Intended for healthcare professionals

Opinion The Bottom Line

Partha Kar: We’ve let the medical workforce down. Let’s provide some basics

BMJ 2023; 381 doi: (Published 24 May 2023) Cite this as: BMJ 2023;381:p1149
  1. Partha Kar, consultant in diabetes and endocrinology
  1. Portsmouth Hospitals NHS Trust
  1. drparthakar{at}
    Follow Partha on Twitter: @parthaskar

Huge issues are facing the UK’s medical workforce: angst among staff, battles for training opportunities, a lack of basic amenities, discrimination, shortages of posts, roles with no career progression, and a failure to support workers asking for pay reviews.

Compared with its neighbours, the UK has the highest proportion of doctors it has trained who now work abroad, and more overseas staff are leaving the UK than coming here and staying.12 This follows a strategic move by the NHS to recruit medical graduates and other healthcare workers from overseas.

The UK also has a big issue with healthcare salaries: however you cut it, doctors in the UK earn less than their colleagues in many other developed countries, which is a big problem in a global economy with a shortage of healthcare staff. UK medical graduates now face a bottleneck in terms of opportunities for training and access to specialist posts, leading to frustration at the current state of affairs. Then there are problems with the basics—hot food, a bed to sleep in, a place to relax. The NHS has worked overtime to stop all of that over the years, aided and abetted by many medical staff in senior roles. And issues around discrimination and differential treatment on the basis of protected characteristics such as sex and race continue to be widely ignored.

As senior doctors we’ve contributed to changes in training programmes, expanded assessment based on ticking boxes, and bottlenecks of training posts. At the same time, most people have turned a blind eye to the creation of a separate workforce of “locally employed doctors.” These doctors mostly come from abroad and are either given jobs without any opportunity for progression or faced with so many forms and processes to work through that it’s nigh on impossible for them to advance in their careers.

We hear about accountability all the time, yet there seems to be very little of it for these challenges in the medical workforce. Health Education England is dead, with little to show for what it managed to deliver for medical staff. Will amalgamation of medical training into a monolith such as NHS England make things any better? One hopes so, but moving poor wine into new bottles rarely improves the quality. We should start with the basics: not yoga mats, coffee coasters, vouchers, or teabags, but simple things such as provision of food, organising leave, and offering a human touch. And we need to lobby hard, and publicly, for an expansion of senior medical posts to improve the opportunities available to doctors working in this country—along with looking at tuition fees and the use of bursaries to attract others from deprived backgrounds.

Half baked plans such as the recent attempts to bring in “medical apprenticeship” without much thought towards trainers or agreement from all quarters is not helpful—not to mention creating the impression of a cheaper workforce, similar to what we’ve done with so many “newer” grades. In an era of disgruntled medics and students the last thing we need is to create yet another grade of staff who are sold a future of hope, when, like many others, the eventual conclusion is a dead end career without the satisfaction either of the job or the training. When the house is on fire you don’t need more fire alarms: you need to tackle the problem at hand. Why add further to the bottleneck of training posts, which is already an overwhelming problem dividing UK and international medical graduates?

Is there hope? There isn’t much in the immediate future. We need fresh leadership to lead basic changes with support from the royal colleges and unions, and other external organisations need to step up now. Do the basics right, show the workforce that you care and are ready to battle for them, and believe it or not, you may make some progress on morale. Make the workplace better, and people stay. If that’s rocket science to some, they’re not in the right job.


  • Competing interests: see Partha Kar is national specialty adviser, diabetes, and lead of the Medical Workforce Race Equality Standard.

  • Provenance and peer review: Commissioned; not externally peer reviewed.