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State of medical recruitment

The NHS is at breaking point, plagued by workforce shortages and exacerbated by funding cuts. Increasing workload, low morale, stress and burnout are unfortunately characteristic of life for too many doctors working in the NHS today.

Against this backdrop, fewer people are choosing medicine as a career - and many more are choosing to leave the health service at a time when they are needed most.

This briefing examines the current state of medical recruitment in England, with additional UK-wide data for the foundation programme. Looking at data from 2013 onward, it identifies some of the ongoing issues facing medical recruitment, and recommends how some of these key concerns can be addressed.

 

Key findings

 

 

  • Although still highly competitive, fewer people are applying to medical school.
  • Foundation programme posts and applications are decreasing.
  • Applications to specialty training are decreasing.
  • Nearly three quarters of all medical specialties faced under-recruitment in 2016.
  • There are geographical variations in recruitment trends, with the northern regions bearing the brunt of the recruitment crisis.

Download the briefing

 

Analysis and recommendations

  • Medical school applications

     

    Although medicine remains highly competitive, applications to UK medical schools have decreased for the third year in a row.

    • The number of people applying to UK medical schools from England has decreased by more than 15% since 2013.  
    • The number of EU applicants is at its lowest since 2013, with a 16% drop since last year.
    • The number of non-EU applicants is also at its lowest since 2013.

    More than three-quarters of medical students said that they were now less likely to recommend studying medicine to friends and family.

    BMA medical student survey 2016

    The rising cost of medical education and training may be a prohibitive factor for would-be doctors.

    In addition, more needs to be done to make sure medicine remains an attractive career choice for people from all backgrounds.

    More should also be done to attract a more diverse range of applicants to medical careers. The BMA explored this topic in its report 'The Right Mix'.

    View the data for medical school recruitment

  • Foundation programme recruitment

     

    Foundation trainees are a vital part of the medical workforce. A reduction in their numbers will have a knock-on effect on speciality recruitment and ultimately on the NHS' ability to provide safe services.

     

    Foundation year one

    2016 had the lowest number of applicants and the fewest appointments to foundation year one posts via the national allocation process since 2013.

    Recruitment numbers across some other channels have also decreased.

    • The number of LTFT (less-than-full-time) foundation doctors recruited was less than half what it was in 2013.
    • The number of newly qualified doctors recruited to the academic foundation programme had also fallen.
    • Recruitment by other methods has increased since 2013, but these numbers remain small.

     

    Foundation year two

    While the number of foundation doctors beginning the second year of their two-year foundation training in 2016 was higher than in the previous year and in 2013, total recruitment to F2 has fallen by almost 3% since 2013.

    In 2016, those recruited to the second year of the academic foundation programme fell from previous years. Those appointed to one-year F2 posts also decreased.

     

    View the data for foundation programme recruitment in 2013, 2014, 2015 and 2016.

  • Specialty medicine recruitment

    While applications to specialty training are decreasing, the number of training posts is increasing year-on-year.

    • Although the ratio of appointments to training posts (fill rate) fluctuates, in 2016 it was nearly 6% lower in England than it was in 2013.
    • In the same year, just 50.4% of F2 doctors said they would progress directly into specialty training. This number has been steadily declining since 2011.

    This widening gap could lead to staffing problems in the future.

  • Variations between specialties

    Nearly three quarters of all medical specialties were under-recruited in 2016.

    While year-on-year shortages of doctors in general practice, emergency medicine, psychiatry and paediatrics are widely acknowledged, many smaller specialties are also finding it difficult to recruit trainees.

    Some specialties – including Clinical Pharmacology and Therapeutics (ST3), Haematology (ST3) and Allergy (ST3) have been unable to fill all available posts for several years.

    This calls into question the NHS' ability to continue providing these services in the way they are currently delivered.

    Download the data on specialty fill rates from 2013 to 2016 (excel)

  • Geographical differences in specialty recruitment

    The ratio of appointments to training posts (fill rate) for specialty medicine is significantly wider in some parts of the UK.

    • The north of England (North East, North West, Yorkshire and the Humber) has the lowest fill rates in the country.
    • The east of England and the West Midlands have seen a steady decrease in fill rates since 2013.
    • Fill rates increase significantly in London and the south of England.

    Download the data on specialty fill rates by region from 2013 to 2016 (excel)

  • Recommendations

    The BMA recommends the following measures to improve recruitment.

     

    Increase opportunities for flexible careers

    Efforts to support flexible working could make a significant impact on recruitment. These could include:

    • more flexibility in part-time medical roles, with a wider range of options for part-time working
    • e-rostering and addressing systemic issues to ensure trainees have advance notice of their shifts
    • greater flexibility around shift patterns for LTFT trainees with caring responsibilities
    • more affordable and flexible childcare
    • shared parental and carers' leave
    • a more flexible approach to part-time working at every career stage, including consultant level.

     

    Improve health and wellbeing services

    Improving trainees' health and wellbeing should be prioritised. The BMA recommends:

    • a fully functional and resourced occupational health service be provided for NHS staff
    • new efforts be made to raise awareness of health and wellbeing services.

     

    Tackle rota gaps

    Anecdotal evidence suggests that many trusts are underestimating the effects of rota gaps.

    The BMA is working with junior doctors to investigate the impact of rota gaps on their working lives and identify ways to mitigate the worst pressures.

     

    Address geographic variation in medical recruitment

    Further research into how doctors choose their career paths, such as the BMA's recent survey on career choices, can help identify which incentives for this will most appeal to doctors.

    Investments must be made to ensure high quality training placemements are provided consistently across geographical areas.

     

    Maintain the NHS' ability to recruit from overseas

    With EU nationals making up nearly 7% of the UK medical workforce, it's clear that the NHS will continue to rely on overseas recruitment, from the EU and elsewhere, in the short to medium term.

    The BMA has called for:

    • permanent residence for all EU doctors currently living and working in the UK
    • EEA medical students currently studying in the UK to be given sufficient stay to allow them to complete their course and continue to foundation training and training posts
    • any future immigration system to be flexible enough to allow for recruitment of overseas doctors where the NHS cannot fill posts with qualified UK nationals.

    Read more about our work on EU doctors and Brexit

     

    Improve workforce planning

    The BMA has long advocated for substantive workforce planning at a national level.

    Despite this, workforce planning has been devolved to Health Education England's regional structures, risking making planning even more difficult in the future.

    A longer-term strategy for a flexible and sustainable workforce that is valued and treated fairly is urgently needed.