad.

What this research tells us is that many doctors are not leaving UK practice because they’ve fallen out of love with medicine. Instead it’s because they can’t tolerate the environments in which it’s practised. The problem is not their work, it’s their workplace.

This is a senseless waste of talent, not least because these issues are preventable. With a focus on compassionate, supportive cultures, they can be put right. This will not only improve doctors’ wellbeing, but also their productivity. Happier workers are better workers, and they deliver better results.

Getting culture right has become even more critical as the composition of the medical workforce has changed.

Our data show that the number of IMGs has increased by 40% in the last five years. This is leading to a more diverse workforce, not only in demography but also in role – with the proportion in SAS and LE grades growing fast. If we want these doctors to flourish, and grow their careers here in the UK, we must make inclusive, caring environments a priority.

We all have a part to play in this. But there’s a particular job for employers in constructing roles that make the most of their talents and allow them to grow their skills. Reforming the rules that prevent them from working in primary care is a good place to start.

There is a practical imperative here – to keep doctors in the workforce. But also a moral one – to make doctors’ working lives better. Because confident, contented doctors deliver better care.

Wellbeing issues compromise patient outcomes. Doctors who feel isolated and unsupported don’t perform as well as those who feel included and fulfilled.

And everyone – from patients to employers to the doctors themselves – suffers as a result.

We all agree that there’s a workforce crisis in the health service. And the longer it persists, the greater the damage. There is no cavalry coming over the hill. The next few years will arguably be the hardest the NHS has ever faced, harder even than the pandemic. Resolving the issues that brought us here will therefore require huge resolve and commitment.

Many of the solutions are outside of our control. But it is not right to say we have no role to play in what happens next. There are more than 350,000 doctors on our register. Think what a difference it would make if every one of them stayed in UK practice even 6 months longer. The benefits would be vast.

So it’s time for all of us to roll up our sleeves. Watching our health services haemorrhage talent is not an option. We simply don’t have the luxury of being defeatist.

To manage the rocky road ahead, we need to get culture right. If we do that, then we can get into more of a virtuous cycle, enabling us to retain more doctors and improve patient care.

I look forward to working with you to do just that.