An exodus because of poor planning and the shape of the job. Deprofessionalisation….

The Times reports on the exodus of doctors without looking at the reasons they leave, either the profession or the country. It is certainly not the money….The is only the beginning of the Health Service Disaster… We are just not TRAINING ENOUGH..The Leading Article is reproduced below (with apology).. See “don’t become a GP ” from

Francis Elliott & Kat Lay report in The Times 24th Aug 2015: New doctors may be forced to work in NHS for two years

Times Analysis: Doctors already think that the health secretary is against them, and the latest proposals from Jeremy Hunt will do nothing to change that (writes Kat Lay).

One of the biggest clashes is over Mr Hunt’s desire to bring in weekend working for consultants. He argues that 6,000 patients die needlessly each year because of a lack of good seven-day services.

The NHS has been promised an extra £8 billion by 2020 but, according to Simon Stevens, the head of NHS England, it will also need to find another £22 billion in savings. Holding on to the 12 per cent of medical graduates who are no longer in the NHS two years after graduation would go some way to filling the gap.

The Leading Article opines that this is justified on specious grounds. NHSreality concurs but would like to point out the conflicts.

NHSreality asks:

Why is Medical Training and different to any other training (economics, geology, hairdressing) that is subsidised by the state? There are more medical graduates from many African countries in the UK than there are in their own countries but we have not taken a stance against poaching them. Is the cost the differential? If so what is the principal?

Why not take fewer women and undergraduates into medicine? We know that these are the groups with the highest drop out rates? Other countries insist on graduate (mature) training in medicine which seems to weed out the unmotivated. And why not train enough or a small surplus?

What about the Liberal Philosophies: The European Convention of Human Rights and the freedom of movement guarantee within the EU? Doesn’t Greece need doctors more than the UK? Why stop a doctor trained in the UK from going to another and more desperate EU country?

If this Conservative administration believes in “free markets” then what is their long-term philosophy – once they mend the manpower planning? Their knee jerk response is understandable..

The longer term issues of rationing by undercapacity and the politicisation of the UKs Health Services still need to be addressed.

The references to private practice are interesting. Younger doctors are not wanted except as lackeys in private practice as they don’t have the experience. But now many services are contracted out, and training suffers unless juniors are exposed to all aspects of a speciality. This AQP (or Any Qualified Provider) “privatisation” will come home to bite a future administration.

The right of passage whereby young doctors have worked for charities and abroad in other capacities for short periods needs to be fostered.

The reason behind the unhappiness in our profession is important and explained by Rosemary Stewart:

The shape of a job We are generally over-managed, and have fewer choices and less freedom than we used to. Some of us feel standards are falling, and lack of choice and systemic honesty leads to de-professionalization.

NHSreality concurs with the idea of requiring doctors to work in the Health Services, but it is a short term measure for an emergency, not a long term philosophy for a first world nation. It is circumstantial and knee-jerk..

The NHS may be widely envied, but too many of the doctors it helps to train are using the service’s kudos as a route to employment elsewhere. The service’s poor retention rate is exacerbating acute shortages in both hospitals and primary care, and a point of principle is being violated. It is time to compel doctors trained at the expense of British taxpayers to start their careers by taking care of them.

It takes a long time to train to be a doctor: typically five years at university followed by a two-year foundation programme. Many then train in a particular specialism. Medics have to fund the first four years of their training through normal student loans, but from the fifth year onwards tuition fees are paid by the NHS. Some future doctors are also eligible for a generous scheme of means-tested bursaries to cover maintenance costs. In all it costs £500,000 to train a GP and half as much again to train a consultant.

Despite the state’s support, one in nine new doctors is not working in the NHS two years after qualification. Some are lured by the quick financial fix of private practice; others take their skills to sunnier climes. The NHS, and particularly general practice and emergency care, can ill- afford to lose these doctors.

The number of unfilled GP posts has quadrupled over the past three years. The west of England requires 25 per cent more GPs by 2020 to keep up with demand. In 2013 only 20 per cent of medical students chose to work in general practice after their foundation training, despite a national target of 50 per cent by 2016. Little wonder, for there is a vicious cycle at work. As fewer doctors enter general practice, the burden on those who do becomes heavier, meaning that more abandon their field prematurely and still fewer decide to become a GP in the first place. There is a similarly dire shortage in emergency care, forcing the NHS to pay inflated fees to locums for single shifts.

It may not be surprising that the response of many young doctors to a GP and A&E system in crisis and a growing clamour for a seven-day service is to steer a wide berth. Yet a simple principle is being forgotten by those young doctors who choose to get out as soon as they can. The NHS has trained them, and funded much of that training. They have an obligation to work in the service long enough to repay that investment.

Moral entreaties may not, however, be sufficient. As a result, Jeremy Hunt is right to consider requiring newly qualified doctors to stay working in the NHS for at least two years. NHS management should applaud this move, and direct as many new doctors as it can towards general practice and emergency care. Even if some subsequently decide to emigrate, be it to Australia or Harley Street, it will do their CVs no harm for them to have had experience at the front line of one of the world’s largest healthcare providers.

Mr Hunt’s aims are commendable but they have met headwinds already and he can expect more from the British Medical Association. The doctors’ union has previously argued that the NHS is losing doctors because of rising workloads and a feeling of being undervalued. For older doctors, that may be true. By contrast, those who have only just qualified cannot blame frustration at a status quo they have barely experienced. The principle is simple. If the NHS pays for your training you cannot object to being asked to pay it back.


This entry was posted in A Personal View, Consultants, General Practitioners, Medical Education, Professionals, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s