Britain's GP shortages don't need to be filled from outside EU, say experts

http://www.theguardian.com/society/2015/feb/25/britain-gp-shortages-outside-eu-experts

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Shortages of GPs in Britain do not need to be met by further recruitment of doctors from outside Europe, the government’s official migration advisers have said.

They also rejected claims there is a national shortage of nurses that needs to be met by more overseas recruitment.

The home secretary-appointed migration advisory committee (MAC) does, however, say that some key health service jobs, such as paramedics and clinical radiology consultants, and some senior roles in the digital economy should be officially declared shortage occupations in Britain. This would allow qualified overseas staff to be recruited in these areas.

In terms of the GP gap, the committee says there is no shortage of medical students in the UK, and the Department of Health should focus on providing incentives to ensure they become GPs rather than consultants. The experts say they received no evidence of a national shortage of nurses.

The DoH told the committee that 3,280 trainee GPs were needed every year, saying they are falling short of this target by 400.

Health officials said the long-term shortage of GPs was caused by a failure to attract sufficient numbers of trainees among medical graduates, the difficulties of attracting new doctors to specific parts of Britain as older GPs retire, a “work-life” balance issue caused by the increased “feminisation” of the workforce and a shift to salaried GPs.

The DoH says it wants to see a ratio of 0.7 doctors per 1,000 of the population. This ratio was almost achieved in 2009, but has since been falling.

The MAC’s recommendations follow the first review in two years of the official shortage occupation lists under which British companies and the public sector can recruit skilled, graduate-level labour from outside the EU. The number of people coming to work in Britain through the tier two skilled occupation route forms only a very small proportion of overall immigration into Britain.

The committee also says there remains a serious shortage of experienced staff, including ones to help small firms expand, in the rapidly growing digital economy. The experts say a small number of senior jobs in digital technology, limited to people with at least five years’ experience, should be added to the list of occupations with a shortage.

The MAC recommends that 10 new occupations should be added to the list, including paramedics, clinical radiology consultants and old-age psychiatry consultants. They also say specialist overhead power-line workers should also be added.

Prof David Metcalf, the committee’s chairman, said the solution to the shortage of GPs lay in the hands of the DoH as there was no shortage of medical students in Britain. Initiatives were already being developed to make it more attractive for medical students to become GPs, he said. Metcalf added that the DoH had known since 2009 that the ratio of GPs to patients has been declining.

He said there was a national shortage of about 1,200 paramedics, who have started to work for GPs as well as the ambulance service. Currently, many paramedics shortages are being met by temporary staff from Australia. The shortage is likely to last about five years.

“We recognise that there is a shortfall in the numbers of GPs being trained but consider that the solution to this is in the hands of the health service,” said Metcalf. “The health sector told us that, nationally, they do not need any jobs in nursing to be on the shortage list, but we agreed with their assessment that there is presently a shortage of skilled paramedics.”

He added that despite the language difficulties, the GP shortage could also be met by recruiting qualified doctors from other EU countries. A small number of non-EU doctors could also continue to be recruited through the general skilled migration route as long as the vacancy passed the test establishing that there was no qualified EU candidate for the post.

Dr Peter Carter, chief executive of the Royal College of Nursing, suggested that the committee’s views were not realistic and would not help relieve the NHS’s “desperate” shortage of nurses.

“Recruiting from overseas is not a sensible long-term solution to a profound nursing shortage, but in the NHS as it operates today it is absolutely necessary. This means recruiting and retaining nurses from outside the EU as well, given the projected shortage of 500,000 nurses across Europe over the next five years,” said Carter.

“There is a huge difference between aspiring to be self-sufficient in nurses and saying that we don’t need to recruit them from overseas, and we would hope that the migration advisory committee would take on board the desperate need for more nurses in the immediate term.”

While the NHS has always relied on overseas nurses, recently “the figures become completely skewed as hospitals in particular have plugged huge gaps in their workforce with overseas nurses”.

Dr Maureen Baker, chair of the Royal College of GPs, welcomed the attention the committee had drawn to the UK’s “chronic shortage” of family doctors, but was “disappointed at its lack of action to rectify the problem by unlocking the potential of skilled medical professionals in the many countries that have similar health systems to ours”.

The ageing GP workforce and growing demand for appointments mean the UK needs 10,000 more GPs, but too few newly qualified medical graduates are electing to become GPs, she added.

The MAC recommends that a number of health jobs on the list should be removed as the shortage has been resolved. This category includes haematology consultants and therapeutic radiographers.

Metcalf said listing of digital economy jobs would be restricted to those being recruited by small companies of below 250 staff to avoid a mass switch by the large digital employers away from an “intra-company route” under which thousands of IT specialists are brought to Britain, especially from India.

The digital economy jobs to be listed include product managers, data scientists, senior developers and cyber-security specialists.