Doctors have cautiously welcomed new government plans to create more medical student training places, but some warned more needs to be done to strengthen and retain the current workforce if staffing issues within the NHS are to be resolved.
The Department of Health announced plans to create 500 extra medical school places next year as part of previously announced plans to boost medical student numbers by 25% by 2020.
"This announcement should be welcomed as both an attempt to redress the balance in what is an 'under-doctored' service compared to similar countries, and to recruit a more diverse medical workforce," Dr Tom Oates, a senior registrar in London, told BuzzFeed News.
But, he added, "given the well documented issues around retention of junior doctors after foundation training, and the fact that Health Education England's recent listening exercise on improving junior doctors' lives seemed to result in very few concrete action points, it can only ever be half of the battle to driving up the numbers of active doctors."
While the number of applications to medical schools have dropped in recent years, with some universities offering clearing places to medical degrees for the first time ever last year, the course remains substantially oversubscribed.
Current staffing issues seem to be less about the number of doctors entering the workforce and more about the low number of them staying in it.
The government hopes the creation of the new places will eventually help to ease staffing pressures in the NHS, as well as increasing diversity in the medical profession by offering many of the new places specifically to students from disadvantaged backgrounds.
The plans have been criticised by doctors who believe more needs to be done to address staff shortages in the current workforce, as while the new places are welcomed, it will be almost a decade before those doctors will be staffing hospital wards.
Medical degrees typically last six years, so 2018's intake will not enter their first year of training as a qualified junior doctor until 2024. Junior doctors then train for around 10 years – if they don't take any breaks in their training, which many do –before progressing to consultant stage.
One of the main reasons for staff shortages in the NHS is retention of doctors once they are qualified, with many choosing to leave the profession at various stages of training. According to the Royal College of Physicians, 44% of consultant physician posts advertised were unfilled last year as a result of an insufficient number of junior doctors completing their training.
There is also a shortage of junior doctors choosing to take up certain specialties, psychiatry in particular, despite an increased number of training places. Figures released by Health Education England, the body responsible for training junior doctors, show that the number of doctors taking up psychiatry training places had fallen by almost 20% between 2016 and 2017.
Dr Ben White, a junior doctor who was instrumental in campaigning against the government's proposed changes to the junior doctors contract last year, told BuzzFeed News that far more needed to be done to ensure doctors working now remained in the workforce.
"We need guarantees on the number of doctors we will have providing teaching and training to junior doctors, as well as reassessment of what has and hasn't worked with the new junior doctors contract," he said.
Changes to medical leadership is key to this, White said: "We should be working with doctors and nurses groups and unions, not against them, and boosting morale with positive messages about all healthcare professionals rather than constant attacks."
Morale among staff in the NHS is at an all-time low, and is regularly cited as a key reason for poor staff retention. White said he believed even simple changes such as providing doctors with their working rotas more than a week in advance and offering doctors adequate car-parking and hot food at work would go a long way to tackling this.
The British Medical Association, the union that represents doctors, also welcomed the boost in student numbers, but believes more attention needs to be paid to tackling issues facing the current workforce if the government is to ensure there are enough doctors working in the NHS.
“The students who will benefit from these new placements will take at least 10 years to train and become senior doctors so we mustn’t forget this promise won’t tackle the immediate shortage of doctors in the NHS, which could become more acute following Brexit," a BMA spokesperson said.
"As such we require equal focus on retaining existing doctors in high-quality jobs, which will provide more immediate relief to an overstretched medical workforce.
“This proposal isn’t necessary as only a small minority of doctors do not complete their training in the NHS and it would only serve to worsen poor morale and potentially discourage students from choosing medicine."
Health minister Philip Dunne said: “Not only is this the biggest ever expansion to the number of doctor training places, but it’s also one of the most inclusive; ensuring everyone has the chance to study medicine regardless of their background, and ensuring the NHS is equipped for the future with doctors serving in the areas that need them the most.”
Laura Silver is a reporter for BuzzFeed News and is based in London.
Contact Laura Silver at firstname.lastname@example.org.
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