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GPs buried under trusts' workload dump

Newly trained doctors to be tied to NHS for four years, announces Hunt

Doctors will be required to work in the NHS for at least four years upon qualification as part of a £100m plan to make the NHS 'self sufficient' for doctor recruitment by the end of the next Parliament.

Health secretary Jeremy Hunt will unveil the new requirement alongside plans to expand medical school training places by a 'up to' a quarter by 2018, from a current cap set at just over 6,000 a year.

Speaking later today at the Conservative Party's annual conference, Mr Hunt will say that 'we need to prepare the NHS for the future' by 'doing something we have never done properly before: training enough doctors'.

He will say that this comes as currently a quarter of NHS doctors come from overseas.

The news comes as the Government is working towards recruiting 5,000 new GPs by 2020, but a Pulse analysis has suggested it will miss this target by more than half.

Mr Hunt will say his plans will make the NHS in England less reliant on doctors trained overseas and locums and ensure ‘all domestic students with the skills and capability’ to be a doctor have the chance to do so.

He will say: 'They do a fantastic job and we have been clear that we want EU nationals who are already here to be able to stay post-Brexit. But is it right to import doctors from poorer countries that need them whilst turning away bright home graduates desperate to study medicine?'

He will say that this is why he is announcing an expansion of training places, but that this will come with strings.

He will say: ‘From September 2018, we will train up to 1,500 more doctors every year, increasing the number of medical school places by up to a quarter. Of course it will take a number of years before those doctors qualify, but by the end of the next Parliament we will make the NHS self sufficient in doctors.

‘In order to ensure these reforms deliver for the taxpayer, the Government will also require for the first time that all those trained as doctors on the NHS will be required to work in the NHS for a minimum of four years after graduation.

'This mirrors the approach taken for those whose higher education was funded by the Armed Forces. It currently costs the taxpayer £220,000 to produce a graduate from medical school.'

The Government expects that expanding training will cost £100m by 2020/21 but that in the long run this will be offset by savings made from the locum bill which currently stands at £1.2bn a year.

Mr Hunt is also planning for international students in the UK to pay more towards their education and training.

Mr Hunt will says: 'Our medical schools have an outstanding international reputation, and these changes will in part be funded by charging international students for the totality of their training, including clinical placements which they do not currently pay for.'

It is not clear how the commitment to become self sufficient will be squared with NHS England’s commitment to recruit more GPs from international medical schools, revealed in NHS England board papers in July.

Pulse has reported as many as 600 European GPs are currently in the ‘pipeline’ to work in England, according to recruiters working with the NHS.

BMA chair Dr Mark Porter said the announcement 'falls far short of what is needed' and 'this initiative will not stop the NHS from needing to recruit overseas staff'.

He said: 'We know there are chronic staff shortages and rota gaps across the NHS, with major recruitment problems in areas such as emergency medicine and general practice.

'The Government must tackle the root causes of this workforce crisis and the reasons why so many UK-trained doctors are considering leaving the NHS rather than forcing doctors to stay in the health service. Demotivated, burnt-out doctors who don’t want to be in their jobs, will not be good for patients.”


Readers' comments (85)

  • @11:29 - broken link. You can't possibly think it's sensible to include their salary in the costs. You can't ever repay your 'debt to society' if you include salary as it's a never ending cycle - we might as well just work for free if we're going to play silly buggers and include that.

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  • Is he also planning to pay for the £9000 year university fees which the medical students have to pay? Didn't think so.

    And if not, then what moral grounds has he go to force the newly qualified doctors into a contract?!!

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  • Lets leave morale a side.

    If you are an A'level student, would you want to be tied to a job which can have contract imposed by the country at drop of a hat? And it's not even the best paid job compared to other profession.

    I certainly would not advice my daughter to go into medicine

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  • Medical families used to be the best advocates for studying medicine. Now all my medic friends and myself actively discourage our children to do the same. It is not a good or safe career anymore. I can see this changing in the next 10 years. Certainly with Hunt at the helm.

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  • You know, joe public do not have the faintest clue what is going to hit them in a few years! No NHS, medical tourism, private medicine (that is if there are any doctors left standing)......
    Jeremy is doing the most amazing job of destruction and once people do wake up, he will conventially have semi retired with a nice directorship in a private medical company and a gong.

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  • It is a Tory party headline. Will be Fish and Chip wrapper tomorrow
    There will be no new money, no new doctors and I suspect no binding of doctors to NHS, unless they do the same for ALL PAMS- They're too busy with BREXIT to do it

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  • I'm overwhelmed at the stout defence and utter rejection at this further attack the T&C of junior doctors by BMA this morning.

    Sorry, got 'over' and 'under' mixed up.

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  • I don't think I'd accept the reassurance that because doctors generally stay at least 4 years anyway, it's okay. If the principle were accepted, what's to prevent extensions to 5 years, 10 years or more +/- a ban on entering private practice?
    If the NHS wants to retain staff, it has to be like any other employer and offer acceptable terms and conditions. It's not that difficult, Mr Hunt - at least, it didn't used to be

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  • Dear Anonymous | GP registrar04 Oct 2016 9:07am

    You asked:

    "Has anybody ever seen a breakdown of the oft cited "£220,000" cost of producing a doctor?"

    Great question!

    I have corresponded with Lesley Curtis about this at PSSRU - which is funded by the government to look at these costs.

    Here is the latest set of data:

    The total is marginally higher than the costs quoted by the SoS at conference today.

    You can see that the "costs" include an element of tuition that is paid for by the students with a loan and then repaid to the taxpayer/student loanco anyway. (As you suspected) There is also a significant amount of £61,740 for living expenses/lost earning included in the total figure which are economic opportunity costs and NOT direct tax payer funded costs.

    The cost of clinical placement was surprisingly variable between universities and is supposed to be moving to a single tariff of around £33,000 per year. This only applies (pro rata) to clinical placements and the tariff for GP placements is usually lower. Tariff arrangements are set out here:

    It annoys me when people quote data that they do not understand. Politicians are notorious for doing this to meet their political aims

    But I have also heard HEE misquote this data to a Parliamentary Select Committee.

    It may be interesting for you to know that older versions of the PSSRU document had higher costs for GPs for Foundation Training than for consultants' foundation training!

    The figures for GPs and Consultants training costs assume UK undergraduate costs apply to all and do not allow for the costs of attrition. (That is the cost of the percentage that do not make it to consultant, which are significant percentages in some specialties.)

    All data is incorrect in some way. The experts in collecting data very rarely have any contextual understanding of the area that the data relates to.

    Great question though! I believe that the direct tax payer costs of UK undergraduate medical training that are not recovered through repayment of loans are much less than £200,000.

    Medical training is a common good. We need doctors and it is always better if they are trained doctors rather than untrained doctors!

    Some wastage and attrition is inevitable and we are net gainers from medical migration in both manpower and economic terms.

    There are many direct and indirect economic benefits to health services that discount the costs of training in other ways.

    I remember Don Berwick saying that the median health care spend in some US counties exceeds the median income! In an employer funded medical insurance system, medical insurance is a significant burden of employing someone.

    The NHS is a bargain for UK PLC and gives our employers/industry a competitive edge in a global economy, because approaching health as a common good means that per capita costs are reasonably low in return for a comprehensive, reasonable quality service.

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  • @1:52pm Thank you so much! That's a gem of a reply, I've been struggling to find anything useful. Really appreciated.

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