The NHS may be widely envied, but too many of the doctors it helps to train are using the service’s kudos as a route to employment elsewhere. The service’s poor retention rate is exacerbating acute shortages in both hospitals and primary care, and a point of principle is being violated. It is time to compel doctors trained at the expense of British taxpayers to start their careers by taking care of them.
It takes a long time to train to be a doctor: typically five years at university followed by a two-year foundation programme. Many then train in a particular specialism. Medics have to fund the first four years of their training through normal student loans, but from the fifth year onwards tuition fees are paid by the NHS. Some future doctors are also eligible for a generous scheme of means-tested bursaries to cover maintenance costs. In all it costs £500,000 to train a GP and half as much again to train a consultant.
Despite the state’s support, one in nine new doctors is not working in the NHS two years after qualification. Some are lured by the quick financial fix of private practice; others take their skills to sunnier climes. The NHS, and particularly general practice and emergency care, can ill- afford to lose these doctors.
The number of unfilled GP posts has quadrupled over the past three years. The west of England requires 25 per cent more GPs by 2020 to keep up with demand. In 2013 only 20 per cent of medical students chose to work in general practice after their foundation training, despite a national target of 50 per cent by 2016. Little wonder, for there is a vicious cycle at work. As fewer doctors enter general practice, the burden on those who do becomes heavier, meaning that more abandon their field prematurely and still fewer decide to become a GP in the first place. There is a similarly dire shortage in emergency care, forcing the NHS to pay inflated fees to locums for single shifts.
It may not be surprising that the response of many young doctors to a GP and A&E system in crisis and a growing clamour for a seven-day service is to steer a wide berth. Yet a simple principle is being forgotten by those young doctors who choose to get out as soon as they can. The NHS has trained them, and funded much of that training. They have an obligation to work in the service long enough to repay that investment.
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Moral entreaties may not, however, be sufficient. As a result, Jeremy Hunt is right to consider requiring newly qualified doctors to stay working in the NHS for at least two years. NHS management should applaud this move, and direct as many new doctors as it can towards general practice and emergency care. Even if some subsequently decide to emigrate, be it to Australia or Harley Street, it will do their CVs no harm for them to have had experience at the front line of one of the world’s largest healthcare providers.
Mr Hunt’s aims are commendable but they have met headwinds already and he can expect more from the British Medical Association. The doctors’ union has previously argued that the NHS is losing doctors because of rising workloads and a feeling of being undervalued. For older doctors, that may be true. By contrast, those who have only just qualified cannot blame frustration at a status quo they have barely experienced. The principle is simple. If the NHS pays for your training you cannot object to being asked to pay it back.