Written evidence submitted by The University of Plymouth (RTR0081)

Introduction to organisation

The Collaboration for the Advancement of Medical Education Research (CAMERa) exists to improve the development and sustainability of the healthcare workforce through high-quality research. Our research programme is supported by external funding bodies including NIHR, Erasmus Plus, GMC, GDC, HEE, Health Foundation, Medical Council of Ireland, Advance HE, and the Department for International Development. The CAMERa research team sits within the Plymouth Institute of Health and Care Research group, where researchers within the Faculty of Health focus on research related to the Future Ready Workforce. The team come from a range of disciplinary backgrounds and use a mix of qualitative and quantitative research methods.

Our world-leading research investigates workforce sustainability, seeking to address the critical questions and develop tangible solutions that have local, national and international impact. Our work focuses on three main themes:

1. Workforce development
2. Continuum of education in healthcare careers
3. Professional regulation

The areas of research we specialise in are capability, preparedness for practice, recruitment, selection, remediation, revalidation, resilience, fitness to practise, and migration of healthcare professionals.

Areas of evidence we can contribute to

• What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?

Our work on the migration of doctors answers an aspect of this question specifically why doctors are choosing to migrate overseas.

Migration from the UK:

• Currently around 4% of doctors are giving up their right to practice in the UK each year, with around half stating their reason for leaving as ‘overseas’.
• The number of doctors leaving, including those that leave to move overseas, has fallen since 2015.
• A much higher proportion of non-UK Primary Medical Qualification (PMQ) doctors leave to move overseas than UK trained doctors, especially doctors with a European Economic Area (EEA) PMQ.
• The most popular place UK PMQ doctors migrate to are other English-speaking high-income countries, especially Australia and New Zealand
• A similar proportion of male and female doctors leave to move overseas each year.
• The highest proportion of UK PMQ doctors moving overseas are under 30, whereas the highest proportion of non-UK PMQ doctors moving overseas are aged 30-39.
• Doctors on neither the specialist or GP register and not in training are more likely to leave to move overseas than doctors on other register types.
• International Medical Graduate (IMG) doctors, especially doctors with a PMQ from Middle Income Countries, spend longer on the medical register before leaving than EEA doctors. However, the gap has closed since 2013.

• Ireland and New Zealand have a higher reliance on foreign doctors than the UK.

Our systematic review of the literature identified the following drivers as being most important:

1. Macro-level: poor working conditions in the UK, attractive working conditions overseas, and employment opportunities
2. Meso-level: pushed/desire to leave the NHS, better training and development opportunities, feeling undervalued professionally
3. Micro-level: better quality of life, family reasons, desire for a life change, financial gain for self.

The qualitative interviews with stakeholders confirmed that many of the reasons associated with attracting doctors to the UK, also constituted push factors for UK doctors to decide to leave the UK and practise abroad, typically in Australia, New Zealand or mainland Europe. Two factors that aid migration are the extent to which the destination health system is comparable to the UK, and the ease of the registration process within the destination country. Doctors in the UK are attracted to emigrate by the general notion of a better balance between work and one’s personal life, and overall a better quality of life. There is a perception of a better work-life balance, a better work rota, the ability to take breaks during working hours, and have days off and protected annual leave, as well as a greater appreciation of well-being. These factors are extremely significant because altogether they contribute to better employee well-being, but also a sense of appreciation, of being valued professionally, and of being able to provide better patient care. Finally, UK-PMQ doctors may also be drawn overseas by the desire to experience a new healthcare system. Stakeholder interviewees described this migration trend as a rite of passage that will make them a more competitive and well-rounded candidate with a more interesting CV.

• What changes could be made to the initial and ongoing training of staff in the health and social care sectors in order to help increase the number of staff working in these sectors?

Our work on the migration of doctors, which involved an analysis of secondary data, showed that the vast majority of doctors migrating to the UK do not join the GP or specialist register at the time of initial entry and relatively few go on to gain specialist or GP registration. Looking at the cohort of doctors that registered in 2009, within 5 years only 448/3,860 doctors (11.6%) had joined the specialty register, but for those that have been on the register for 10 years (2019) the percentage rises to 27.2% (2009 cohort). Training opportunities and support provided to these doctors need to be examined to understand why this is happening, and to make changes to ensure that more of these doctors gain appropriate accreditation to join the specialist and GP registers.  

• What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?
• What can the Government do to make it easier for staff to be recruited from countries from which it is ethically acceptable to recruit, with trusted training programmes?

Our work mapping basic dental training across the UK and EU member states illustrates the challenges of recruiting healthcare staff from outside the UK. Establishing what constitutes a ‘trusted training programme’ is complex, and our research found:

• Only seven EU member states had national level curricula or learning outcomes (Belgium, Finland, France, Germany, Ireland, Spain and Sweden).
• For some countries, there was a lack of easily accessible information about the training processes and standards in place.
• The extent of clinical experience with patients that dental students are exposed to during their basic clinical training varies, and requirements in some countries for additional vocational training as a prerequisite for full registration should be taken into account where dentists may seek to migrate following completion of their basic training but without completing that additional clinical training.
• Processes for quality assuring dental education vary considerably.
• Due to differences in training provision between institutions within countries, approving training programmes at a national level may be problematic, especially where there are no national curricula or learning outcomes in place.

References

Brennan N, Langdon N, Bryce M, et al. Drivers of international migration of doctors to and from the UK, 2021.  https://www.gmc-uk.org/-/media/documents/drivers-of-international-migration-research-final-report_pdf-88769526.pdf. Accessed 14th January 2022.

Gale T, Bryce M, Burns L, Hanks S, Zahra D. Review and mapping of basic dental training in EU member states: final report, 2020. https://www.gdc-uk.org/docs/default-source/research/review-and-mapping-of-basic-dental-training-in-eu-member-states6453cb89-113a-4197-85bf-52564a644da8.pdf?sfvrsn=29396567_3

Professor Tom Gale, Dr Nicola Brennan, Dr Marie Bryce

Collaboration for Medical Education Research,

Plymouth Institute of Health and Care Research,

University of Plymouth

Jan 2022

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