Brexit Exposes the Government’s Failure to Train Specialist NHS Doctors
Ellie Newis digs into the post-Brexit recruitment and retention crisis in the NHS
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The Government has decided to hold firm on a 7,500 cap on medical school places – even with NHS staff shortages causing delays and disruption across the UK. But even if this cap was lifted, it wouldn’t aid an ailing NHS that lacks an adequate provision of trainee doctor places, hindered significantly by the UK’s departure from the EU.
The longstanding under-funding of the NHS by the Conservative Party has led to junior doctors’ pay falling in real terms by 25% since 2008/09, accompanied by the under-provision of speciality training places for doctors across most fields.
Before Brexit, the Government relied on doctors from EU/European Free Trade Association (EFTA) countries coming to the UK, making use of the foresight of other nations that train sufficient numbers of doctors.
Brexit has exposed this lack of planning, inflicting yet another problem on an already stretched health service.
While Vote Leave promised an extra £350 million a week for the NHS, official figures from September showed the NHS overall vacancy rate to be at a five-year high of 9.7% (about 133,400 vacancies), with a nursing vacancy rate of 11.9%. Roughly one in six (16%) of NHS hospital and community staff are of non-British nationality.
There has been a steady decrease since 2010 in the number of junior doctors progressing directly from their foundation ‘F2’ year into specialist training posts – a decline that correlates with the Conservative Party’s tenure in office.
In 2019, only 35% of F2 graduates had taken up a speciality training post in the UK the year after their foundation studies, according to data from Health Education England (HEE). This is down from 71.4% in 2011.
Some HEE data shows that 90% of these people find a post in the NHS within three years, but this still delays the qualification of specialists when it takes most doctors up to 10 years to reach consultant level.
Dr Ayan Basu, a committee member of Doctors’ Association UK, told Byline Times: “Recent political calls to ‘train more doctors’, are not enough. We need to ‘train more specialty doctors’. Enabling greater numbers to develop into specialty doctors means more training posts, which requires sufficient funding.”
Dr Basu also referenced the bottleneck in progressing from F2 to specialist training, saying “specialty entry ratios are growing steeper”.
He added that “due to fewer posts” being available, “UK-qualified and UK-trained doctors leave the UK to broaden their outlook in Australia, New Zealand, or Canada, citing better pay and work conditions”.
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The issue of retention at the F2 stage has many factors, but a combination of too few trainee places and poor working conditions has led to a stark lack of staff.
The data from HEE shows that, in 2019, 22.8% of those who did not obtain an NHS training post after their F2 year were working in ‘service appointments’ in the NHS, which are non-training doctor posts. In 2011, only 2.3% of F2 graduates were in a non-training post, marking an increase of more than 800% by 2019.
Non-trainee doctors perform the same labour as a trainee, but without the educational progression that allows them to move forward in their careers – and become the GPs and specialist consultants that the NHS so needs.
While non-training posts can be beneficial for those who wish to choose their location (as opposed to the postcode lottery of NHS job applications), or for those who are taking a break in their career, these posts are not adequately preparing our NHS for the future – or indeed allowing it to meet people’s needs in the present.
What’s more, these individuals are not able to access the support, teaching sessions, study leave and study budgets that their trainee counterparts have access to.
As well as non-trainee posts, some junior doctors work in locum posts. Again, they receive no training, but they can gain experience in a preferred field. Locum roles are better paid than NHS ones because locum doctors are employed by agencies, meaning that many health workers go into locum work as the only way of increasing their pay to a liveable standard. All the while, the Government continues to reject an inflation-level wage increase for NHS nurses.
The Post-Brexit World
Many non-trainee doctor positions have historically been taken up by doctors from other countries, mostly notably the EU/EFTA, for whom obtaining a consultant title in the UK can require too much money or time.
In cardio-thoracic surgery, the number of EU/EFTA doctors has tripled in the past 15 years and, since 2014, there have been more cardio-thoracic surgeons trained in these countries working in Britain than UK-trained cardio-thoracic surgeons.
The number of anaesthetists working in the UK has also declined by 33 whereas, according to an analysis by Nuffield Health, without Brexit this number would have increased by 400.
“Brexit has made longstanding recruitment challenges for specialist doctors worse in several specialities facing ongoing shortages,” the report said.
Nuffield Trust’s Brexit programme lead, Mark Dayan, told Byline Times: “The drop-off in EU and EFTA doctors coming to the UK has exposed some of the weaknesses in UK training and retention. UK-trained doctors dropping out at each stage has been a major problem – for example it has meant that increases in GP training in recent years have not actually raised the number of [new] GPs.”
Dayan also noted the high proportion of doctors from EU countries in the UK. “Part of the response [after Brexit] has been remarkably high migration from non-EU countries, which now make up the majority of new joiners to the medical register,” he said. “But our research shows this simply isn’t working in certain specialties, leaving shortages un-addressed.”
Dr Basu echoed this, saying that the “post-Brexit slowing of medical supplies and staff recruitment from the EU means decreased systemic capacity in the NHS. For decades we depended on sufficient immigration of overseas doctors. EU-trained doctors could become senior clinicians to bolster the NHS”.
He further emphasised that the effects of Brexit on the NHS aren’t limited to the number of staff. “Rising poverty, due to socio-economic fall-out from Brexit, is a social determinant of health and disease,” he said. “That means greater demand for NHS services and poorer patients may be disproportionately affected by NHS sustainability issues, compounding the social dimension of Brexit.”
The Government may claim that there is a “record number of doctors and nurses” in the NHS today. But it is clear to most people using the NHS – or indeed working in it – that this is not the case.
Until the Conservatives offer the specialist training previously provided to UK doctors by other countries – and the conditions to retain these individuals – a post-Brexit NHS is likely to continue to lack much-needed expertise.