The UK’s medical profession is at ‘a crunch point’ and will suffer increasing pressure over the next 20 years unless action is taken, the General Medical Council’s (GMC’s) State of Medical Education and Practice report warns today (19 December 2017).
The report, published annually, analyses data on the medical workforce across the UK. It identifies a raft of challenges facing the medical profession today against a backdrop of an increasing and older population, and highlights four priorities for the UK’s governments and agencies responsible for medical training and workforce planning.
It follows the launch of a consultation by Health Education England on future workforce provision for the health service.
Four ‘warning signs’ stand out in the report:
- Supply of new doctors into the UK’s medical workforce has failed to keep pace with changes in demand - the number of doctors on the medical register has grown by 2% since 2012, while in contrast A&E attendances and GP appointments have risen sharply. In England there has been a 27% increase in A&E attendances in that time, while Northern Ireland saw a 10% increase
- Dependence on non-UK qualified doctors has increased, ranging from 18% in the south-west to 43% in the east of England
- At the same time the UK is at risk of becoming a less attractive place for overseas doctors to work in
- Continuing pressure on doctors involved in training and a greater desire for more flexibility in how they work and train.
Charlie Massey, chief executive of the GMC, said: "We have reached a crucial moment - a crunch point - in the development of the UK’s medical workforce. The decisions that we make over the next five years will determine whether it can meet these extra demands.
"Each country needs to think carefully about how many doctors are needed, what expertise we need them to have so they can work as flexibly as possible, and where they should be located given the changes and movement in population expected.
"We are a professional regulator, not a workforce planning body, but we want to be an active partner in helping each country of the UK to address these priorities."
Although there is work under way to address these issues and pressure on doctors - an increase in medical school places in England, the growth of health and care associate roles, and drives to boost overseas recruitment - their impact will not register for some time and the GMC believes more needs to be done to meet the challenges on the horizon.
The report sets out four key priorities for workforce planning and how the GMC will work to support them in the years to come:
- Maintaining a healthy supply of good doctors into UK practice
- Helping the UK medical profession to evolve to meet the future needs of patients and healthcare
- Reducing the pressure and burden on doctors wherever possible
- Improving the culture of the workplace, making employment and training more supportive and flexible.
Charlie Massey added: "The underlying challenge for all in healthcare is how we retain the good doctors we have right now. Everything we hear from the profession tells us that we need to value them more; nurture cultures that are safe and supportive, and do what we can to help staff achieve the right balance between their professional and personal lives through more flexible working arrangements.
"The pressure on our health services shows no signs of letting up. It’s on all of us to understand why doctors are making different choices about their lives and careers."
Responding to the report,’ Professor Neena Modi, president of the Royal College of Paediatrics and Child Health (RCPCH) said: “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.”
Dr Pallavi Bradshaw, senior medicolegal adviser at the Medical Protection Society, added: “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.”
The full State of Medical Education and Practice report can be viewed at https://goo.gl/SbTYJY
