Difficulties in replacing a fifth of the general practice workforce in England after Brexit will primarily threaten healthcare in more deprived areas, according to a study published in the open access journal BMC Medicine. 21.1 per cent of General Practitioners (GPs) employed in English primary care are doctors who qualified outside the UK (4.1% in the EEA and 17% elsewhere). These non-UK qualified doctors work longer hours, tend to be older, serve a larger number of patients in more deprived areas, and appear to be paid slightly less, researchers at the University of Manchester suggest.
Evangelos Kontopantelis, senior author of the study said: "The workforce crisis affecting recruitment and retention in general practice is likely to worsen over the next ten years. Our findings point towards a Brexit 'paradox': the more deprived parts of the UK population that voted for Brexit are the ones that will be primarily affected by the inability of the NHS to replace older, non-UK qualified GPs following Brexit and new policy-restrictions on immigration."
Professor Aneez Esmail, lead author of the study added: "The ongoing crisis in GP recruitment resulted in a promise of 5,000 more GPs by 2020 in the run-up to the 2015 elections. However, there was no increase between 2015 and 2016, so it is unclear how this target will be met in the context of hardening public attitudes to immigration. An additional promise of 1,500 new medical graduates per year from 2018 is not enough to meet the 2020 target: it will take at least 10 years for new GPs to be trained, assuming that more than the current 30% of UK graduates choose to become GPs."
The researchers analyzed data on 37,792 GPs in England and found that non-UK qualified GPs made up 21.1% of the total numbers of GPs, with the largest percentage working in East England (29.8%) and the lowest in the South West (7.6%). The areas found to be most heavily dependent on non-UK qualified GPs include the Greater London area, the East of England, the North West and North East.
Compared to UK qualified doctors, EEA qualified doctors were found to work longer hours, while doctors who qualified outside both the European Economic Area (EEA) and the UK worked longer hours than both. The authors also found that GPs who had qualified in the EEA or elsewhere worked more often on a full-time basis and that they worked in practices whose patients lived in considerably more deprived areas. This was particularly the case for elsewhere qualified GPs, according to the authors.
Practices with high percentages of EEA or elsewhere-qualified GPs had a higher number of patients per GP and more people with chronic conditions per GP, while GPs in these practices appeared to be paid less. Average pay per patient was £133, £132 and £129 for UK, EEA and elsewhere qualified GPs respectively. Adjusting for patient age and the total number of chronic conditions there was no difference in pay between UK and EEA qualified GPs, but a ten per cent increase in elsewhere qualified GPs within a general practice was linked to a £1 decrease in average pay per patient.
The authors used primary care workforce data from NHS Digital from 30 September 2016, which contains information on the location of GP practices, numbers of patients, numbers and working hours for GPs. The authors analysed characteristics of GP practices such as average working hours per GP, average pay and patient deprivation and their association with the number of overseas qualified GPs. Because this was an observational, cross-sectional study, it can only report associations and does not allow for assumptions about cause and effect.
Professor Esmail said: "This is the first investigation to evaluate the characteristics of the populations served by non-UK qualified GPs. Members of this largely undervalued group of doctors are sometimes marginalized or even stigmatized, but our study shows that they are a hard working group serving the most deprived areas of England. They are part of the solution to the recruitment crisis facing general practice and that needs to be acknowledged by policy makers and politicians."
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Notes to editor:
1. Research article:
The potential impact of Brexit and immigration policies on the GP workforce in England: a cross-sectional observational study of GP qualification region and the characteristics of the areas and population they served in September 2016
Esmail et al. BMC Medicine 2017
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