Earlier this year, NHS England announced plans to recruit around 2,000 overseas GPs by 2020 to help tackle the current recruitment crisis. Some 600 of these GPs are expected to be in post in 11 areas of England by April 2018.
The numbers involved are a significant increase on the original plan to recruit 500 overseas GPs, mostly from the EU. But, given the scale of the crisis facing the GP workforce, it is perhaps not surprising NHS England has had to start looking elsewhere to bolster numbers.
Latest workforce figures from NHS Digital show that almost 1,300 full-time equivalent GPs have been lost from the NHS workforce over the past two years. Meanwhile, even though Health Education England has recruited more doctors to GP training posts than ever before, GP leaders have warned this will not be enough to reverse the current crisis.
What are NHS England's plans?
Under NHS England’s plans for overseas recruitment a new GP International Recruitment Office will be set up to manage the operation and a framework will be put in place for recruitment providers to identify potential candidates and support them in the hiring process. More detail is expected from NHS England on how this will work later this month.
Recruitment will initially focus on doctors in the EEA whose GP training is recognised in the UK and can automatically join the GMC’s GP register.
However, as part of the programme the RCGP and the GMC will review the training and assessment processes for GPs trained outside the EEA, starting with Australia. NHS England believes this could help to ‘streamline the GP registration process for those doctors whose training is seen as equivalent to the UK GP programme’.
How will it work on the ground?
The move to expand overseas recruitment follows successful pilots in Lincolnshire, Essex and Cumbria, which have involved EEA doctors. So how will this scheme work on the ground?
Lincolnshire is the most advanced of the current pilot schemes. Dr Kieran Sharrock, Lincolnshire LMC medical director, explains that it was established in spring 2016 and attracted 260 expressions of interest. Now, 26 doctors are working in 16 practices in the region.
The fully-qualified GPs have come from seven EU countries: France, Spain, Italy, Poland, Romania, Lithuania and Croatia having gone trough eligibility language assessment and face-to-face interviews with practices.
‘We had two to three rounds of interviews so practices could meet all of the candidates,’ explains Dr Sharrock. ‘We matched them up by asking practices to rank candidates in order of preference, and vice versa.’
What training do GPs receive?
To meet all the regulatory requirements for entry on to the national performers list, the doctors in the Lincolnshire scheme first attended a 12-week residential intensive training programme at a campus in Poland. ‘This aimed to get candidates’ English language and knowledge and skills around basic NHS processes up to scratch,’ says Dr Sharrock. ‘They were given bursaries to attend.’
Each doctor completes a learning needs assessment, which feeds into their individualised personal development plan. They also have an individual clinical educational plan, which follows a similar blueprint to the MRCGP, covering areas including: clinical updates, screening and immunisation updates, medicines management and prescribing, regulatory aspects, primary care administration, unscheduled care and the role of allied health professionals.
In addition, the recruits have undertaken mandatory online training requirements such as infection control, information governance and safeguarding
The GPs will be mentored by their recruiting practices, for which surgeries have been given a small amount of funding, Dr Sharrock adds.
‘A well-structured training programme and induction is key,’ Dr Sharrock explains ‘English general practice is unique since we have a broader and deeper knowledge of medicine than in many other countries. We used the RCGP curriculum to identify learning needs and had a training programme built locally.’
What other support is provided to GPs?
However, it’s not just about training and education. The scheme relies on providing a high level of support to doctors and their families in the relocation process and settling into a new and unfamiliar area, says Dr Sharrock.
‘We have a full-time person meeting and liaising with the candidates, looking for houses for them and their families, identifying schools, finding jobs for partners and arranging details such as phone contracts. Practices have also given a lot of support to GPs and the LMC is also providing ongoing support.
‘Ensuring this help is in place is vital to the success of the scheme and its importance cannot be over overestimated,’ Dr Sharrock adds.
What do patients and practices think?
Patients in Lincolsnhire have responded positively to the new GPs. ‘It’s been overwhelmingly positive,’ says Dr Sharrock. ‘Patients and practices have been very welcoming, I haven’t heard a single negative comment.’
In Essex, the international recruitment work is being led by Castle Point and Rochford CCG, which is working closely with a commercial recruiter to bring in a targeted 50 GPs from overseas.
‘Ten EU GPs have been appointed so far across Essex,’ says Tricia D'Orsi, Castle Point and Rochford CCG's chief nurse. ‘Three of those have completed the preparatory phase and are embarking on the national Induction and Refresher Scheme (IRS) and one is waiting to be put on the national performers list before enrolling on the IRS.’
Dr Brian Balmer, chief executive of North and South Essex LMCs says the LMCs are in favour of the scheme and, despite it being small scale in terms of actual doctor numbers, it is making a difference at practice level.
For example, it has boosted morale, he says. ‘One practice that lost a couple of partners has had a new GP join them and it has lifted them a bit and given them help and support.’
Dr Sharrock thinks the international recruitment scheme is key to helping address the shortage of GPs and providing support to practices now. ‘Ideally, we would be training doctors born and bred in this country and who understand our general practice systems,’ he says. ‘But even if we start doing that now it wouldn’t come to fruition for seven to 10 years. This scheme is plugging the gap now.’
He also highlights that the cost of training someone to be a GP from A-level qualifications onwards is around £600-700,000. ‘Even if the total cost of bringing in and training a new recruit from abroad is £100,000, which is an over estimation, that’s still more cost effective. It’s also quicker, they can be up to speed within a year.’
Dr Radhi Sultan is a GP partner at the Ingham Practice in Lincoln, one of the practice’s involved in the Lincolnshire pilot. The practice has recruited Dr Mihaela Koroknai, who is originally from Romania, under the scheme.
Dr Sultan believes the programme has been positive. ‘Having a full time GP is a great help in managing the workload of the surgery,' he explains. 'Dr Koroknai has proved to be very popular and an excellent clinician. I am sure she will contribute significantly to the improvement of patient care. We have had excellent feedback from patients who have seen her.
‘Bearing in mind the shortage of GPs in the country, this is a very good programme that addresses this recruitment issue.’
Dr Koroknai worked as a surgeon and a GP in a large practice in her native Romania. She says her move to the UK has been ‘a mixture of enjoyment and a challenge'.
'It is a new culture for me, but I am very proud to work here,' Dr Koroknai says. 'I was working in a very busy surgery in Bucharest when a recruiter came and offered us the opportunity. My background is in surgery and I had worked in London for three years so I knew how good the NHS was. It was not a difficult thing to choose to do – it was a marvellous chance.'
Dr Koroknai says that she prefers Lincolnshire to her time in London. 'It is more friendly, calm and a better environment to live in. The people are much more friendly. I am planning to stay here.’