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BMJ 2005; 330 doi: https://doi.org/10.1136/sbmj.0503118 (Published 01 March 2005) Cite this as: BMJ 2005;330:0503118
  1. Katie Reid, freelance journalist

More and more UK doctors are working privately, and the Scottish National Party has proposed golden handcuffs to retain doctors in the state system. Katie Reid asks medical students around the world if they feel a duty to serve the public

The Scottish National Party last month raised concerns that Scotland is training doctors who go to England and often end up working in the private sector. Fiona Hyslop, member of the Scottish National Party, told members of the Scottish parliament that the answer might be “golden handcuffs” to keep doctors in Scotland and the NHS. The policy would bind junior doctors to a minimum period of service within the Scottish NHS.

“The idea of the golden handcuffs is simple—if you're getting the benefits of a high quality Scottish medical education, we want you to give something back to the NHS in Scotland,” shadow health minister Shona Robinson said days before the meeting in the Scottish parliament in January.

The proposal, which might not be legal under European law, is not the answer according to Pauline McNeill, Labour member of the Scottish parliament. “I don't support it. I don't think it is really practical to hold doctors here. I think we need to make the job attractive enough for doctors to remain here and because we have so many English students they will want to go home.”

The proposal of golden handcuffs leads to questions about how much freedom doctors should have to choose where they work. It costs the government £67 000 ($126 381; a97 329) to educate each medical student in Scotland. Do doctors have a duty to serve the taxpayers who helped to finance their education?

Leigh Bissett, chairman of the BMA's Medical Students Committee, believes that there are no ethical reasons for a doctor not to …

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