As the NHS faces the most challenging years in its history, our workforce report gives a clear warning of what lies ahead if the system does not act now to make the most of a changing medical workforce.
The data, gathered for The state of medical education and practice in the UK study we publish each year, reveal significant imbalances in the profession. But with that comes a real opportunity to make positive changes that will meet patients’ needs, enable more doctors to fulfil their potential, and keep highly skilled doctors in our health services for longer.
The research paints a stark picture. While the number of doctors joining the workforce overall has grown by around 17% over the last five years, that growth is not consistent. It varies considerably between different groups of doctors, leaving a shortfall in primary care that puts at risk patients’ ability to access GP services.
The number of specialty and associate specialty (SAS) and locally employed (LE) doctors on the GMC register has increased at six times the rate of GPs, largely driven by doctors coming from overseas. If the trend continues, by 2030 SAS and LE doctors in secondary care will form the largest group in the medical workforce.
SAS and LE doctors are a valuable asset: we are fortunate to have access to their knowledge and expertise. But the system does not always make the most of their talents. Supporting the varied career aspirations of SAS doctors, either by enabling them to progress further within their chosen specialties or by offering opportunities in different areas of the healthcare system, will be crucial to a sustainable medical workforce.
Many SAS doctors tell us they want better working environments, more support with career development and progression, and more flexibility in positions available to them – but instead, too many of them encounter barriers that hinder their development. Furthermore, rules actively prevent these doctors from working in areas like primary care, where we see the most significant workforce challenges.
We must make the most of the incredible pool of ability at our disposal in SAS and LE doctors. One way to start immediately would be for the government to change the Performers List criteria, to allow more doctors to work in general practice.
Lifting the barriers that prevent SAS doctors from working alongside GPs in complementary primary care roles would expand SAS doctors’ career options and provide new opportunities for those who want them. Importantly, it would also give GPs much-needed support, allowing them to focus on the areas of practice where their particular skills and specialist expertise are most in demand, to the benefit of health services, doctors and patients.
Significantly, our data also show a dramatic increase in international medical graduates (IMGs) practising in the UK. While the recent expansion in UK medical school places and postgraduate training is welcome, it is far outstripped by the growth in registrants from overseas: UK graduates joining the workforce rose by 2% from 2017, compared to a 121% rise in IMGs.
Our health services could not function without IMGs, but this reliance puts healthcare systems in a precarious position. Not only is the flow of IMGs into the workforce unpredictable, but our data also show that IMGs leave the UK workforce at a higher rate.
As a regulator, the GMC does everything within its power to maintain the flow of IMGs who help to keep health services afloat: over 10,000 joined the UK medical register last year alone. But employers must step up and look more closely at the reasons IMGs – and other doctors – are leaving UK practice.
Our research published in 2021, Completing the picture, shows that poor working environments have been a key factor in driving doctors away. Burnout, stress, lack of flexible working arrangements and poor organisational and team cultures were cited repeatedly by doctors across all groups as reasons for leaving the profession. The message is clear: we must address these issues urgently if we are to retain the doctors required to meet patients’ needs.
The solutions to these problems are within our grasp if the wider healthcare system – from training bodies to employers, and legislators to regulators – works together. Health services must make sure doctors, irrespective of background or identity, have the supportive workplaces they need. And doctors new to UK practice must get the high quality and consistent induction that they deserve if they are to be as productive as they can be and provide the best possible patient care.
For our part, we will continue to build equality and inclusion into our guidance, provide a supportive welcome for IMGs registering to practise in the UK, and set ambitious targets for fairer fitness to practise referrals and eliminate attainment gaps.
But we are only one part of a wider system. And every organisation in that system must take urgent action to improve the cultures and environments in which it expects doctors to work. Employers must also provide more structured support for their growing numbers of IMG doctors as they adjust to life and work in the UK, and to the complexities of our healthcare system.
Our health services would be mistaken to look at inclusion from a purely ethical viewpoint. Of course, it is the right thing to do, but we must recognise that it is also – like stress management and wellbeing – a crucial factor in productivity and workforce retention. By making it a priority, we can encourage much-needed doctors to remain in UK healthcare and make the most of their potential.
If we do not take tangible action to make support, inclusivity and fairness the norm, we will be doing a disservice not only to the doctors who want to work here, but also to the patients in need of their care.
We are lucky to have a diverse and growing workforce of highly skilled, talented and experienced doctors. It is only by nurturing and valuing that workforce that we will keep it.
