A report by the Royal College of Physicians (RCP) - Underfunded, underdoctored, overstretched - the NHS in 2016 - warns that NHS funding has failed to keep pace with demand.
It calls for an immediate overhaul of NHS efficiency targets, urging the government to set realistic goals, invest in the 'long-term sustainability' of the health service and protect funding for transformation.
Overall numbers of doctors in training must increase, the report warns, pointing out that government plans for an extra 5,000 GPs by 2020 must not be delivered at the expense of other specialties.
Under current arrangements the NHS workforce is struggling to cope, the report warns, with NHS staff increasingly feeling 'like collateral damage in the battle between rising demand and squeezed budgets'.
RCP registrar Dr Andrew Goddard said: 'It is clear to all of us working in the NHS that we are at a point of no-return and the NHS in its current form is unsustainable without a significant increase in funding. We can’t continue to provide ever-more expensive treatments to an ever-increasing group of patients and not expect the system to collapse.
'As doctors, we see the problems this creates on a daily basis, be it at the front door of the hospital, in A&E or in outpatients. Patients can see it too and realise that the NHS is no longer the envy of the world and isn’t fit for our changing world. There are some big decisions that society has to make and the political parties have to stop blaming each other for where we are and work together to build a health and social care system that is fit for the UK in the 21st century.’
The report warns that shortages in the medical workforce can only be addressed 'if there is a coherent plan to increase the overall number of training places across medicine, from medical school onwards', highlighting that there are fewer medical students now than in 2010 despite rising numbers of patients.
Future of the NHS
It warns that the NHS is currently relying on significant numbers of older doctors, and a high proportion of doctors recruited from outside the UK. Two in five hospital doctors qualified outside the UK, it says, a figure that is among the highest for any OECD country. 'This leaves the NHS vulnerable to the potential impact of the Brexit vote and changes to immigration rules,' it says.
Growing numbers of doctors choosing to work part time also mean that overall numbers of doctors in training need to rise faster, the report adds. 'We need joined up action across government if we are to address the workforce challenges facing the NHS. The DH, Treasury, Home Office Department for Exiting the European Union and the Department for Work and Pensions need to work together with the healthcare professions and NHS organisations to find immediate and long-term solutions.
'Migration rules and plans for exiting the EU must enable staff from outside the UK to work in the NHS; pension rules should not disadvantage doctors for staying longer in the NHS; and medical school and medical careers should be accessible across society.'
NHS Confederation policy director Dr Johnny Marshall said: 'We look forward to working with the RCP and welcome its strong focus on developing the workforce. Their report represents an important contribution to the debate on the future of the NHS.
'Further growth in the numbers of doctors is currently necessary but it will become unaffordable if allowed to continue indefinitely – putting healthcare at risk. It must go hand in glove with developing new roles, such as that of physician associates and developing new models of care that are more in tune with patients’ needs, such as moving services from hospital settings to community settings.'