Dr Krishna Kasaraneni: What does Brexit mean for the GP workforce?

As LMC leaders gather for the 2018 England LMCs conference, GPC workforce lead Dr Krishna Kasaraneni looks at the state of the NHS GP workforce - and considers the potential impact of Brexit.

Cast your minds back to May last year. Promises of a 'strong and stable' future filled the papers, TV news and the airwaves. Now, as our government does its best not to self-destruct over what is or isn’t a good deal, let’s look at some recent headlines and statistics slightly closer to home – and what Brexit means for the stability of general practice.

Firstly, England has the lowest number of GPs per 100,000 patients in the UK. We have 58.7 GPs compared to the UK average of 60.4,and the dizzy heights of 76.2 in Scotland. Wales isn’t that far from us with 60.1 GPs.

What hurts more is that Northern Ireland, which has more than its fair share of issues and hasn’t had a functioning executive government for two years has 67.4 GPs per 100,000 patients.

GP trainees

The second headline is that GP recruitment in England has reached a record high this year.  For the first time, we have recruited 3,473 trainees, against a target of 3,250. So, we beat our target and it is a 10% increase on last year.

This number needs to be interpreted with caution though as some of them will defer their entry until next year. Crucially it is not the number of trainees who start GP training that determines the overall state of the workforce, it is the number who actually complete training and take on and stay in a substantive GP role.

The third piece of data is that the number (WTE) of GP providers (partners) has reached a record low. For the first time ever, this number is less than 20,000 (19,342 to be precise). I am sure colleagues will not struggle to picture a bucket that has water leaking out of it at a much faster rate than the water that is being poured into it. That would be an appropriate image to describe what is happening to the GP workforce.

The next point I want to mention is the variety of places where UK-registered GPs gained their primary medical qualification. Medicine has always depended on doctors from Europe and beyond to provide a high quality, reliable and safe service to patients.

Global workforce

NHS Digital data show that around 79% of GPs working in England qualified in the UK, but the rest of the workforce is truly global. GPs trained in European countries account for 4% of the workforce in England, while 12% trained in south Asia, and the rest as far afield as Africa, Australasia, North America, Central America and South America.

These European and international doctors enrich general practice with their skills, enthusiasm and diverse perspectives and have become essential members of the GP workforce. With more than one in three doctors presently working in the NHS having graduated outside of the UK, you cannot help but wonder what the omnishambles that Brexit is turning out to be has in store for the workforce.

Indeed, last week, BMA research showed more than three-quarters of EU doctors are not convinced by the prime minister’s pledge to guarantee the rights of them and their families in the event of a no-deal Brexit, and that more than one in three are currently considering leaving the UK.

We have since written to the PM outlining our grave concerns about this and demanding the government publishes a formal statement guaranteeing the rights of EU doctors if we crash out without agreement in March. These concerns are shared by the whole profession, as is evident with the group of motions dedicated to Brexit and the risk it poses to general practice, in Friday’s LMC conference.

That then nicely brings me on to the final statistic – the total number of full-time equivalent GPs is now lower than it was in 2004 (28,567 in 2004 compared to 28,278 in June 2018). While the way that GPs are actually counted changed in 2015, you get the general point– demand for GP services is increasing at a time when the workforce numbers are dropping.

So despite whatever chaos is ensuing in Westminster, the government and the new health and social care secretary (I’ve deliberately not named them as one cannot be entirely sure who it is actually going to be in view of the last few days!) must not get carried away with ‘record levels of GP recruitment’, but focus on the wider issues -  retaining GPs and valuing the wealth of knowledge and skills international and European GPs bring to the NHS.

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