A&E doctors driven abroad by ‘toxic’ stress levels in NHS
A THIRD of A&E doctors have moved abroad in the past five years due to “toxic” levels of pressure, Britain’s most senior casualty doctor has said.
Dr Cliff Mann said the health service is facing “an existentialist crisis”, squandering hundreds of millions of pounds on training doctors who then turn their back on the NHS, and yet more plugging gaps with locums.
Half of all trainee casualty doctors – who each cost around half a million pounds to train – are abandoning the speciality within four years, the president of the Royal College of Emergency Medicine said. To cover the shortages, the NHS is spending as much on locums in a fortnight as it would cost to run a whole A&E unit for a year, he said – a situation he described as “madness” that made a “nonsense” of claims there was not enough money to tackle the issue, he told the King’s Fund in London.
More than 600 consultants and trainee A&E doctors have gone abroad within five years he said, the vast majority to Australia. Those who moved said it was because hospitals abroad were better staffed, with lower stress levels and a “non-toxic environment”,
On current trends, within a decade Britain will spend more money training casualty doctors who emigrate than it does on those who stay here, he said.
The British Medical Association has raised fears of an exodus of junior doctors in a growing backlash against a new contract which will remove premium pay on evenings and Saturdays. More than 1,600 UK doctors registered to work overseas in just three days last week – 20 times as many as normal.
Dr Mann said it was crucial for the NHS to do more to stop high levels of burnout among A&E doctors.
Training doctors is expensive. The NHS rightly invests heavily in those who will care for us and determine the health of the nation. At about £500,000 for a GP and a quarter of a million more for consultants, the costs aren’t remotely covered by the tuition fees they pay as undergraduates. Yet some young doctors are taking the skills they have acquired at British taxpayers’ expense overseas. The General Medical Council reports a surge in those seeking to move abroad to work – there were almost 1,700 applications last week alone.
It is time for us to require those trained at our expense to work a number of years in the NHS before working abroad.
An Army doctor who has been supported through university must promise to serve for six years after qualifying. A civilian doctor, who costs roughly the same to train, can leave the very next day and take a job in Australia. This is not right.
In the Armed Forces we call this commitment “return of service”. The longest is for fighter pilots, who cost around £4 million to train. They must serve for 12 years so that the RAF can get a worthwhile return on its investment in their exceptional skills. Only then can they leave without paying a penalty – buying themselves out, as the expression goes – and join the more lucrative commercial sector.
This commitment is not simply financial. GPs take time to train and gaps cannot be filled overnight. We spend £5 billion a year on training new medical personnel. Yet an increasing amount of that money is going overseas. Every year some 5,000 doctors leave the UK. The most popular destinations are Australia, Canada and New Zealand. These are wealthy countries benefiting from British taxpayers’ expenditure. It is hard to argue this is the best use of resources when our population is ageing and in need of greater investment in medical services.
That’s why I suggest introducing a “return of service” obligation for our medical staff.
This isn’t about punishing those whose lives take a turn they didn’t expect, or about stopping those who decide medical life isn’t for them. It is about ensuring the medical services, like the Armed Forces, are able to meet their commitments to the British people and, when necessary, recover the money needed to train a replacement. Putting a figure on the commitment, whether in years or pounds, is a way of ensuring everyone understands the investment being made in training.
For most doctors, as for most servicemen, the contract would be irrelevant. But to some, it would serve as a reminder that the decisions they take affect not just them but the whole country. It is impossible to fill gaps in a hospital if every time you train up a replacement, they leave.
Of course there will be exceptions. Unforeseen circumstances may mean individuals wish to leave medicine or the UK. In that case the investment, or a portion of it, can be paid back so someone else can be trained instead. In exceptional circumstances, the cost may even be waived.
But the principle should be recognised that the investment of taxpayers’ money demands a return for the taxpayer. Just as in the Armed Forces, NHS doctors are commissioned to serve.