Anthony Browne is MP for South Cambridgeshire, the Chair of the Conservative backbench Treasury Committee and a member of the Treasury Select Committee.
One of the Government’s most pressing priorities is to tackle the post-pandemic NHS backlog of 6.4 million people. But doing that is made harder by staff shortages in the NHS – there are over 100,000 vacancies, 10,000 of which are for doctors.
We need more doctors and nurses, and we are not starting from a position of strength. The UK has around 2.8 doctors per 1,000 people, compared to the OECD average of 3.5. Many of our Northern European neighbours have more than four doctors per 1,000.
The Government is making progress on its commitments to increase the numbers of nurses and GPs. But we clearly need to go further. The short-term way to do that is to recruit more from overseas, reduce the numbers that leave the profession, not least by early retirement, and increase the help provided by others such as pharmacists
But the only sustainable long-term solution to ensuring we have enough doctors is to train enough doctors – something the new Chancellor and former Health Secretary, Jeremy Hunt, has previously championed. The Government has already increased the number of training places – in 2018, we delivered 1,500 more medical school spaces and five new medical schools, a 25 per cent increase in places. We have also introduced medical apprenticeships, an exciting new development. But to train enough for our own needs, we need to train about 50 per cent more than we currently do.
For decades, the UK failed to train enough doctors secure in the knowledge that we can recruit from overseas. We are not alone – when it comes to training numbers, we are in the middle of the pack amongst OECD countries. We train 13.1 medical graduates per 100,000 inhabitants, more than the US (8.5 per 100,000) and Germany (12) but behind Italy (18.7) and world leaders Ireland (25.4).
The UK has rather prioritised recruiting doctors from abroad. In 2021, over 50 per cent of new doctors registered to the General Medical Council were trained outside the UK and the European Economic Area. Over 500 doctors came from Sudan, which has a doctor to patient ratio of 0.3 doctors per 1000 people, one tenth of the UK rate. Sudan, like many of its African neighbours, is one of the 47 countries that is deemed to have a severe shortage of doctors by the World Health Organisation – and so is on the UK government’s “red list”. That means that “active” recruitment is not allowed in these countries, but passive recruitment continues apace. The GMC offers the Professional and Linguistic Assessment Board test in Sudan, Ghana, Pakistan, and Bangladesh for those who want to come to the UK independently.
International doctors are rightly very welcome in the UK, and make a vital contribution both to patients and to science, bringing fresh ideas and experience. Many of the UK’s top doctors are trained overseas. We should ensure they continue to be welcome.
But by refusing to train enough doctors for our own needs, we are contributing to the global shortfall of 6.4 million doctors. The ethics of relying on recruitment from less developed countries is questionable, and directly goes against our ambition to promote international development. As the world’s fifth biggest economy, we have a duty not to contribute to the global doctor shortage.
But it is also not in our own long-term interest. We cannot guarantee our ability to attract 10,000 doctors a year as other countries face similarly ageing populations and as the global shortage of doctors becomes acuter.
Increasing doctor training will also help levelling up, and help ensure we have doctors in parts of the UK where it is currently most difficult to recruit. Unsurprisingly, doctors tend to want to work close to where they trained. The new medical schools would be targeted at areas with the acutest shortages and would focus on recruiting locally. The new schools, like Sunderland, have been a success, helping relieve shortages in areas that have had historical staffing problems.
Increasing the number of training places will also increase opportunities for young people desperate for a medical career. It is a tragedy that the UK has the talent and is squandering it, with the rejection rate from UK medical schools about 90%. The people we turn away are intelligent and ambitious, many with straight A*’s, and would make great doctors. Many are forced to move overseas just to get medical training denied by their own country.
Nor is it in our economic interest. My constituency is the life science capital of Europe, and the sector is absolutely booming. Being a world-leader in life science is key to our future economic growth, but it relies heavily on a steady supply of trained doctors to work in research and run clinical trials.
The main medical professional bodies have all been pushing for “self sufficiency” in doctors. At the recent Conservative Party conference, I attended a roundtable on the need to increase the number of training places with the heads of the British Medical Association and presidents of many of the Royal Colleges. Currently, there are 9,500 places for budding doctors each year, and medical bodies are proposing that we increase that by around 5,000 places to 14-15,000, an increase of over 50 per cent.
So when there are such strong arguments for increasing the number of doctor training places, why has the campaign stalled?
The answer is the Treasury, which has been blocking it. It costs the taxpayer around £250,000 to send a student through medical school. If we significantly increased our medical school places, it could cost over £1 billion a year.
With our financial black hole, it is difficult to fill that gap, but it is largely based on false accounting. About 80 per cent of a doctor’s training time is spent providing clinical care, and so if we have more trainee doctors, it will reduce the need for hospitals to hire in more expensive fully trained clinical care. But also staff shortages mean that the NHS has become heavily reliant on very expensive locums and agency staff, which cost a total of £6bn a year. If we train more doctors, we can dramatically cut the bill for locums.
Fortunately, the man who championed the cause of increasing doctor training when he was Health Secretary and chair of the Health Select Committee, is now Chancellor. He understands the arguments, and is in a unique position to unblock the blockage.
We should not underestimate the difficulty of this task. It will require effective collaboration between the NHS and medical schools. While the capacity of some medical schools can be increased many of the additional places will have to come from 15 or so new schools. These schools will need access to hospitals with clinical training facilities.
But we cannot equivocate any longer. While the additional places delivered in 2018 were a good first step, the first intake will not enter the workforce until next year. They will not be fully qualified GPs until 2028. We should not delay this decision any longer. We need to demonstrate to voters, and the NHS itself, that we are the party capable of securing the long-term future of our health service.