An estimated 3,000 British medical students are currently completing their degrees in Bulgaria alone - a trend fuelled by heavy competition for UK medical school places, sky-high tuition fees and high UK living costs.
With the NHS facing a GP workforce crisis, top GPs have called for more support to help these young doctors join the UK workforce when they complete their degrees.
They add that targeting these doctors could be a better use of money than the multi-million pound international GP recruitment scheme that has brought in just 140 doctors - well short of the 2,000 the NHS aims to recruit - top doctors say.
Former BMA chair Professor Sir Sam Everington and ex-RCGP deputy medical director of assessment Dr Anwar Khan told GPonline that a ‘systematic approach’ was needed to ensure that British students who had studied abroad were helped to enter UK practice, with a view specifically to boosting GP numbers.
They revealed that British medical graduates returning from Europe had struggled to secure employment within the NHS because of a shortage of ‘stand-alone’ FY2 positions. This is the level these doctors need to enter the workforce after completing six years of training abroad.
A single application window each year is also making it harder for European-educated British doctors to apply to these posts, the two GPs say, often leaving graduates without work for a year.
They argue a special integration programme to help this cohort of British doctors learn about the culture of the NHS and how to use its systems would help to ensure safe practice.
Dr Khan, who regularly visits Plovdiv Medical University in Bulgaria, said he knew of around 250 medical students who had expressed an interest in working in general practice when they returned to the UK but for whom a ‘lack of pathways’ would make it hard for them to find jobs.
‘These doctors who have studied abroad are keen to come back to the UK - they speak the language, they know the culture and many of them have families in East London, so there wouldn't be any relocation costs.
‘But when they qualify, there are actually very few pathways to help them come back to the UK and, with increasing numbers of British students studying abroad, we’re going to need new pathways [to help these doctors return],’ he said.
Completing an internship year during the final year of their six-year course, UK graduates from Bulgaria head straight into FY2 stand-alone positions, unlike their medical students trained in the UK, who must start at the FY1 level.
However, a limited number of these positions, mixed with competition from more experienced, foreign doctors, has made it difficult for returning students to enter the UK workforce.
Ade Adetayo and Abdullah Malik, British students in their fifth year of medical degrees in Bulgaria, explained the difficulty some of their fellow students had faced.
‘We have to compete against experienced doctors with years of training applying for FY2 posts and it’s quite difficult for us because we have just qualified from medical school and we have little experience,' Mr Malik said.
Another complication for British graduates looking to work back home is that they receive their certificates later than those who have studied in the UK. As a result, the medical students say they can’t get their GMC registration in time to meet the FY2 stand-alone deadline, which is usually in August.
Dr Khan said this meant British medical graduates were waiting up to a year before applying for jobs; something which wasn’t making applying to NHS jobs any easier.
Mr Adetayo added: ‘If you’re not practising for 8-9 months, that sets back your confidence and that could be detrimental to both ourselves and to patients.’
Medical graduates electing to enter general practice could be helped by a specific induction process which would help to familiarise the doctors with the NHS, Dr Anwar and Professor Sir Sam said.
‘You need to know about the NHS systems. It might be simple things like how you use EMIS on a general practice computer or how the referral systems work. it’s those basic things,’ Professor Sir Sam said.
The medical students added that the chance to apply for FY1 positions - which they currently cannot apply for - could help them to get used to the NHS systems while being offered more support from peers, improving patient safety.
The Bromley-by-Bow GP said it was 'crazy' that the government was spending millions of pounds on attempts to recruit GPs from abroad when it could do more to support a pool of British doctors who trained abroad. The international GP recruitment scheme promised up to £100m to recruit around 2,000 doctors - but has brought in just 140 to date.
Professor Sir Sam said: ‘I think the government has spent millions trying to recruit people from abroad with very little success. Imagine if, instead, the government said: "Let’s just sort out the problem of those Bulgarian students". It shouldn’t, in theory, cost anything. It’s just a question of sorting out or making sure there are enough posts available and recognised as available.’
A Department of Health and Social Care spokesperson, said: 'The upcoming NHS People Plan will examine options for growing the workforce, including the possibility of further medical school expansion, increasing part-time study and expanding the number of accelerated degree programmes.
'Additionally, our ongoing 25% expansion of medical school places in England will see 7,500 available annually by 2020/21.'