Can the NHS attract more GPs?

Critics say a scheme to attract qualified GPs back to work or from overseas may not do enough to boost recruitment. Siobhan Chan reports

Vacancies: Can the I&R scheme boost GP recruitment?
Vacancies: Can the I&R scheme boost GP recruitment?
With recent figures showing that more than one in five GPs in the UK has been trained abroad, it is clear that overseas-trained GPs are sorely needed in the NHS.

The Induction and Refresher (I&R) Scheme, launched by Health Education England, NHS England, the BMA and the RCGP this month, aims to make it easier for overseas GPs to practise in the UK, to encourage UK-trained GPs back from abroad, and to bring back GPs from career breaks.

It offers a £2,300-a-month bursary for GPs going through an induction and assessment programme.

But doctors applying to work in the UK say that while the I&R scheme is an improvement on previous ‘haphazard’ local initiatives, it still needs major changes.

As part of the scheme, GPs have to take a multiple choice clinical knowledge test (MCQ), and are assigned a supervised placement for two weeks to six months based on their performance, before they can be put on the performers list.

But with some GPs reporting long waits, repeated checks and bureaucracy, and warning that overseas colleagues have been deterred from practising in the UK, will the I&R scheme boost GP numbers?

Application headache

Dr Nancy Loader trained as a GP in the UK before leaving to practice in New Zealand.

After deciding to return to the UK, she arrived in February to start her role at the Beccles Medical Centre, Suffolk, but found that she had to repeat previous checks. She was then told she had to apply to the new I&R scheme and has to wait until June for the next MCQ.

She says she is ‘saddened and disgusted’ by the situation, which has left her unemployed.

‘The UK is short of 8,000 GPs - so why are they making it worse by turning away or stonewalling experienced UK-trained GPs who are motivated to return from Australia and New Zealand?’ she says.

Dr Loader believes the I&R scheme is still surrounded by unnecessary bureaucracy.

‘I don’t think it’s going to be particularly helpful to UK doctors in New Zealand either, because it’s still very difficult,’ she says.

‘They still insist on GMC registration first and that means you have to come over and have an ID check, then go back and do the MCQ, then eventually come back again. An awful lot of people are going to be guinea pigs for that process to start with.’

Dr Tim Morton, a GP partner and Dr Loader’s potential employer, says: ‘The new system is still far from good enough – it’s hugely bureaucratic.

‘She’s not the only Antipodean trying to get back to the UK who’s found the hurdles insurmountable.’

Dr Tim Wilson, a GP who was trained in New Zealand but is originally from the UK, has been preparing to return for months.

He says the ‘obstacles are formidable, with bureaucracy in triplicate’.

Applying to join the GMC’s GP register has meant spending 500 hours putting together a 1,000-page document. He will need to come to the UK to join the register, before applying to the I&R scheme. Dr Wilson says the process should be more co-ordinated, meaning GPs have to complete fewer steps: ‘You could dovetail these together rather than making it seem like an uphill hurdle race.’

One of the selling points of the I&R scheme was making the GP National Recruitment Office a single ‘constant point of contact’ for applicants, to speed things up compared with previous local schemes. But the process still lacks co-ordination, Dr Wilson believes.

‘I don’t think anyone has designed the process with an overall view to making it efficient – any significant gap between the stages constitutes a potential financial barrier.’

The I&R scheme ‘adds a degree of uncertainty,’ Dr Wilson says, because until the results of the assessment come back, it is unclear how long the placement will take. ‘It’s anything from a few weeks to a few months, during which you’ll be paid this bursary. But is £2,300 a month enough to support a family?’ he says.

‘I view it as a positive thing that there is a national scheme that provides certainty and clarity – it looks to me like an improvement – but it could all be made a lot more unified and streamlined.’

Dr Loader and Dr Wilson say that friends and colleagues who had been considering coming to practise in the UK have been put off after hearing about their experiences.

‘Basically everyone I’ve spoken to out here who’s thought of doing this has been put off when they realise the amount of paperwork they’re going to have to provide,’ says Dr Wilson.

‘You basically have to commit all of your spare time for a year. Most people, when they look at what’s involved, say life’s too short.’

Dr Loader has said that if she’d known about the difficulties getting onto the performers list here, she ‘would have stayed in New Zealand’.

Dr Morton says: ‘I don’t think the I&R scheme will help – I think the damage has been done. The way they’ve treated Nancy and the others has done far more damage then they could ever believe. You’re not going to apply when you see how other people have been treated.

‘They’ve managed to in essence cut off any chance of recruitment from New Zealand and Australia. The reputation of the NHS has gone down the pan as far as recruitment
is concerned.’

Dr Morton and the New Zealand GPs believe the solution lies in intercollegial recognition between the RCGP and equivalent colleges in New Zealand and Australia, who use similar accreditation systems to the UK.

However, the RCGP says that this is ‘beyond the college’s remit’.

‘According to performers list guidelines, anyone who has not practised in the UK for two years or more no matter where they got their qualification would still need a period of induction into the NHS,’ says RCGP chairwoman Dr Maureen Baker.

Improvements needed

Dr Baker says the scheme will ‘undoubtedly simplify the processes and minimise the costs involved for trained GPs’ but admits that further improvements still need to be made.

‘The I&R scheme is a welcome step in the right direction, but it is a work in progress and we are still working to make the new scheme as transparent and user-friendly as possible,’ she says.

GPC deputy chairman Dr Richard Vautrey, too, is positive about the scheme.

‘I think the revamped returners’ scheme should improve things and provide a degree of consistency,’ he says.

‘It will take some months to know whether there are any significant numbers of GPs wanting to use the scheme, then we’ll need to assess it as time goes on.’

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