The cap on medical training places should be scrapped and new funding arrangements introduced to incentivise doctors to commit their careers to the NHS, a report urges.
Despite a severe shortage of doctors in the NHS, medical school places are restricted by the government to just over 6,000 a year. This is exacerbated by many newly-trained doctors quickly leaving the NHS to work for agencies, private providers or overseas.
The report proposes scrapping the upfront public funding of medical training and instead requiring students to take out loans which would then be paid back by the government – to the same value as upfront funding is currently available – on the condition that doctors then work in the NHS.
Civitas healthcare researcher Edmund Stubbs says: “The only way to solve the current medical staffing crisis is to find a way to train more medics in this country. What we need is a far larger pool of medics from which we can produce a stable, permanent workforce.
“It is also imperative we ensure that doctors continue to work for the NHS after the UK taxpayer has made such a major investment in their training.”
In ‘Supplying the Demand for Doctors’, Stubbs suggests that instead of Health Education England (HEE) making upfront payments for the training of its medics (via bursaries, fifth year tuition fees and clinical placement fees), medical students should be required to take out a loan from the Student Loans Company to cover the total cost of their training.
The eradication of upfront payments by the NHS would mean the current cap on the number of doctors training each year could be lifted and the UK could train the number of doctors it needs.
This training loan would then be repaid on behalf of each medic by the NHS through HEE on condition that doctors work for the NHS after graduating. If graduates leave the country to work abroad or transfer from the NHS into the private sector they would become liable for the repayment of these loans.
The extent of staff shortages in the NHS is demonstrated by the increasing proportion of doctors employed by the NHS from overseas or through staffing agencies. Of the 23,544 doctors who applied to the GMC in 2014 to be registered as ‘fit to practise’, 15,201 were from the UK, 4,621 from the EU and 3,722 from non-EU countries.
The number of overseas doctors applying for GMC approval in 2014 (8,343) is higher than the total number of commissioned UK medical school places in the same year (6,071). Meanwhile, thousands of UK-trained doctors are leaving the UK to work abroad each year.
These shortages are set to worsen given the high number of retirements that are thought to be imminent and the expansion in the workforce that is needed in the coming years:
- About 13,500 consultants and GPs are set to retire in the next five years.
- The consultant and GP workforce must grow by around 9,400 posts between 2015 and 2019 to meet projected demand.
The failure of centralised workforce planning is illustrated by the fact that the NHS is using up to £12 million per year from its training budget for overseas students to study in the UK – who are free at the end of their course to leave the UK.
International students who study undergraduate medicine are given their placement fees (at £34,000 per year) – the same as any UK national student.
“The NHS, faced with a staffing crisis and serious under-funding cannot reasonably be expected to fund the training of medics who have no desire to work for the organisation,” Stubbs argues.
“Those medics who want to work in the private sector or abroad after qualifying might, in the light of the proposed scheme, be encouraged to consider undertaking their medical education overseas or even in the rapidly expanding private medical university sector.
“It is possible that some private or overseas healthcare employers might be prepared to repay student loans on behalf of their employees as an incentive to work for their enterprises.”
“The fact that we fully fund the placements of international students is alarming. The money saved from the NHS no longer paying clinical training placement fees on behalf of such students could fund the training of many more UK medics.”