The NHS is falling back on its constant saviour to solve the GP recruitment crisis – importing more doctors – with talk of giving private recruitment firms £100m to bring in 2,000 GPs.
The NHS has always sustained itself on medical migration when the going gets tough, but the relationship that we have with international medical graduates (IMGs) fluctuates from seeing them as saviours to, at times, ‘pariahs’ – with duplicitous undertones of IMGs providing poor quality care.
It won’t have escaped the attention of IMGs that if they come for GP training in the UK then currently they will be at least 12 times more likely to fail the final qualifying examination of the RCGP when compared to their white colleagues. It does not seem fair that we recruit IMGs for a short-term fix and discard them when we no longer need them.
So if we want the international GP recruitment drive to succeed, we need to tackle this problem head on. Currently 800 doctors have completed GP training but did not complete the final accrediting exam (MRCGP). They are still working in the NHS as associate specialists, A&E doctors and in other clinical specialities. Just because they did not complete the final GP examination does not mean that they are unsafe doctors or can’t be good GPs.
They may need longer in training and further supervision. The feature that defines these doctors is that they want to be GPs. Bring these doctors back as associates in general practice, working under supervision, and give them five years to gain accreditation through an alternative route. These exist (for example the Membership by Assessment of Performance run by the RCGP). Most practices could easily accommodate and support this group of doctors as they reboot their careers in general practice.
But paying private consultants large sums of money to recruit GPs does not address the reasons for the shortage of GPs. We, as GPs, are probably the best recruiters for our own specialty and we need to sing the praises of the exciting opportunities that general practice offers as a career.
We need to consider other measures – but big ideas are sadly lacking. While NHS England wants to turn on the tap of international recruitment to solve a crisis of its own making, the RCGP fares little better – simply demanding that more should be done, without suggesting a single credible policy initiative. Yes, we need more money and more GPs – but how are we going to get that?
I, therefore, would like to see the following measures:
1. Reconfigure GP training so that it all takes place in general practice – a suggestion recently made by Dr Sam Everington. General practice as a speciality is general medicine writ large. Increasingly the training that junior doctors receive in hospital medicine is totally unsuited to the needs and demands of general practice. This does not mean that future GPs do not need exposure to hospital based clinical specialities but they need to do this through the medium of general practice.
2. Give a golden handshake to newly qualified doctors who commit to training as GPs (for example a student loan write-off after five years working in general practice) would act as a huge incentive.
3. Make sure that the extra medical school places that the Government has funded in universities are contingent on students electing to choose GP as career. There is currently a huge variation in the percentage of graduates who choose general practice as a career depending on the medical school they have attended. For example, over 25% of Keele graduates choose general practice as a career, compared with just 8% of Manchester graduates. This may reflect the curriculum, or the positive support that graduates receive in considering general practice as a career. Clearly it makes more sense to fund more places in Keele rather than Manchester if the aim is to increase the number of graduates who become GPs.
Treated with the respect they deserve, international GPs will have a part to play in solving the GP recruitment crisis. But this will only be part of the solution.
Professor Aneez Esmail is professor of general practice at the University of Manchester