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08 Nov 2016

The British Government has been accused of a “stunning own goal” over its muddled plan to make the country self-sufficient in doctors by the middle of the next decade.

Just days before Prime Minister Theresa May told senior National Health Service officials there would not be any more money for public health services when the Government issues a financial update this month, Health Secretary Jeremy Hunt announced an extra 1500 home-grown doctors would be trained each year from 2018 in order to reduce the nation’s reliance on international medical graduates.

Under the plan, which the Government said would cost £100 million (A$160 million) in its first two years, doctors would be fined £220,000 (A$352,000) if they left the NHS before completing a minimum four years of service.

The goal is to make the country self-sufficient in doctors by 2025.

Mr Hunt outlined the plan as a response to concerns that a shortage of medical practitioners is contributing to overwork and poor morale among NHS doctors.

Ms May also portrayed it as a way to reduce the country’s reliance on practitioners from overseas to help fill workforce gaps – an issue with heightened implications given the UK’s decision to cut ties with the European Union.

But, coming against the backdrop of a bitter dispute over the Government’s attempts to impose new work contracts on junior doctors, the policy has been criticised by some as ham-fisted and ill-conceived.

Harrison Carter, co-Chair of the British Medical Association’s medical students committee, told The Lancet the initiative was poorly directed and failed to address the underlying problems afflicting the UK’s medical workforce.

“It’s a stunning own goal by the Secretary of State [for Health],” Mr Carter said. “[The Government] needs to deal with the underlying issues causing doctors to walk away from the NHS.”

A recent survey of 420 British doctors who have graduated in the past decade found that 42 per cent planned to practise overseas, because their experience of work was worse than they had expected. A further 16 per cent said they had “taken a break” from their medical career.

The results have underlined concerns that the bruising industrial battle over work contracts, which involved unprecedented strikes, has created significant ill-will and disillusionment among junior doctors, encouraging many to look elsewhere to develop their careers.

Dr John Zorbas, Chair of the AMA Council of Doctors in Training, told the Financial Times that there was strong interest among young UK doctors about working in Australia.

“When I speak to my overseas trained colleagues already working here, interest from UK doctors in training about working in Australia is high,” Dr Zorbas said. The AMA has written to the UK Government about the [NHS] dispute, which is no doubt impacting on the morale of doctor sin training in the UK. Unfortunately, it appears the Government’s agenda is more about an attack on working conditions than improving the quality of care for patients.”

Mr Carter said Mr Hunt’s plan to create extra training places and impose a four-year service requirement was no solution.

“This is not the way to address the crisis in morale in the profession,” he said. “What they will be faced with is doctors who are disillusioned, with low morale, and who will be bound to their job, not because of desire but because of an obligation.”

His concerns have been echoed by Royal College of Physicians Registrar, Andrew Goddard, who told The Lancet that although the extra training places was welcome, an extra 1500 graduates a year was not enough.

There is also dismay at the way the Government has sold its policy, particularly remarks by the Prime Minister regarding overseas trained doctors.

In an interview following the announcement, Ms May should doctors from overseas would stay “in the interim period until the further number of British doctors are able to be trained and come on board”.

While the PM later clarified her comments to say that overseas trained doctors did not have to leave, senior figures in the profession said the remarks were damaging.

“I think it is really dangerous to start thinking that all overseas doctors are about to go home,” Medical Schools Council Chief Executive Katie Petty-Saphon told The Lancet. “We really appreciate the work of overseas doctors…and the NHS would fall over without them. They are welcome here and they need to stay here.”

Mr Carter said the Prime Minister’s comment betrayed confused thinking within Government over the push to self-sufficiency in doctors.

He said if the goal was to train local doctors to take over roles currently filled by overseas trained practitioners as well as meeting the growing need for health care, the Government would need to train many more than just 1500 extra a year.

“There is no way that by 2025, with the 1500 who will come in [from] 2018, we will be anywhere near being self-sufficient,” Ms Petty-Saphon said.

Adrian Rollins

Published: 08 Nov 2016