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“We need to do everything we can to retain and value the doctors the NHS has”

RCP president, Professor Jane Dacre

The findings and the focus of this report by the GMC are encouraging. The efforts and recommendations echo much of our own work and come at a time when there is a renewed drive from organisations such as Health Education England and the GMC to improve the working conditions of the NHS workforce.

We share the reports concern about the low numbers of doctors in some specialties. Following our census, we are particularly concerned about geriatric medicine and acute internal medicine. The fact that our population is ageing rapidly, with individuals often having many complex diseases, there needs to be incentives to encourage many more of our physicians into these specialties, especially in parts of the UK where skilled medical professionals are particularly scarce.

While we agree that in the long term our reliance on doctors from overseas should be reduced, in the short term we do need to fill significant gaps in the workforce by making the UK attractive and accessible. That is why it is welcome to see the GMC’s support for the expansion of the Medical Training Initiative.

Finally, we agree with the report’s findings that doctors need protected time for learning and development, however, crucially, this should also include more time for research. We need to do everything we can to retain and value the doctors we have.

Danny Mortimer, chief executive of NHS Employers

This report provides more evidence of NHS services under increasing pressure.

We need to make sure the UK remains an attractive prospect for the brightest and best from the EEA and the rest of the world, as we know we won’t be able to fill gaps with domestic recruitment in the short to medium term.

The draft NHS Workforce Strategy is an opportunity  for the NHS to address some of the challenges facing our medical workforce including those identified by those responding to the GMC survey.

Dr Chaand Nagpaul, BMA council chair

We welcome the regulator’s recognition that the NHS is in the midst of a workforce crisis and that decisions made today will have a significant impact on what the health service and patient care will look like in 20 years’ time.

Today’s report reflects our own concerns – notably that the number of doctors has failed to keep up with demand, leaving the health service underprepared to meet current demands and manage a growing and ageing population suffering from increasingly complex conditions.

We know doctors are worried about their ability to provide safe patient care, so it’s important to see the regulator, whose responsibility it is to ensure patient safety, acknowledging the impact that staff shortages has on the delivery of safe, high-quality care.

As the research notes, the UK is reliant on doctors from abroad, and Brexit could compound difficulties recruiting and retaining these staff. Despite pledges from the government to protect European doctors already working in Britain, the tangible effect of the referendum result on the lives of EU nationals is beginning to become clear, with our own research showing that a fifth of EEA doctors have made solid plans to leave the country since last June.

The report shows that doctors are increasingly choosing to take breaks in training or in some cases leaving the profession all together, often due to heavy workloads, poor morale and burnout. It is vital that we address these issues to ensure medicine is seen to be an attractive and accessible career choice, and the solutions proposed by the GMC are a step in the right direction.”

Dr Pallavi Bradshaw, Senior Medicolegal Adviser at the Medical Protection Society

This report shows that the vast majority of GMC investigations are closed without further action, the end result being that over a thousand doctors go through a needless, stressful and slow process each year, while many complainants also end up disappointed with the outcome. While some improvements have been made in this area, the GMC must continue to improve the complaints triage process as a priority to avoid unnecessary investigations.

More fundamentally, the Medical Act needs to be reformed so the GMC are given more discretion to not take forward investigations in cases where the allegations clearly do not require action. Its current powers were framed over 30 years ago – when a very small number of complaints were received and the GMC could investigate each and every one. The GMC now receives over 8,000 complaints a year but very few of these come close to the threshold of serious concern that the GMC was set up to address.

The Government’s current consultation on health regulation reform offers the perfect opportunity to address the issue of why so many cases are able to proceed to a full investigation. We hope it results in reforms that create a fairer and more proportionate system that patients, healthcare professionals and the Government can have confidence in.

Professor Neena Modi, President of the Royal College of Paediatrics and Child Health

The RCPCH welcomes the publication by the GMC of the seventh annual report on the state of medical education and practice in the UK and the recognition within the report that doctors continue to provide exceptional care to patients.

It is true the UK population is growing, people are living longer and services are having to meet the ever increasing demands made by long term health conditions. But many of these conditions are preventable and effective child health services, and the promotion of good health in early life, are key to creating a healthier adult, no less child, population. It is therefore very disappointing that paediatrics, a specialty serving 25% of the UK population, is only briefly referred to within the GMC report.

Paediatricians always go the extra mile to provide safe care to infants, children and young people but paediatric rotas across the UK are only 82% filled and neonatal rotas are more critical at just 79%, so it is becoming increasingly hard to keep the speciality afloat.

Recruitment to paediatrics has become very difficult, not because it is not a rewarding, fulfilling career, but because the UK trainee workforce has become demoralised, frustrated, and fed up with the escalating pressures being placed upon health services. Between 2013 and 2016 there was a 27% fall in the number of foundation doctors planning to apply to paediatric specialty training and applicants for ST1 training in paediatrics fell from 800 in 2015 to 688 in 2017.

There has also been a 58% fall in the number of doctors from the EU applying to work in paediatrics between 2015 and 2017. The report from the GMC states the number of licenced paediatricians has increased by 16% (2012-2017), but less than full-time training is most popular in paediatrics where 20% of doctors report being less than full time; resulting in the number of whole time equivalent paediatric trainees  falling by 1%.  In addition workloads have increased as the number of in-patient admissions and emergency department attendances for children continues to grow.

Scotland has recognised paediatrics as a shortage speciality, but despite these stark facts, this is not the case elsewhere in the UK. This variation in national policy is inequitable, and we have repeatedly called for paediatrics to be placed on the national shortage occupation list.

The RCPCH is committed to training a paediatric medical workforce able to work flexibly with confidence across care boundaries and locations. We are delighted that, as mentioned in the report, the GMC have just approved our new curriculum which will ensure paediatricians acquire expertise to meet the needs of infants, children and young people in the 21st century. However the GMC report also clearly demonstrates that training, education and regulation are not enough. What is needed is a health service that cares for staff as well as patients, maintains an adequate workforce, and supports our dedicated doctors to give of their best.

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