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The NHS needs to train and retain more doctors

Edmund Stubbs, 2 June 2016

The NHS needs more doctors. Each year the General Medical Council (GMC) registers 23,544 doctors as being fit to practise. It is a telling statistic that while over 8,000 of these newly registering doctors come from abroad annually, British universities train as few as 6,000 new medics. This number reflects a limit imposed by the Department of Health on medical students to prevent what Health Education England (HEE) describes as the risk of producing a surplus of ‘highly skilled unemployed people’.

In reality however, under the present training system, the NHS makes large upfront payments in placement fees for its undergraduate medics, a sum which amounts to £798 million per year, and this is probably the main reason for the limitation on training numbers. At present this expenditure stands whether or not trained doctors choose to remain within the NHS.

To modify this situation and consequently allow for increased numbers of trainees who will remain committed to the NHS, I suggest, in a Civitas report released today, that loans could be taken out by medical students to cover the costs of their placement fees. This would relieve the NHS from the upfront responsibility of funding training costs and thus allow it to lift the restriction on training numbers in the UK.

Importantly however, this proposed loan for placement fees (to the value of a little over £130,000) would be repaid by the NHS on each doctor’s behalf, at a rate of around £4,700 per year, provided that they remain within the NHS organisation over the term of the loan. If doctors chose to leave the service to work abroad or in the private sector then they would have to cover the loan repayments themselves, thus reimbursing the considerable cost of their medical education to the State.

This seems a fair way of encouraging doctors to remain within the NHS and of protecting the service’s investment in them. The NHS cannot reasonably be expected to pay such large sums for the training of medics who have no desire to stay working for it after graduation. NHS trained doctors who choose to work in the independent sector might find that their new employers were willing to repay their training fee loans on their behalf as an incentive. In such circumstances it would mean that the private sector would be financing the training of the medics from which it benefits.

The report proposes a means whereby the NHS might become less reliant on recruiting doctors from abroad, often sorely needed and trained at great expense by their home countries. It would also ensure that more UK-trained doctors would choose to remain as direct employees of the NHS rather than being employed by agencies who re-sell their labour to the NHS at greatly increased rates.

In short, were the Civitas report’s proposals to be adopted, the NHS  would benefit from a more stable medical workforce composed of doctors who, after being trained within the system for many years, become familiar with its mode of operation and would be encouraged to remain with the NHS for the entirety of their careers.

Edmund Stubbs is Healthcare Researcher at Civitas

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