Dear Jeremy Hunt, do you know why many UK doctors want to work abroad?
Jeremy Hunt's latest announcement must be, for him, a welcome break. For once, he's not in the headlines for his handling (or mishandling) of the junior doctors' dispute. This time he was on firmer ground with the pledge that from 2018, 25% more medical students will be trained in the UK, with the aim of making us self-sufficient in doctors when we're out of the EU. Hurrah! Or not….
Because that's where the first problem comes in. From my reading of Theresa May's announcement, her promise of when she will invoke article 50 means we'll be out of the EU by March 2019 - 2 ½ years from now. The new increased intake will start just six months before that.
It takes five to six years to qualify as a doctor, at least five more years to become a GP and at least seven to nine more to become a consultant. That means that if all those medical students stay in the UK, we might have 25% more GPs in 13-14 years' time, and 25% more consultants in 15-16 years. That's a long time to wait for relief with an ever-ageing population and a profession on its knees.
Of course, implicit in his statement is the fact that this won't be an increase, but rather a replacement for the wonderful, hardworking overseas doctors who work here now. Currently, 77% of GPs and 58% of specialist doctors qualified in the UK. Of the rest, 30,000 are EU trained and 70,000 come from other parts of the world. Hunt says he wants the ones already here to stay, but adds, "Is it right to import doctors from poorer countries that need them?" Yet when he has been asked repeatedly in the past why he wouldn't increase training places, his position was always that doctor training places in the UK had already increased under his party's government - somehow I'm not convinced altruism is behind his rhetoric.
Then there's the question of how to make the new doctors he's planning to train will stay in the UK. I love my job and I love the NHS - but for many of my young (and not-so-young) colleagues, the grass is greener across the channel. UK general practice has long been held up as a model of excellence for countries across the world. But the rising bureaucracy, endless time spent hitting targets and the domino effect of ever-shorter supply of GPs putting increasing pressure on those who remain, has been devastating for recruitment. Hospital consultants can regularly earn much more for fewer hours by working abroad - and with so many countries speaking English and admiring UK medical training, their prospects are bright.
Between 2008 and 2014, an average of 2,852 certificates, which allow doctors to work abroad, were issued by the General Medical Council. Add to those 'certificates of good standing', which allow doctors to register with overseas employers, and we've lost at least 22,000 doctors in the eight years to 2014. Those figures don't include the impact of the junior doctors' dispute. After Jeremy Hunt's contract was confirmed last year, the GMC received almost 3,500 requests for certificates to practice overseas within just 10 days. As a GP and trainer of other GPs for the last 21 years, I'm not at all surprised by these numbers. One of the gripes with the new contract is that it penalises part-time doctors, mostly women, disproportionately - and general practice has a higher percentage of female doctors than any other branch of the profession.
Hunt is also proposing that doctors will have to work in the NHS for at least four years after they qualify if they have trained in the UK. The trouble is, while junior doctors work very hard, they aren't equipped to do nearly as much as their more senior colleagues, with years more experience. You wouldn't expect anything else. During this time senior doctors put much time and effort into supervising them and teaching them the skills they do need - so that in five or seven or nine years' time they can pass those skills on to others. If newly-qualified doctors stay for four years, while they're spending the highest proportion of their time being supervised, and then take off just when they're starting to gain the skills to practice more independently - you get the picture.
Of course, we can't blame Jeremy Hunt for years of under-doctoring (although some of my colleagues are loathe to let him off the hook for anything). When he came to the position of Secretary of State for Health in 2012, the UK was already lagging way behind other countries in terms of the average number of doctors per head of population.
We have a long way to go to catch up. Currently there are 2.8 doctors for every 1,000 people living in the UK. While this is indeed way up on the 2 per thousand we had in 2000, to match the OECD average that would have to increase to 3.4 per thousand. In fact, we have fewer doctors per head of population than any country in the EU apart from Republic of Ireland, Poland, Romania and Slovenia. With 150,000 doctors in the UK, we would need an extra 30,000 doctors even to meet the EU average; Hunt's 25% increase represents just 1,500 doctors a year, starting in seven years' time.
So is this good news? Of course any increase in doctors, for any of the reasons above, should be welcomed. But let's not for a moment imagine it's going to solve the problems of the NHS. And let's not even get started on the shortage of nurses.