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NHS brain drain: why the busman's holidays?

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There is a national recruitment crisis in general practice and some other specialties. At the same time, many doctors are choosing to work abroad

Sunshine, new experiences and a rewarding working life — the appeal of leaving the UK to work abroad is only too apparent. 

But with so many  doctors expressing the desire to depart for distant shores there are fears of a brain drain from the NHS.

With a national recruitment crisis in general practice and in certain other specialties, the UK can ill afford to lose its medical workforce to Australia and New Zealand. 

Last year, 4,925 doctors applied for a CCPS (certificate of current professional status) from the GMC, which is often needed to work overseas. 

Cornwall GP Mark McCartney did some GP locum work in Australia during a year out early in his career. 

Twenty years later he left his position as a GP partner and returned to Queensland with his wife and three children. 

He says: ‘I wanted to get out of the NHS and work in a different clinical environment. I went into a practice which was a great place to work and did lots of interesting clinical things, which were  challenging and rewarding, and I had a great experience.’


Escalating workload

Although Dr McCartney originally planned to stay for four years, he returned to his practice after 12 months on account of family responsibilities.

He says: ‘General practice in the NHS is not in a great place at the moment because there are lots of issues. Since I’ve come back, the workload is just escalating and the systems are so complicated, and access to investigations for patients makes it not such an easy job. 

‘The media in Australia don’t seem to attack the profession in the way the British media likes to denigrate professionals. On the whole, people respect you for what you do and the service and the care you give them.’

At the BMA annual  representative meeting this year, Cambridge locum consultant in geriatric medicine Gordon Campbell posed the following question: ‘Can I ask you to imagine the medical workforce as water in a bath? The bath has several leaks, and one of those leaks is emigration.’


The meeting called for NHS Employers and the Government to develop incentives to encourage doctors to stay in the UK, in addition to a financial resettlement programme specifically designed to help  doctors who wish to return. 

To work in the UK, GPs have to be on the GMC’s GP register, hold a GMC licence to practise and be on the performers list. 

GPs returning to the UK from abroad are required to apply through national induction and returners schemes, even if they have been working in general practice overseas. 

 

Incentives to return 

In a bid to tempt GPs back  to the NHS, NHS England’s Shropshire and Staffordshire area team advertised GP jobs in two Australian magazines promising ‘a fully funded induction and returner scheme’ for UK doctors working overseas. 

The scheme attracted 40 initial expressions of interest and three doctors have since relocated from overseas and taken up the scheme to complete the educational programme developed between NHS England, Keele University and Health  Education West Midlands.

NHS England medical director (north Midlands) Ken Deacon says: ‘There is a national shortage of qualified GPs, with more doctors retiring than completing their training, and this has led to challenges around GP recruitment and retention in some city and rural areas. 

‘To address this situation, we placed advertisements locally and nationally, aimed at UK-trained doctors working overseas (including in Australia) who wish to return to NHS practice but have not been able to do so because of difficulties in finding places on approved returners schemes.’

A national induction and refresher scheme was launched in April this year, but there is much more to be done to encourage GPs to stay in the UK. 

According to the BMA Future of General Practice survey, 9 per cent of GPs and 21 per cent of GP trainees hope to work overseas in the next five years. 

A BMA cohort study — a 10-year longitudinal study of 430 doctors — shows that after about eight years post-graduation, approximately one in 10 doctors had worked overseas at some point during the previous year. 

Three in 10 said they wanted to work overseas temporarily in the future and one in 10 said they wanted to work overseas  permanently in the future. 

Some of the reasons given to practise abroad were to broaden or gain medical experience, and to achieve a better lifestyle and better working conditions.

The experience of working in a different healthcare system or in humanitarian or development medicine were other reasons. Another reason given was to ‘escape’ from working in the NHS.

 

Undervalued

One doctor, who posted anonymously on the BMA Communities forum, said that after spending a year working in emergency medicine in Queensland, Australia, they had now decided to finish their specialty training before looking for a post abroad. 

'I love my country, I have been a passionate believer in the NHS all my adult life.'

Anonymous

The doctor wrote: ‘This is not a decision I have taken lightly — I love my country, I have been a passionate believer in the NHS all my adult life — but I cannot and will not continue to be exploited, undermined and demeaned at every turn by the Government, by NHS management and by the British media.

‘As far as I can tell, Britain alone expects doctors to work long hours, plus many more unpaid and unacknowledged while simultaneously subjecting them to pay cuts, pension raids and systematic attacks on their professional status and standing in the public arena.’

A feeling of being undervalued, vilified by the media and attacked by the Government were prevalent throughout the comments. 

So what can the NHS do to retain its doctors? 

Dr McCartney says: ‘The system is broken. It’s not working. The amount of administration and paperwork is phenomenal  compared with what a doctor in Australia has to do. 

'Younger doctors don’t want to own a  practice or manage a practice. They just want to do the clinical work and have nice working conditions where you have the time for appointments with patients and can manage them well with easy access to investigations and treatments.’

It seems that until doctors feel respected, listened to and in control of their working lives in the UK, the exodus will continue.


We asked for doctors’ experiences of working abroad on the BMA Communities forum and this is what some of you told us

Treated with respect

‘I spent 18 months split between Australia and New Zealand as a junior in emergency medicine after completing foundation doctor 2. While I was in Australia and New Zealand I was paid well and compensated well for my unsociable hours, but that is not why I enjoyed it so much.

‘I was treated with respect as an employee and my employers took the time to make the job right for me and compromise service provision with my training and work-life balance.’

 

High staffing levels

‘Service provision in the USA does not come before the training of junior doctors, primarily because the staffing levels are high enough that senior doctors have time to teach and junior doctors don’t have to spend hours on end doing mundane admin tasks.

‘The other great thing about the US is that training programmes are tailored, so docs don’t end up finishing their general training having repeated experience in some specialties and been given no meaningful experience in others.’

 

Time for paperwork

‘I left the NHS nearly four years ago and am now a full-time GP in the North Island of New Zealand. 

'In terms of money, it’s about the same; in terms of lifestyle it’s incomparable.'

Anonymous

‘In terms of money, it’s about the same; in terms of lifestyle it’s incomparable.

‘Here I do 15-minute appointments, and if I need to do a visit, there is time allocated for this. I even have paperwork time allocated. 

‘I generally work from about 8am to 5.30pm and get a lunch break. I am generally on time to collect the kids from childcare afterwards.

‘There is no weekend work here, and we do a lot more minor trauma. The work is very varied. Housing is cheaper, and from our house you can see both the mountains and the sea.’

 

Propaganda hurts

‘I am on a year out between F2 and specialty training. 

‘It physically hurts hearing all the nasty propaganda about doctors in the UK by the media and the Government, seemingly trying to turn the public against the profession.

‘Australia — in a more rural hospital — is a much less pressured, calmer environment to work in. 

‘There are teaching opportunities in the emergency departments, which are mainly filled by UK graduate juniors — opportunities that in four months of working in a UK emergency department I never received due to high pressure and targets.’

 

Returning to fight

‘My husband is an anaesthetist and I am a GP, both in Australia for a year out. We are looking forward to coming home to the UK but lots of friends and colleagues think we’re mad ... it’s sunny and you get paid lots of money so people are happy to forget about any negatives.

‘Why do we want to come back then? Despite the cliché, money isn’t everything for us and we like our life in the UK ... and most of all we still love the NHS, still free at the point of delivery and still the best state-run system in the world.

‘Despite all its difficulties and the Government’s best intentions to tear it down, we are coming home to fight for it.’


Your experience? 

  • Are you a UK doctor working abroad, or thinking about it?
  • Have you worked in another country and returned to the UK?