According to the General Medical Council, 63% of doctors joining the medical register in 2022 qualified overseas. Is this a long-term solution to NHS pressures?

6 minute read

The current crisis in the NHS is rarely out of the news, and this week, the BBC reported on the continued reliance of the health service on doctors trained overseas.

With deep-rooted problems recruiting and retaining doctors, employing overseas doctors to plug the gap seems set to continue. But is recruiting from overseas a long-term solution? What criteria do overseas-trained doctors have to meet? And what is the government doing to recruit and retain more doctors?

What percentage of NHS doctors trained overseas?

According to a report by the General Medical Council (GMC), 63%, or just under two-thirds, of doctors joining the medical register in 2022 qualified overseas. The NHS currently employs doctors from 168 countries including India, Egypt, Ireland, Nigeria, and Pakistan.

 In addition, the report found that:

• The number of doctors joining the UK medical register has increased by 18% since 2018

• Since 2019, an average of two doctors join the workforce for every doctor that leaves

• The number of doctors leaving the profession increased last year, from 9,825 in 2021 to 11,319 in 2022

What qualifications do overseas-trained doctors need to practice in the UK?

All doctors that wish to practice medicine in the UK must register with the General Medical Council (GMC), and are subject to the GMC Fitness to Practise actions. They must also follow the GMC’s good medical practice guidance.

Registration with the GMC depends on a number of factors, including:

• The doctor’s nationality

• The country where they achieved their primary medical qualification

• The type of work they want to do

• Whether or not they have completed an internship or post-graduate training

In addition, international medical graduates (IMGs) must demonstrate their medical knowledge and skills and may have to show that they are competent in English before registration.

Why are numbers of overseas-trained doctors in the NHS so high?

The NHS has long had problems recruiting and retaining nursing and medical staff, and there are currently over 110,000 vacancies in the health service, increasing the workload and pressure on staff.

As of June this year, there were 10,855 vacancies for doctors in secondary care, which amounts to 7.2% of all medical posts — posts that are increasingly being filled by doctors from overseas. Without action, the number of vacancies in the NHS could rise to 360,000 by 2037.

The reason for the shortage of doctors in the UK is twofold; limited medical school places has led to a lack of new doctors graduating, and increasing numbers of doctors are leaving the NHS.

Limited medical school places

Medicine remains a popular career choice. Every year, tens of thousands of applicants compete for a limited 7,000 medical school places in England and around 1,900 places across the rest of the UK.

However the growing demand for doctors means that not enough doctors are being trained in the UK, resulting in the NHS recruiting from overseas.

Doctors leaving the NHS

Besides a lack of medical school places and new medical school graduates, UK-trained doctors are leaving the NHS in alarming numbers. According to a survey conducted by the BMJ, four out of 10 UK junior doctors plan to leave the NHS as soon as they find another job.

33% of those said they planned to work overseas, with Australia and New Zealand being the most popular choices, followed by the Middle East, Canada, and Europe.

Why are so many doctors leaving the NHS?

According to the BMJ survey, the top reasons junior doctors gave for wanting to leave the NHS were poor pay and working conditions.

Recent strikes by junior doctors have made headlines in the UK as junior doctors demand reforms, including:

• Reversing the steep decline in pay faced by junior doctors since 2008/2009

• Preventing any future declines against the cost of living and inflation

• Reforming the DDRB (Doctors’ and Dentists’ Review Body) process allowing pay increases to be recommended independently and fairly to safeguard the recruitment and retention of junior doctors

What is the government doing to recruit and retain doctors in the NHS?

In an attempt to recruit and retain more doctors in the NHS, the government recently unveiled a new “delayed workforce plan” to train more doctors and nurses and create thousands of new roles to work alongside them.

The plan includes:

• Doubling medical school places for student doctors to 15,000 a year

• A 50% increase in GP trainee places for junior doctors from 4,000 to 6,000

• 24,000 more nurse and midwife student places a year – almost double the current number

• Doubling training places for nursing associates to more than 10,000 by 2031 — a nursing associate is a new role that bridges the gap between healthcare assistants and nurses

• Increasing training places for physician associates to 10,000 by 2036 — a physician associate is a new role that will be created to help doctors diagnose and manage patients in both hospital and GP settings

The “delayed workforce plan”

Prime Minister Rishi Sunak said the plan would:

“Deliver the biggest ever expansion in the number of doctors and nurses that we train, and a plan to reform the NHS so we deliver better care in a changing world”.

But he admitted the plan will take time to have an effect on the NHS workforce, saying that it “won’t be quick or easy.”

A recent report by the GMC welcomed the doubling of medical school places but said that the effects would not be seen for a number of years due to the length of time it takes to train a doctor. It added that the UK must continue to recruit overseas doctors for the foreseeable future, and predicted that 14 years from now, 39% of UK doctors are likely to have qualified overseas.

Charlie Massey, Chief Executive of the GMC, said:

“Doctors from overseas bring skills and experience and are vital to the UK’s health services. There is already a lot of good work going on around induction and support, but the more we and our health services can collectively do to support doctors arriving in the UK, the better the chance of retaining their services for longer. They need to be welcomed, valued, and supported, and their expertise must be properly recognised.”

Concluding points

With a combination of underfunding, overwork, disputes about pay, job dissatisfaction, and burnout, doctors are leaving the NHS in droves. This is resulting in record numbers of vacancies that are being filled by overseas doctors.

The government’s new plan to recruit more staff is a step in the right direction, but its effects will not be seen for several years. The plan also fails to address two of the biggest reasons for doctors leaving the NHS; working conditions and pay.