Hunt aims for fully home grown doctor workforce

Expanding the number of medical student places by 25%, announced by England’s health secretary at the Conservative Party conference in Birmingham on Tuesday 4 October, will take at least a decade to have an effect in the NHS, doctors’ leaders have warned.

In his speech Jeremy Hunt announced that “from September 2018 we will train up to 1500 more doctors every year” in England in a bid to expand the number of home grown doctors and to replace doctors recruited from overseas, who currently make up 25% of the medical workforce. “Of course, it will take a number of years before those doctors qualify, but by the end of the next parliament we will make the NHS self sufficient in doctors,” he said.

The number of medical school places fell by 2% in 2013 and currently stands at 6000 a year. Doctors’ leaders have welcomed the planned rise in student numbers but have warned that they will not replace the need for foreign doctors in the short to medium term.

Taj Hassan, president of the Royal College of Emergency Medicine, said, “Medical student expansion is a helpful step in the right direction, but will not have an effect at all in the short or medium term. Any meaningful impact will be at least 10-12 years away, once these training programmes deliver fully trained physicians.”

He added, “More urgent action is needed to address the short term challenges to give time for longer term solutions, such as this one, to deliver.”

In a statement the Royal College of Radiologists said that though it supported “all measures to maintain the long term sustainability of the NHS . . . urgent stopgap measures are crucial to ensure there is an NHS to sustain in 15 years’ time.”

The expansion in student numbers is expected to cost roughly £100m (€115m; $130m) for the period up to 2020, but the government said that savings would come from charging international students “the full cost of their medical training” and, in the longer term, through cutting the medical locum bill, which is £1.2bn a year.

Chandra Kanneganti, chair of the British International Doctors Association, said that students from other countries already paid extra fees. He told The BMJ, “I do have concerns about plans to charge international doctors for clinical placements, which has not been done before, because that will reduce international doctors’ interest in coming here. There should be a recognition that international doctors contribute to the NHS enormously, and there should be an element of exchange of ideas, skill sets, and knowledge between different countries.”

Simon Wessely, president of the Royal College of Psychiatrists, told The BMJ that it would be 10 to 15 years before any benefit was seen from the proposals and that it was more important to tackle the current crisis of medical graduates not wishing to enter the profession, poor retention, and low morale.

The plan to expand medical school places by 25% may not be achievable within a year, Wessely said, as it would require creating new medical schools or enlarging existing ones. He criticised the proposal to “conscript” newly trained doctors to the NHS for four years unless they repaid part of the cost of the £220 000 it took to train them, in an approach that mirrored that taken for people whose higher education was funded by the armed forces, and the lack of detail about how the expansion in trainee numbers would be accomplished. The Department of Health has said that a consultation on the detail would take place later this year.

Hassan also criticised the sanctions planned for doctors leaving the UK. “The key to keeping doctors in the country is to create the right training environment for them,” he said. “They need to be well supported and feel valued so that they can deliver on their talents. There is much more to do in this area.”

Maureen Baker, chair of the Royal College of General Practitioners, said, “Increasing the numbers of medical school places available is a positive step, and we look forward to receiving more details about how this will work—for example, whether these extra places will be in existing medical schools, or whether new medical schools will be established.”

She also called for assurances that “measures are in place to ensure sufficient numbers of the new workforce enter a career in general practice, so that we have a more balanced split between generalists and specialists in medicine.”