The NHS must address why general practice is less attractive to UK graduates, said GMC, while revealing that the number of IMGs joining the GP workforce has almost tripled since 2018.
Over the same period to 2022, the number of UK graduates joining the GP register has fallen by 4%, according to the GMC’s annual workforce report, published today.
The report said that systems must tackle issues around workload and burnout in order to make a GP career more attractive.
The regulator also found through modelling that even with planned increases in domestic supply as per the NHS long term workforce plan, IMGs could still make around a third of all doctors in 2036.
The GMC’s figures revealed that in 2022, more than half (52%) of the doctors who joined their register were IMGs – the report therefore said it is ‘essential’ that health systems ‘improve the induction and integration’ of this cohort.
It said this work is ‘even more vital’ for training programmes with a high proportion of doctors who have qualified overseas – in general practice, the proportion of IMG trainees has risen from 23% in 2018 to 43% in 2022.
The report said the high numbers of IMGs in general practice training may also be ‘in tension’ with NHS England’s long term workforce plan which aimed to boost home-grown GPs.
GMC chief executive Charlie Massey said the ‘rapid growth’ in IMGs working in general practice is ‘extremely welcome’ given that demand on primary care which has ‘never been higher’.
But he warned that GPs ‘consistently report high workloads and higher risk of burnout than other register groups’.
‘Healthcare leaders must not only urgently address why general practice currently appears to be a less attractive option for UK graduates, but also ways to ensure it is a more rewarding career path for all doctors, no matter where they graduated,’ Mr Massey added.
The GMC highlighted general practice specifically when examining IMG intake, saying: ‘The UK’s healthcare systems must address why general practice appears to be less attractive to UK graduates, which will require efforts to resolve the persistent issues in workloads and other indicators of burnout that GPs report.’
Figures showed that there were 936 IMGs who joined the GP register in 2022 – a significant increase from the 321 who joined in 2018.
The report also said it was ‘notable’ that in 2022 the proportion of female GP trainees decreased by six percentage points, suggesting that this could be down to the increase in IMG doctors – a group which generally has a higher proportion of male doctors.
A key finding for the whole medical profession was that more doctors are taking time away after completing their foundation training, and the GMC argued that greater flexibility can benefit UK health services.
Their research found that taking time away to go abroad or take a break rarely meant they stopped working as a doctor altogether and did not convert to high numbers of doctors abandoning postgraduate training altogether. But this time away could provide benefits such as helping doctors to decide on their specialty or preventing them from suffering burnout.
- Based on current and planned increases to medical school places, there will be almost 48,000 more UK primary medical qualification (PMQ) doctors joining by 2036 than there would have been if numbers had stayed at the 2017/2018 level;
- Even in a scenario which accounts for planned increases to UK medical schools and extrapolating the workforce plan to all four UK nations – with those extra UK graduate replacing IMG joiners – 32% of doctors would be IMGs in 2036.
- Most IMGs in the 2022 specialty training cohort were in the general practice training programme (6,872, 46%).
- The ratio of headcount to FTE doctors is lower in primary care than in secondary care;
- For primary care, the ratio has decreased from 0.81 in September 2015 to 0.75 in April 2023 (an 8% decrease);
- Whereas in secondary care the ratio is 0.9.
- Ethnic diversity across the workforce is increasing – the number of Black or Black British doctors and Asian or Asian British doctors increased by 69% and 35% respectively between 2018 and 2022;
- The proportion of Black or Black British and Asian or Asian British GP trainees increased by around five percentage points, whereas the ethnicity profile across most other training programmes has not changed significantly.
- The proportion of doctors leaving the profession has returned to the pre-pandemic level of just under 4% – but an increasing proportion of doctors reported taking ‘hard steps’ towards leaving the profession.
In response to the new report, Emma Runswick, deputy chair of BMA council, said: ‘What’s clear from today’s General Medical Council report is that far more needs to be done to value and develop doctors and stop their exodus from UK practice.
‘Increased recruitment is heavily reliant on international medical graduates who accounted for more than half of all new joiners in 2022. International colleagues are highly valued in our workforce but when they continue to face systemic discrimination of the UK visa systems and local contracts, they often move again. That said, continuous recruitment of international medical graduates is not sustainable solution to the UK workforce crisis and we also have ethical concerns that reliance on them could cause serious shortages elsewhere; we must focus on developing and retaining our existing doctors.
‘More doctors than ever continue to leave UK practice, and a growing number are quitting because of dissatisfaction and the high risk of burnout. Others are taking longer periods away from training after working just two years post-graduation, with many citing their health and wellbeing as a common reason. Employers should look at offering these doctors an alternative career pathway, drawing on their skills with appropriate Specialty or Specialist contracts, but employers are often resistant to this approach. The Government must take the findings of this report seriously and implement a thorough workforce retention plan before our current staffing crisis reaches breaking point. The GMC itself acknowledges that the clock is ticking.’
Dr Rob Hendry, medical director at Medical Protection, said: ‘The GMC’s state of medical education and practice: workforce report 2023 highlights the need to urgently address why general practice appears to be a less attractive career path to UK graduates.
‘The GMC’s report found that the number of UK graduates becoming GPs has fallen by 4%, which the GMC attributes to the fact that GPs consistently report high workloads and higher risk of burnout than other register groups.
‘This finding aligns with separate research from Medical Protection this year, which found that burnout, exhaustion and staff shortages had taken an incredible toll on GPs, with more than half (52%) saying their mental health is worse now than it was during the pandemic.’
Sir Julian Hartley, chief executive of NHS Providers, said: ‘With more black and Asian doctors as well as more recruits from abroad in recent years, the increasing diversity of the NHS medical workforce is welcome.
‘Leaders of health services know, however, that there is always more to do to tackle inequalities and discrimination – a priority for trusts – in the workplace.’
Dr Sai Pillarisetti, chair of BIDA’s Postgraduate Doctors Forum, told Pulse: ‘The GMCs new workforce report illustrates perfectly how IMGs are not just a temporary phenomenon but are and will continue to be an integral part of the NHS machine – they form around 30% of the workforce and this is estimated to stay the same till at least 2036.
‘It is also very positive to see that more IMGs in LED roles are making their way into postgraduate training, with 39% from the 2018 cohort successfully making this shift. We look forward to seeing this number grow even more in years to come and are keen to work with the GMC and other stakeholders to support this progression however we can.
‘IMGs currently make up more than half of new doctors joining the GMC register every year. However, in surveys we are seeing more than half of these IMGs reporting discrimination and microagressions at work. If we want them to stay and continue to support the NHS this way, we must take tangible steps to address their concerns and improve their wellbeing at work. This will also ensure this large and influential part of our workforce do not feel alienated. For our patients to have the best care, doctors need to be at their best and making them feel safe and supported is critical.’
Last week, the GMC amended its guidance so that decision makers have ‘more flexibility’ to reconsider decisions to refer a case to a tribunal – these changes were made to ‘achieve targets to tackle areas of inequality that exist for doctors’.
A recent UK-wide survey by a medical defence organisation found that more than half of IMGs experience everyday instances of racism at work.