The UK risks wasting the talents of tens of thousands of overlooked and undervalued doctors, to the detriment of patient care, General Medical Council (GMC) Chief Executive Charlie Massey has warned in a new report.
The warning comes as new data in the medical regulator’s The state of medical education and practice in the UK: workforce report 20241 highlights the changing nature of the country’s medical workforce.
UK-wide, the overall headcount of doctors rose in the last year at the fastest rate since the report began over a decade ago. But one group has been growing much faster than others – locally employed (LE) doctors.
In England and Wales, the only places where specific data is currently available, the number of LE doctors grew by 75% between 2019 and 2023. By comparison, doctors on the specialist register grew by 13%, and those on the GP register grew by 9% over the same period.
LE doctors are employed on local terms by trusts and health boards, rather than employed in formal postgraduate training programmes. For some it’s a career choice, while for others it’s a necessity. In England and Wales alone there are at least 36,000 LE doctors, and more than two-thirds qualified outside the UK.
But, the regulator says, the roles are too often poorly defined with limited opportunities for career progression and training. And many are employed in short-term or non-permanent posts.
"Without changing the way we think about training, the UK risks sleepwalking into a situation where these doctors are overlooked and undervalued, to the detriment of good patient care,” said Charlie Massey, Chief Executive of the GMC.
He added: “Locally employed doctors have a lot to offer our health services. But too often they find themselves in roles without proper access to the education and training they need to develop their skills. Without changing the way we think about training, the UK risks sleepwalking into a situation where these doctors are overlooked and undervalued, to the detriment of good patient care.”
The report shows the growth in headcount marks an increase in doctors joining from abroad, principally India and Pakistan. Last year, more than two-thirds of new joiners came to the UK from abroad, compared to under half in 2017. For those joining from abroad, the GMC says ‘concerted, sustained efforts’ are needed to provide the inductions, integration, and inclusion vital for doctors to thrive in the UK.
Between 2016 and 2023, the number of doctors on the medical register from an ethnic minority background increased by 78%. Around one third of all doctors are now Asian or Asian British and, for the first time, the UK now has more doctors from ethnic minority backgrounds than white doctors.
The GMC warns the infrastructure to train and support doctors across the UK is already struggling to keep pace with growing numbers. Urgent action is needed to provide proper access to training for an increasingly diverse workforce. Doctors in GMC-approved training roles are also under pressure, and in need of greater support. Many report unsustainably high workloads, and up to one in four are at high risk of burnout.
Based on existing government commitments to expand medical school places, the GMC projects that by 2034 there will be more than 6,000 additional UK graduates entering the profession each year. The regulator says the number of trainers available must keep pace, and their time should be protected in upcoming job planning.
Mr Massey continued: “We now have the highest number of doctors registered since our report began. Equally, government commitments to increase medical school places are a much-needed boost to a workforce that has been under sustained and significant pressure.
“But for doctors to thrive and provide high quality patient care, training and development must be tailored to each group’s needs, whether that’s supporting a doctor to adjust to working life in the UK or helping a newly qualified doctor navigate a challenge faced on a shift. Opportunities for doctors to develop their skills, and prioritising support for the trainers and educators who help them do so, are key to job satisfaction and to the UK retaining its healthcare workforce.
“As we look to the next decade, it’s critical that all doctors have the infrastructure, support and resources they need to achieve their ambitions. That’s in their interests, but also the interests of a growing and ageing population, who have never needed their skills more.”
The GMC runs free workshops for doctors new to the UK,2 offering practical guidance on ethical scenarios and the chance to connect with other internationally-qualified doctors. Last year, more than 10,500 international medical graduates were able to attend a session, a 20% increase on the year before.
In 2025, the GMC will establish a new race equality forum to engage with organisations representing doctors from an ethnic minority background, to help shape its strategic focus and the delivery of its regulatory functions.
Responding to the report, Suzie Bailey, Director of Leadership and Organisational Development at The King’s Fund, said: “As patients still struggle to access appointments and with the waiting list for planned hospital care standing at 7.6 million, it is encouraging that the number of doctors on the register has been growing at the fastest speed in the past decade. It is also clear from this new data that hiring new doctors on its own is not enough, there needs to be adequate training and support in place, all of which can be in short supply in a stretched healthcare system.
“The reasons why the number of locally employed (LE) doctors in particular are increasing should be examined to understand why individuals may be choosing this career path. Reasons may include flexible working, potentially better choices around work-life balance, as well as avoiding yearly transfers between different hospitals that may involve moving to different areas. However, we know these doctors also experience racism, inadequate inductions, lack of recognition, poor access to training and career development.
“The report finds that more than two-thirds of new joiners came to the UK from abroad. The NHS would not be able to function without its international workforce, and the medical profession is more reliant than other staff groups on overseas recruits. Ethical international recruitment is essential to fill staff shortages in the short term given the time it takes to train staff. However, to provide the number of staff the NHS needs, greater investment in training and staff development will be needed, alongside improved retention rates.
“There are immediate actions the government can take to improve working conditions and therefore keep hold of the staff it already has. These include introducing minimum standards for facilities like staff access to food and water, supporting flexible working patterns, tackling race discrimination, bullying and unprofessional behaviours, introducing key indicators to measure staff wellbeing improvements and supporting the development of high-quality leaders in health and care.”
References
- The state of medical education and practice in the UK: workforce report 2024, accessed at: https://www.gmc-uk.org/-/media/documents/somep-workforce-report-2024-full-report_pdf-109169408.pdf
- Accessed at: https://www.gmc-uk.org/about/what-we-do-and-why/learning-and-support/workshops-for-doctors/welcome-to-uk-practice
