Intended for healthcare professionals

Rapid response to:


Coastal areas need more doctors, says England’s chief medical officer

BMJ 2021; 374 doi: (Published 20 July 2021) Cite this as: BMJ 2021;374:n1852


The health of coastal communities: a national problem

Rapid Response:

Re: Coastal areas need more doctors, says England’s chief medical officer

Dear Editor,

The recent article ‘Coastal areas need more doctors, says England’s chief medical officer’ examined health inequalities resulting from ‘staffing shortage’ faced by coastal communities. It also proposes several long-term solutions to these issues, such as financial incentives for staff and the location of new medical schools. We believe there is another faster, more cost-effective option that should also be considered when addressing this issue.

There is a population of highly qualified and motivated refugee and asylum seeker healthcare professionals living in the UK who face insurmountable but avoidable barriers to qualification to work in the NHS. These include: the high cost of competency exams in English language and clinical skills; inadequate access to preparatory resources to improve their language skills, and a lack of guidance through a complicated and unfamiliar process. Whilst the General Medical Council does provide some financial assistance to those granted refugee status in the UK, the total cost, if all exams are passed first time, still stands at around £757 (1). This is still a notable sum for a group who is known to be more likely to face significant financial hardship.

We believe that Health Education England, NHS England, and the other agencies mentioned in the report should be trying to reduce these obstacles and support existing schemes (such as The Lincolnshire Refugee Doctor Project, REACHE NW, and, our organisation, The Phoenix Project) that help these professionals into work. This could be achieved by providing grants for these costs, but also by assisting them in achieving fluency in English in a medical setting and organising the placement experience necessary to adapt their practice to the NHS. This process would be faster and cheaper than the other suggestions in the article and for comparison vastly cheaper than training a single UK medical student from scratch, which is known to cost 100,000s of pounds. Assistance from some local NHS authorities and roles like that of Medical Support Workers are important steps that have already been taken to support this group, but we believe that there should be a national, coordinated campaign for a response to help as many of these professionals join the workforce as possible. As future and current healthcare professionals, we believe it is our duty to use our position of privilege to help our future colleagues begin their new professional lives here.

Providing this support in return for a commitment to work in understaffed trusts would provide fast and cost-effective relief to the staffing crisis facing coastal areas. Though it wouldn’t entirely solve the problem addressed in this article, it could provide a stream of competent professionals to areas that need them, for a fraction of the cost of other measures suggested, as well as provide a marginalised community an opportunity to regain their professional identity.

1. General Medical Council. Help for refugees. (Retrieved from:

Competing interests: Trustee and Co-CEO of The Phoenix Project (UK registered charity no. 1191100).

09 August 2021
Molly A Kavanagh
Medical Student
Jonathan C Bowley
University of Nottingham
School of Medicine, University of Nottingham