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NHS: Doctor Retention

Volume 802: debated on Wednesday 4 March 2020


Asked by

To ask Her Majesty’s Government what steps they are taking to improve doctor retention in the National Health Service upon qualification.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and in doing so declare the interest that my wife is a retired full-time senior partner in general practice.

My Lords, this Government are committed to growing the workforce by 6,000 more doctors in general practice as part of their manifesto commitment. Doctor retention is a huge part of this commitment, which is why we are making changes to support general practitioners, including the GP retention scheme, a two-year primary care fellowship programme, the new partnership programme and the locum support scheme.

I thank the Minister for that Answer, but are there not two particular issues? The first is medical school intake. According to the latest figures, for 2018-19, nearly 9,000 more female medical students were taken on than male ones. As the House will be aware, 75% of the female intake work only part-time. Secondly, is there not also the question of the return to service agreements? This is something that we in this country use for medical Army, Navy and Air Force personnel. Is it not time to look at what Singapore, Canada and Australia have done? If it works in those areas, should we not look at it for the NHS?

My noble friend makes a good and fair point on return to service agreements. Service time for doctors was tested in 2017; the results were mixed and had a negative impact on the number of applications. However, on his point on female attendance for education, I do not recognise his numbers and I completely reject the idea that there might be too many women working in the NHS.

My Lords, I regret to say that one of the key issues is not being addressed by the Government. Increasingly, inevitably, medicine is becoming a very academic subject; academics at the highest level are now going into medicine. There is a major problem with those academics being attracted to research in the NHS. So many doctors are now looking for alternatives because they cannot do research within the NHS. That is a loss to the NHS and, I am afraid, a loss to medicine. We must do something about research in parallel with clinical treatment.

The noble Lord makes a very important point on the importance of medical research to the NHS’s achievements. For this Government, though, the focus of recruitment is on primary and front-line care. Our investment in research remains undiminished, but the new retention commitment is very much about delivering value and clinical delivery for patients.

My Lords, I thank the Minister for his support for women in medicine—being one, I should declare that interest. Will he look actively, with NHS trusts and the GMC, at trying to dissuade people from retiring early and making it easier for them to come back part-time without having to jump through multiple hoops, so that we do not lose many years of wisdom from the NHS for those who no longer want to work full-time in their main specialty but have a great deal to contribute in teaching, research and clinical practice?

The noble Baroness makes a very important point. It is clear that the lifestyles of clinical professionals in the NHS are changing. Many choose to take time off after their studies before joining practice and many seek to return after taking time out from professional front-line work. It is 100% the responsibility of—and in the interests of—the NHS to make that journey as quick and easy as possible.

My Lords, last year the Health Foundation reported that there had been no progress towards the Government’s target of 5,000 extra GPs by this year, mainly because of issues of pay, lack of investment in learning and development, and the stress of the job. Can the Minister update us on whether that target will be met this year?

The noble Baroness’s figures are not exactly the same as the ones I have. Last year, 3,250 students were studying to be doctors; this year there are 3,500, and next year there should be 4,000. Those are the numbers provided to me. If there is any difference between the two, I would be glad to discuss them with her elsewhere.

My Lords, does my noble friend agree that the well-being of doctors is a critical factor in this? He will recall that Professor Michael West and Dame Denise Coia produced a report commissioned by the General Medical Council at the end of last year. Will the Government and the NHS work together with the GMC to try to implement their recommendations?

The culture of the NHS and the well-being of those who work in it are of paramount importance. Getting that right is the focus of the NHS people plan. Working with the GMC on all these arrangements is a priority for the Government and I would be glad to follow up my noble friend’s suggestion.

My Lords, I thank the noble Lord for organising the meeting that we have all just come from; everybody there very much appreciated it. I am sure he agrees that seeing so many doctors leave the NHS in the early stages of their careers is very worrying. Indeed, it will worsen the recruitment crisis that we are seeing. What steps are the Government taking to understand the driving forces of and the motivating factors for the exodus from the UK’s medical training programmes? Have the Government committed to collecting that information from doctors who have left? Understanding that must support strategies for getting them back in again.

The noble Baroness makes an important and fair point. Understanding why people depart is very important. Departure rates are too high for us to hit our objectives and raising retention rates is important. However, I emphasise that the leaver rate has not increased as she implies. In 2014 the rate was 14% and in 2018 it was 15%. That is not a huge increase but it is too high and we are finding ways to address it.

My Lords, in his initial response to the Question, the Minister referred to initiatives to increase the number of GPs. Does he have an estimate of how many GPs will be created through these initiatives, and by which year does he anticipate that the additional 6,000 might be achieved?

The initiatives that I described—the two-year primary care fellowship programme, the new-to-partnership payment and the locum support—are retention rather than recruitment initiatives, but an important part of our recruitment proposition is that those seeking a career in medicine think of it as a rewarding and fulfilling long-term career. As for the numbers we are seeking, we are already hitting the targets for graduate positions, and we have been encouraged by the response.