Remove employment barriers to tackle NHS crisis, says GMC

THE General Medical Council is calling for a relaxation in rules preventing specialty and associate specialist (SAS) and locally employed (LE) doctors from undertaking a wider range of work, such as in primary care.

The regulator believes this is necessary in order to meet the challenges facing the NHS today.

Data cited in the GMC’s The state of medical education and practice in the UK: workforce report 2022 reveals that between 2017 and 2021 the number of licensed doctors in SAS and LE roles rose by around 40 per cent (from 45,578 to 63,740), while in same period the number of GPs rose by just 7 per cent (60,690 to 65,160).

This means that the number of SAS and LE doctors is growing at six times the rate of GPs and by 2030 they could be the largest group in the medical workforce. The GMC points out that existing rules, such as the Performers List (which details practitioners approved to work in primary care), restrict the roles that SAS and LE doctors can fulfil.

The GMC report reveals that SAS and LE doctors, many of whom come to the UK after qualifying in medicine abroad, are more likely to leave after relatively short spells working in the NHS. The GMC believes that providing wider career opportunities may help retention.

GMC Chief Executive Charlie Massey said: “Lots of these doctors tell us they want better career development and progression, and to have more flexibility in the positions open to them. But there are barriers that hinder their development, and rules that prevent them fulfilling some important roles.

“They are a fantastic resource of experienced and skilled doctors. If, for example, they could use those skills to complement the existing GP workforce it would begin to address some of the difficulties patients have accessing primary care, without lowering standards.”

Dr John Holden, chief medical officer at MDDUS, commented on the report: “Removing barriers with the aim of solving staffing issues the NHS is facing is a welcome idea from the GMC, as indeed is any innovation that creates sustainable opportunities for doctors and promotes patient care.

“What it must not do, however, is put a sticking plaster over a problem.

“Recruitment, retention and falling morale in general practice remains a serious issue. We are concerned that simply moving locally employed (LE) and specialty and associate specialist (SAS) doctors into primary care will not make any of these problems better.

“The SoMEP report itself highlights this, finding that ‘dissatisfaction with role, place of work or NHS culture was the most commonly cited reason for leaving’.

“In addition, what would be the impact of SAS and LE doctors leaving secondary care for primary care? We know NHS waiting lists are the highest they have ever been.

“It’s incredibly important that we don’t overlook the need for acceptable working conditions, including access to safe places to rest and the availability of decent food, in a rush to translate additional resource from one professional setting into another.”