Exclusive: Nearly half of GPs back mandatory NHS service for UK-trained doctors, poll suggests

Nearly half of GPs say doctors trained in the UK to work in general practice should be obliged to complete a minimum period of NHS service, a GPonline poll reveals.

Handcuffs: Many GPs back obligatory NHS service for newly qualified doctors

A total of 43% of 425 GPs who responded to the survey backed a mandatory service period.

A minimum of one year of NHS service was supported by 8% of GPs, while 20% called for at least two years, 13% at least five years and 2% at least 10 years.

Although more than half (52%) say mandatory service should not be a requirement, the findings reveal significant support for the concept among GPs.

GPs emigrate

Prominent politicians have backed the idea of 'military-style service' for NHS-trained doctors. Conservative peer and former primary care minister Lord Howe said last year that it could be a way to stop the 'brain drain' that has seen some doctors emigrate out of the UK.

In February, then public accounts committee chairwoman, Labour MP Margaret Hodge, urged ministers to consider mandatory NHS service for doctors.

High-profile consideration of mandatory NHS service reflects the depth of the GP workforce crisis as the DH seeks to boost GP numbers by 5,000 by 2020. A GPonline poll earlier this year found that half of practices in England had lost a GP to retirement or emigration in the past 12 months, while a further investigation found one in three vacant GP posts had been unfilled for more than a year.

But GPC deputy chairman Dr Richard Vautrey told GPonline the move was not the right way to tackle the workforce crisis. 'The best way to ensure GPs trained in the UK work in the UK is to address the unsafe workload and morale-sapping bureaucratic burdens general practice currently has to contend with,' he said.

GP investment

'That requires significant and sustained investment in general practice and government - NHS England, Health Education England and others have to step up their work to deliver this investment. Compelling doctors to work in general practice is not the way to deliver a quality service or improve GP recruitment but introducing incentives such as paying off student debts could have a role to play.'

GPs who backed mandatory service cited the cost to taxpayers of training as a justification. Some called for flexibility to complete service, potentially after a spell abroad.

One respondent said: 'A huge amount of resource is given to training. It's rather like being in the forces - you sign up, they train you, you have to commit.'

Another wrote: 'Given the investment taxpayers have made in their training, some "return" must be sought. Furthermore we cannot afford to lose young trained doctors as happens now.'

But many GPs commented strongly on the potentially damaging impact of mandatory service.

One respondent said: 'How does conscription help? And what does the call for conscription tell us about the attractiveness of the job? Why not make the job more attractive and solve it that way? The work is great - but the job stinks.'

Another GP said: 'It should be made sufficiently attractive and sustainable to mean GPs want to stay in the UK. Making it compulsory will just mean fewer doctors opt to be GPs.'

GP training

One respondent pointed to NHS service carried out during training: 'By the time a GP is fully trained they have given at least five years of postgraduate service to the NHS. If the government is not prepared to offer reasonable terms and conditions of work these highly trained and hard working doctors should be able to work wherever they choose. It is down to the government to decide whether it is going to offer acceptable terms and conditions. If not, newly-trained GPs should be able to vote with their feet.'

Linking a period of NHS service to reduced student fees was an idea mooted by several respondents. 'Obligatory service only if the government scraps tuition fees for medicine and provides a bursary as provided for other healthcare degrees, then having to stay for F1 and F2 seems reasonable - might make it three years to encourage UK-based specialist training,' said one GP.

Another said: 'Maybe if they wish to leave so soon after training they should pay back some of the costs. Alternative would be to "bank" the need to work for five years in the NHS - they can travel when younger then return to UK. If not returning, then have to "buy out" the commitment to the NHS.'

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