We often see and hear from the media that the UK is facing significant GP recruitment and retainment challenges. To tackle the demand in primary care, the UK government aims to produce more than 6,000 GPs by 2024.
In the recruitment year of 2022, more than 4,000 GP training posts were advertised and nearly 50 per cent of the recruited aspiring GP trainees are IMGs. These trainees are entering a system where bureaucratic red tape at the end of training risks them securing long-term employment in general practice.
All GP trainees go through at least three years of training in general practice, after their time in medical school, and likely postgraduate medical internships. While a trainee, IMGs are given a tier 2 (skilled worker) visa to allow them to work and live in the UK legally over a stipulated period, which is often the length of training (usually three years).
In most cases, trainees are given a 2-week grace period after their last day of training. If a trainee has failed to secure a job by the time of visa expiration, they will lose their right to remain in the UK and must leave the country. Two weeks is hardly long enough for anyone to secure a job, let alone kickstarting the time-consuming visa application process.
These restrictions cause a significant amount of stress for a huge number of GP trainees, which will only increase in number with the increasing number of IMG GP trainees. We could have more GPs seeing our patients – instead they are tangled up in red tape, uncertain about their future careers in the UK.
Apart from holding a valid visa, one can apply for ILR (indefinite leave to remain) (ie, permanent residency). However, to apply for ILR, one must have held a tier 2 visa for at least five years or be in the country for at least 10 years.
As the duration of GP training is only three years, most IMG trainees who enter GP training directly will essentially be two years’ short. Being an IMG is already difficult. Post certificate of completion of training career options are being limited by these visa rules. The only practical option is to become a salaried GP, as they can't as easily locum or become a GP contractors without obtaining ILR. This puts them at a disadvantage to their UK-trained peers.
Some GP practices can sponsor visas and help IMG GPs to remain in the country post completion of training. However, these practices are very limited across the UK, and they do not always have job vacancies or funding. It takes up to eight weeks and £1,476 of funding for a practice to apply to become a visa-sponsoring practice. Though the number of visa-sponsoring practices is increasing, the demand is growing even faster owing to the increasing number of IMG trainees each year.
The BMA has guidance on how to become a tier 2 visa-sponsoring practice. The Government could simplify sponsorship by creating an umbrella body to facilitate sponsorship or relax the residency requirement to three years. These solutions could help patients immediately – inaction is only deepening the workforce crisis in general practice.
Our patients and the future GP workforce are already being adversely affected by the loss of IMGs owing to bureaucratic visa issues. There are many freshly qualified IMG GPs, but only a limited number of practices UK-wide that are eligible to sponsor a visa and offer them a job.
If they are unable to secure a job in the area they were trained in or prefer to live, they will have to move elsewhere to look for visa-sponsoring practices. Some will leave the country and move abroad after training. It is also not unheard of that IMG GPs take up hospital jobs as they can’t secure a work visa as a GP.
This is bad for general practice and bad for our patients. Nobody wins – and the UK Government must act now to address this avoidable loss of a highly talented and skilled general practice workforce. GPs should be there for our patients in the community, not worrying and stressing about securing residence to live in the country they have adopted as their home.
I am in my final year of GP training, and I have started searching for possible jobs after I complete training. There are a vast number of GP practices across the UK advertising for their vacancies. However, owing to my residency status of being a non-UK citizen, I am only eligible to apply for a handful of them.
The area I have been training in is always short of GPs, and the primary care service is extremely strained. Disappointingly, I have not come across any practice in this area that sponsors visas. I have a home here, but to put food on the table, I have no choice but to consider leaving for a job elsewhere.
This problem is more apparent than ever before owing to the increasing number of IMGs and will only affect more trainees as time goes on. As much as the UK healthcare system values and welcomes our international trainees, the Home Office and its immigration rules do not.
The Home Office must urgently review the visa rules for new IMG GPs, otherwise we will be expecting more losses to our already overworked and decreasing GP workforce.
Eric Fung is a GP trainee in Dundee