The British Medical Association (BMA) is today warning that patient care is at risk due to a chronic shortage of doctors across most areas of medicine.
Figures obtained by the BMA show that training places across three in four medical specialties in England went unfilled last year, with many specialties experiencing recruitment shortfalls year on year.
The figures, obtained through FoI requests, show that at each stage of the training process, from applications to medical school, to training as a specialist, fewer people are choosing to enter medicine or remain in the NHS as doctors.
New analysis of vacancy rates published today by the BMA shows that:
- Nearly three quarters of all medical specialties had unfilled training posts in 2016;
- Dozens of specialties face recruitment shortfalls year on year;
- The number of applications to UK medical schools has decreased for the third year in a row and by more than 13 per cent since 2013;
- Applications to the foundation programme (the first year of doctors’ training following medical school) are decreasing, with 2016 having the lowest number of applicants in recent years;
- Applications to specialty training are in decline;
- Fewer trainees are moving directly in specialty training and instead choosing to take a career break.
Some areas of medicine with the lowest fill rates include:
- Genito – Urinary Medicine (GUM);
- Emergency Medicine.
There are also significant geographical variations in vacancy rates, with northern regions bearing the brunt of the recruitment crisis. The figures show that:
- The North of England (North East, North West, Yorkshire and the Humber) experienced the lowest fill rates in the country;
- East of England and West Midlands have seen a steady decrease in fill rates since 2013 signalling a worsening problem with recruitment;
- Fill rates are higher in London and the southern regions.
Workforce shortages in areas such as general practice and emergency medicine are well known, however these figures show that dozens of other specialties are also unable to recruit enough trainees, calling into question the NHS’s ability to deliver specialist services in the same way in the future.
Today’s new figures show that genito-urinary medicine (sexual health medicine), for example, has been unable to fill all available posts for several years and the significant ongoing shortages in psychiatric services are particularly worrying considering the growing need for and focus on mental health services.
There are a number of reasons for this continuing decline. Although medicine remains competitive, rising tuition fees and higher student debt could be a major factor in the decline in applications. For many, student debt can exceed £80,000 (including maintenance) and medical graduates on an average salary are unlikely to repay their SLC (Student Loans Company) debt in full.
Rising workloads, worsening morale, the NHS pay cap which has seen doctors’ pay fall by up to 17 per cent in recent years1, and concerns around work life balance are likely factors contributing to doctors taking time out from training or leaving the NHS altogether.
The General Medical Council issued 4805 certificates of good standing to doctors thinking about moving abroad in 2016.2 More certificates have been requested by specialty doctors with the lowest fill rates in this new paper.
A reduction in numbers of doctors progressing through training, at a time when demand on NHS services is growing, will have a significant impact the NHS’s ability to provide safe and timely specialist care.
To address this workforce crisis, the BMA is calling for:
- Greater career flexibility: including greater access to part time working, parental leave, more flexibility around shift patterns, out of hours working and locum working;
- Improved health and wellbeing services: to help NHS staff when they are under pressure or struggling to cope with the demands of the service;
- Rota gaps to be tackled: a recent BMA survey3 found that two thirds of doctors reported rota gaps in the department in which they work, with trainees put under pressure to accept extra shifts and cover additional wards as a result of rota gaps;
- Maintaining the NHS’ ability to recruit from overseas: the UK needs a flexible immigration system post-Brexit so that it can recruit and retain enough doctors. EU nationals make up nearly seven per cent of the UK medical workforce, any drop in numbers will only further exacerbate recruitment challenges4;
- Improved workforce planning: to ensure the NHS can deliver care in different locations as required, without leaving parts of the health service inappropriately or under staffed.
Commenting on the findings, Dr Chaand Nagpaul, BMA council chair, said:
“It is deeply concerning that we are seeing a drop off at each stage of doctors’ training, we have to ask why some, who have spent many years training to become a doctor, are deciding not to continue in the profession.
“We know that many doctors are struggling with unsustainable workloads in an NHS that is understaffed and chronically underfunded. This has a huge impact on their morale and wellbeing, often leading to stress and burnout. Brexit also poses a new risk, with almost half of EU doctors considering leaving the NHS following the referendum result5.
“With the NHS at breaking point, if the government doesn’t get to grips with this workforce crisis, the NHS will struggle to attract and retain highly trained staff, and patient care will suffer as a result. Ignoring this staffing crisis creates to a vicious circle, compound existing problems, adding to pressure on existing staff making them more likely to leave.”
Notes to editors
The British Medical Association (BMA) is the voice of doctors and medical students in the UK. It is an apolitical professional organisation and independent trade union, representing doctors and medical students from all branches of medicine across the UK.
The BMA’s briefing paper ‘The state of pre and post-graduate medical recruitment in England, September 2017’ and figures on speciality fill rates are attached.
The analyses are based on publicly available data, some of which were obtained via a Freedom of Information request, and are current at the time of publication. We examined data from 2013 onwards to identify any on-going issues and trends in medical recruitment. The briefing focuses on recruitment in England only, however, figures for the UK Foundation Programme are UK-wide.
- In real terms, doctors’ pay has sharply declined in the past five years, with junior doctors seeing their income drop by 17 per cent. More information is available here.
- Figures for certificates of good standing were issued in a FOI by the GMC which you can find here.
- In a recent BMA survey, 67 per cent of doctors told us there are currently rota gaps where they work. More information is available here.
- More information on the BMA’s work on Brexit is available here.
- More than four in 10 doctors at work in the UK are considering leaving following the EU referendum result, according to a BMA survey. More information is available here.
- Further BMA analysis on the state of medical recruitment is available here.