As the health service faces growing pressures, is the NHS too dependent on foreign doctors?

Health leaders in the North East say they welcome highly-trained foreign doctors

Yui Mok/PA Wire An NHS logo
An NHS logo

Overseas doctors have played a key role in the NHS for many years as health services continue to face ever increasing pressures and demands.

A recent report by the General Medical Council highlighted that more doctors are coming to work in the United Kingdom from Europe than what has been the case before.

In the past, the largest source of overseas-trained doctors had been south Asia, but recently there has been a significant increase in doctors from southern Europe.

The North East has previously been highlighted as having a “recruitment and retention crisis” within general practice and it could be suggested that the role of foreign doctors is now crucial to help keep the region’s NHS afloat.

In an open letter sent exclusively to The Journal last year, leaders of the region’s Local Medical Committees (LMCs) said they were very worried about problems with GP numbers and the message must be “invest now or lose general practice”.

Surveys undertaken across Tyne and Wear by LMCs showed that 34% of practices in the area are having difficulty recruiting GPs while a staggering 71% of doctors are thinking about early retirement, with 36% of those in their 50s planning to leave their role in the next three to five years.

However, leading medics in the region insist that it is essential the NHS does not become dependant upon foreign doctors and more investment must go in to encouraging young people to join the profession.

Dr Ken Megson from North Shields
Dr Ken Megson from North Shields

Dr Ken Megson, executive of Newcastle and North Tyneside Local Medical Committee, said: “The NHS is heading fast for a workforce crisis, especially in general practice, and GP bodies have been active in raising this concern.

“However, as medical care becomes more complex it is essential that standards are maintained and whilst we welcome highly-trained foreign doctors we must aim to be self sufficient.

“Recognising a fall in GP numbers in the North East of about 9% over the last two years, the expected number to retire and the length of time to train GPs it seems highly likely that the number of foreign doctors will rise to fill the gaps.

“Some hospital specialities are also experiencing similar problems and the solution will take a number of years to solve but clearly we need to train and retain more doctors for the future of the NHS.”

The GMC report shows that an economic downturn in southern Europe and the expansion of the European Union in eastern Europe are likely to have fuelled a 19% increase in European Economic Area (EEA) trained doctors seeking to practise in the UK from 2010 to 2013.

For years the role of foreign doctors working in the NHS has been a hot topic of debate within the medical profession. A survey commissioned by the General Medical Council and carried out by University College London, found that around half of foreign medics would fail to reach the standards expected of British doctors.

The GMC believes that an increase in foreign doctors might have been caused partly by changes to immigration rules which have made it more difficult for doctors from outside Europe to work here.

Dr George Rae at his Whitley Bay surgery with a patient
Dr George Rae at his Whitley Bay surgery with a patient

Dr George Rae, chairman of the North East British Medical Association, said: “The recruitment and retention crisis is something the North East British Medical Association and regional Local Medical Committee have been warning about for quite a time now.

“Over the last three years we have only had about 70% of our training posts filled in general practice which is bad news for the North East. One bit of comfort is that though our region has a lower migration rate of doctors into the area, once they arrive we have less doctors leaving our region than other areas experience across the country.

“General practice is the foundation of the NHS and there can be absolutely no doubt now that, with the pressures GPs are under, we undoubtedly need a new deal for GPs.

“Over the next five years or so, with whatever government we have in position after May, the NHS must invest more in general practice, making it an attractive career proposition for younger doctors to enter and importantly remain in. Not least patients really deserve that.”

The population of EEA graduates grew by far more than that of UK graduates and international medical graduates (IMGs) over the three-year period. But EEA graduates were still only a tenth of all doctors in 2013, whereas IMGs represented a quarter.

The GMC report said: “Once, the main source of non-UK graduates was south Asia, particularly India, and to some extent the Middle East and Africa. Now, a third of the increase in non-UK graduates are from southern European countries.

“We do not know all the reasons for these changes but some are already clear - after changes to immigration rules in 2010 it became harder for international medical graduates to secure training and employment here.

“The data suggests that the economic downturn in the European Economic Area and the increased opportunity for EEA graduates in the new member states to work in the UK following enlargements in 2004 and 2007 are the main reasons for the increase in the proportion of EEA graduates working here.”

A stethoscope on top of patient's files
A stethoscope on top of patient's files

The report also found that a common theme among doctors working in primary care was feeling “overloaded” and “at risk of burning out”.

A Department of Health spokesperson said: “Doctors and nurses recruited from abroad make a valuable contribution to patient care, but they can only work in the NHS if they have the right language skills, knowledge and training. We take professional regulation extremely seriously.

“Individual NHS organisations are responsible for ensuring the people they employ or work with are properly qualified. Doctors and nurses from within the EU are able to work in the UK provided they have a qualification recognised by the General Medical Council or the Nursing and Midwifery Council.

“Those from outside the EU are required to demonstrate that they possess medical knowledge and skills of a high enough standard to ensure safe and effective practice in the UK.

“All applicants must produce evidence that they have the necessary knowledge of English to treat patients. This year, we legislated to allow the GMC to carry out language checks on practicing doctors for the first time.

“A lot of work is underway to boost recruitment and retention. Health Education England has identified four specialities where there are staff shortages and is working to fill them. In A&E, for example, over 200 new doctors will be employed this year following a recruitment drive. Patient safety is always the absolute priority.”

In the annual report it also showed that there has been a significant increase in the number of women becoming surgeons and specialists in emergency medicine. The profession as a whole could soon have equal numbers of men and women.

Niall Dickson, chief executive of the GMC, said: “The face of medicine is changing and it is important that those responsible for workforce planning understand the implications. Of particular concern are the potential shortages in some specialist areas where there are diminishing numbers of doctors in postgraduate training and large numbers over the age of 50.

“Recruitment in some parts of the UK, especially deprived areas and more remote communities, is also a significant challenge.

“The work being done by some of the medical royal colleges and others to boost recruitment and retention in some specialties is welcome and demonstrates that these issues can be tackled.

“For example, a concerted effort by the College of Emergency Medicine has helped to boost the number of emergency medicine practitioners joining the specialist register by a third between 2010 and 2013.

“It is notoriously difficult to predict future demand for doctors, but we do know that the needs of patients are changing, with many more living for years with long-term conditions. We know too that the next generation of professionals will have different expectations.

“We hope that this data from the GMC will help inform future decision making. The challenge for governments, educators and those who commission services must be to work together to make sure we have a medical workforce with the right skills and one which is adequately resourced, trained and supported to meet those needs.”


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