• GMC finds UK is increasingly reliant on international doctors
  • Chief executive calls for UK to be better at “embracing the diversity of our workforce”
  • Despite improvements in shortage specialty numbers, the GMC is concerned about retention

Employers need to do more to support international doctors as the services become increasingly reliant on them, with more non-UK medical graduates joining the register than British-trained, the General Medical Council has told HSJ.

In an exclusive interview, GMC chief executive Charlie Massey said the NHS must think about how it embraces its increasing number of international recruits, as the way these doctors are supported was “inconsistent”.

He said: “In terms of the numbers it is quite startling how many more overseas doctors are coming to the UK. The fact that doctors from outside Europe have doubled over the last two years. We’ve had more doctors coming from outside the UK than coming from UK medical school. And that trend is just continuing.

“If the numbers continue to grow as they have done we would expect 19,500 in 2019 of whom 7,500 would come out of UK medical school, 2,000 from Europe and 10,000 international medical graduates.”

Mr Massey added: ”One thing I do worry about is doctors landing in UK practice face many more challenges in terms of landing well. We are inconsistent in the way we support those doctors.

“Many will end up in [specialist and associate specialist] or locally employed roles and that is a segment of our medical workforce that has felt less valued with less access to education and training than other doctors. We should celebrate the fact we have a diverse medical workforce but we are not as good as we should be when it comes to induction and support.

“We are trying to understand why is it we have such a disproportion of BME doctors referred into the process. Insider and outsider dynamics. I don’t think we are doing enough to support those doctors.”

He stressed this support was the responsibility of employers. 

Mr Massey’s comments come in wake of the GMC’s first report published specifically on workforce, which found a “dramatic increase” in international medical graduates and revealed the number joining the register doubled each year between 2017 and 2019.

For the first time it also identified more doctors were joining the workforce from outside the UK than were trained in British medical schools.

It indicates there are problems with the speed international graduates can join its GP or specialist register – allowing them to work in those areas – and called for “legislative reform to allow us to go further” in improving that. There are some legal requirements to get on these registers.

Mr Massey said: “There is a responsibility for all policy makers in the government and the NHS to understand the degree to which we are dependent on the diverse workforce.”

He added the GMC would welcome the expansion of medical training initiative places and any increase in medical places.

Worry about retention

The workforce report also highlighted concern about a high number of doctors leaving the medical register, particularly international doctors.

It said employers should value and plan for doctors working less than full-time and in flexible roles, rather than “the last resort when pressures become too much”.

“The key point for workforce planners is that politicians focus on how many new doctors or new nurses,” he said. “If we really want a sustainable workforce we need to retain the doctors we have got.”

He said the GMC was doing work to improve flexibility in training to make it easier for trainees to decide if they want to switch specialties.

He stressed the GMC had seen improvements in some shortage specialties. For example, the regulator found a 6 per cent rise in numbers on GP training programmes in the last year and a 2 per cent rise in doctors in psychiatry training following years of stagnation.

“We are worried about retention and we are worried that the way doctors are coping with pressure is to reduce hours, which loads more pressure on those who haven’t reduced their hours,” he said.

Mr Massey also warned of the increased numbers of doctors retiring from the NHS.

“More older doctors are leaving than ever – three times more doctors over 55 leaving than 20 years ago,” Mr Massey said. “Probably the issues around system pressures and workplace pressures are more impactful about driving those decisions.”

The report says the most common reason cited by doctors for deciding to work privately was the ability to offer better patient care, rather than financial reward. 

More generalists

The report also acknowledged a different mix of specialties is required for the future workforce, as meeting future patient demand requires more “expert generalists”, as well as more specialists. This was also emphasised in the NHS long-term plan.

However Mr Massey said it is a “complicated area” as the NHS needs more generalists and specialists.

“Part of the answer to that is, how we are thinking about the postgraduate curricular? One of the things we are doing in terms of flexibility is to create more common curriculum content.”