From the FMS Global News Desk of Jeanne Hambleton   Posted 28 July 2014                   By Christina Kenny Pulse Daily

Exclusive: The number of GPs applying to the GMC for certificates that enable them to work abroad shows no sign of abating, Pulse has learnt, with many escaping to Australia for the shorter working hours and higher wage.

The number of doctors applying to the GMC for Certificates of Good Standing (CGSs), a document which enables them to register with an overseas regulatory body or employer, has remained at a constant of more than 4,700 per year for the past two years, according to new figures obtained by Pulse.

GP leaders have said it is ‘alarming’ that taxpayers’ money is being invested in training graduates to become GPs, only for them to leave the NHS and have warned that the numbers could be higher, with many coming to train in the UK and returning to their country of origin to practice.

Last year Pulse reported that the number of CGS applications had risen by over 12% since 2008. The latest GMC figures show that the numbers are still increasing, although at a slower rate, with a a total of 4,741 UK-trained doctors obtained CGSs in 2013 – up from 4,726 in 2012.

Pulse has also found that a further 2,485 doctors have received CGSs in the first six months of 2014 alone, compared with 2,479 for the same period in 2013.

Figures from overseas medical regulators also indicate that the level of migration of British doctors to other countries has remained constant. Australia is one of the most popular destinations for UK doctors, with 729 granted the certificates of Advanced Standing that allow them to practice in Australia in 2013, and 945 in 2012.

The Australian Medical Council has awarded certificates of Advanced Standing to over 5,500 UK doctors since 2006, 40% of whom have gone on to complete the 12-month supervised performance assessments needed for general registration.

New Zealand is also an increasingly popular destination for UK-trained doctors, with 469 doctors added to the New Zealand medical register in 2013 and 511 in 2012, according to the Medical Council of New Zealand. Specialist medical recruitment consultants have told Pulse that other sought-after destinations include Canada, the USA and the UAE.

Guy Hazel, managing director of the Austmedic recruitment agency, told Pulse that there are fewer GP vacancies available in Australia compared to three years ago, particulary in the cities where UK GPs want to work. However the interest is still there and he sees a spike in ‘serious’ enquiries every year in August as MRCGP trainees receive their CCTs.

He said: ‘Most GP trainees who apply this August will be practicing in Australia by February next year. Most of them graduate and then spend three or four month locuming before moving over. But it is not just newly-qualified GPs – I am helping a 40-year-old GP partner from Northern Ireland to move over this week. I see a lot of partners looking to move because they are attracted to the lifestyle.

‘GPs might work a 65 hour week in the UK. In Australia, they will work 40 and probably earn more. Once they have settled and got to grips with the Australian system, which takes about three months, a UK-trained GP could easily be earning $260,000-300,000 (£143,000-£165,000)’

Paul Brooks, the managing director of the EU Health Staff agency told Pulse that many of the 100 or so UK doctors he has helped emigrate in the last year have sought to escape the ‘overwhelming bureacracy, paperwork and rationing of healthcare’ they associate with the NHS.

‘Two years ago, we would have found a job for any GP that applied. Now there are not as many jobs, and not everyone will get one – but the interest has stayed pretty much the same.’

Pulse reported last year that Australia has seen a ‘sharp increase’ in the number of overseas GPs entering the country since 2006. Mr Brooks added: ‘Money clearly plays a part in it as well. Most GPs are not earning the figures the Daily Mail thinks they are, and they can earn quite well in both Australia and Canada.’

GPC negotiator Dr Beth McCarron-Nash said that the ‘deterioration’ of primary care in the UK was likely to prompt GPs, especially those who are newly-qualified, to consider careers abroad.

She said: ‘Trainees want their work/life balance to be healthy. They see the excessive demands and workloads placed on general practice here, and decide that this is not what they want long term.’

She added: ‘It is very alarming for taxpayers to know that all that money has been invested in young doctors who are considering not working in the NHS. We need to ensure that the best and the brightest remain here.’

Dr Krishna Kasaraneni, chair of the GPC’s training committee, said that GPs of all ages and levels of experience are being lost to the healthcare systems of foreign countries. He concedes that the true number of GPs emigrating may be much higher, as the CGS figures do not include doctors from other countries who train in the UK and then return to their countries of origin to practice.

He said: ‘It is not that one particular age group, gender or location are feeling hard-done by – it is the fact that general practice is getting more and more stressful. It is about self-preservation. I do not blame any of my colleagues for wanting to leave. The workload in general practice is getting more and more every day without the resources to try and cope with it.

‘UK GPs are a great resource for any health system, but if we do not respect them, we will lose them. It is already happening.’

In the absence of any official data, the number of CGSs issued each year is the most reliable indicator of how many doctors are considering moving abroad. However, not all doctors who hold a CGS leave the country, and many of those who do remain on or return to the medical register.

The RCGP is proposing allowing GPs to have their annual appraisal whilst in another country, possibly via Skype, in a bid to remove barriers for GPs wanting to return to practise in the UK.



From the FMS Global News Desk of Jeanne Hambleton Posted 30 July 2014 PULSE DAILY

Any action which can help practices provide excellence in care must be a good thing, the chair of the Family Doctor Association writes.

The FDA fully supports any action which can support practices in providing excellence in care to their patients, with good continuity of care being the hallmark of modern traditional family practice, proven to increase patient satisfaction and reduce health care costs.

The perfect storm of reduced resources, expensive locum cover (my practice had recently to pay £1,000 for a day’s cover) and impossibility of recruitment even to desirable practices is threatening the whole future of general practice in the UK.

The domino effect is becoming a reality. If a neighbouring practice closes due to impossibility of recruitment, how will neighbouring practices recruit to service the patients allocated to them?

Market forces only work where the provider (ie a GP) is a truly independent contractor. We have so many confounding factors here that market forces cannot work. We cannot choose who we take on as ‘customers’. We have a monopoly ‘employer’. We have books of regulations governing how we run our businesses. We are inspected to death. We cannot set our own prices, nor decide what work we do. We cannot even recruit a partner without ‘permission’ from the CQC. We are dependent on the ‘employer’ for premises and for our pensions (which look much more like those of an employee than an independent contractor – also the discretionary sick and maternity pay. We cannot set our prices at a level which allows us to develop premises independently. We cannot choose our hours of opening.

So – market forces? I think not.

If the government believes so much in market forces, it must allow us to have the independence to compete in a true market, with pricing of services set by practices not by central government.

I do not see that happening. What could happen is that an entire area loses its NHS GPs and the remaining doctors set up as private GPs. As long as the government allows patients to receive NHS prescriptions (as is their right) from non-NHS doctors, the economics would work out fine even in deprived areas as no government would leave a population without health care and some subsidy arrangement would be quick to emerge. A medical fund? Panel doctors?

There is a dearth of good young doctors wanting to be GPs and we must wise up to this and work smarter with an increased use of a clinical team. But where are the training schemes for practice nurses and health care assistant to support this? Where is the demand management, which must come from Government, to allow the remaining GPs to cope?

I wonder who will be there to look after me as I head off towards senility.

Dr Peter Swinyard is the chair of the Family Doctor Association and a GP in Swindon.



From the FMS Global News Desk of Jeanne Hambleton Posted 31 July 2014


The Government has decided to scapegoat NHS GPs – and we should let them. Why work ourselves to an early grave to prove the Government wrong? Why bother putting up a fuss and bothering our trade union to ballot on industrial action? Have not you heard ‘British GPs are the most lavishly rewarded in the world’ as quoted in the Times newspaper only the other day? We must ‘drop the moral blackmail and open all hours’, it read.

What would happen if we all resigned and allowed our practices to fail? After all, we can not starve our children or live in our cars if we continue to accept negative monthly drawings for the sake of keeping our surgeries open.

How much worse does it have to get, before we are forced out? Admissions avoidance schemes, referral management schemes, delays, gate-keeping blockades, begging for remuneration, begging for practice lease renewals. Why not do their job for them and just put up a frontage sign that reads, ‘This NHS GP surgery is closed by the CQC due to safety reasons’?

We tried reasoning with the Government, but it did not work. Compromise!, we said. Allow GPs to work like dentists. But please, stop giving us money only to take double away.

But it all fell on deaf ears. It seems there is no recruitment crisis, and no funding crisis.

If we continue to work overtime for less pay, the slave master will expect this as the norm and work us harder. But if we work to rule and allowed all surgeries to fail, we would regain our lives and our self-respect. When the public sees every surgery in the country close in the run-up to the next election, it will wipe out our enemy’s chances of victory. Sweet revenge!

We would finally be in the driving seat. We could bring our old colleagues home from Australia. We could reshape the delivery of primary care on our terms – prioritising patient health needs instead of consumerism; responsibility for outcomes shared between the doctor and patients, instead of the paternalistic approach of the nanny state.

For too long we have relied on the odd brave GP sticking his or her head above the parapet on behalf of the whole profession – only to have their heads blown off in spectacular fashion.

It is time for all of us to make a stand, side by side (not 20 feet behind the leadership). Make some Plan B income provisions and let your surgery fail.

The 2014/5 NHS GP contract is financially unfeasible, and you are all about to prove it to the public.

Dr Una Coales is a GP in south London and former BMA Council member

It’s time for all of us to make a stand, side by side (not 20 feet behind the leadership). Make some Plan B income provisions and let your surgery fail.

The 2014/5 NHS GP contract is financially unfeasible, and you are all about to prove it to the public.

Dr Una Coales is a GP in south London and former BMA Council member


A crisis that is threatening to overwhelm GP services and force the closure of some GP practices. Pulse’s initiative is a timely reminder of these threats, which I believe politicians and the public are slowly beginning to wake up too.

The biggest issue facing vulnerable practices is that there is no one cause for this crisis. Rather there are many interconnected pressures that are coming to fruition at the same time. Patient demand is continuing to rocket and while GPs are working harder than ever before – performing 40 million more consultations than in 2008 – the sheer number of patients arriving for treatment is far outstripping GP’s capacity. Funding has been flat lining or declining for many practices for years, leaving them in the untenable position of doing more, with less.

A number of practices have faced an extra blow due to the phasing out of MPIG which from April has some practices in challenging circumstances begin to see a vital funding lifeline phased out. NHS England have acknowledged the phase-out will leave 98 practices in serious difficulty, while hundreds more will be affected to a high degree, but so far little has been done to help those GP services affected. The BMA has done a lot of work highlighting these cases to the public and the chair of the GPC marched with GPs from Tower Hamlets (an deprived area that could see a whole sway of practices close) to protest the issue. Practices in rural England, the commuter belt and at universities, are facing the same desperate fate.

As recent BMA surveys have shown, GP services are also being undermined by decaying practice buildings and a workforce crisis. Four out of 10 GPs say they are struggling to provide basic GP services because their buildings are too cramped and inadequate.  Around seven out of 10 are considering early retirement. Some 451 GP trainee places went unfilled in the most recent recruitment round – no-one wants to do this job anymore.

Overall, it is clear we cannot allow practices to continue to be undermined to the extent where some – even if a small number – are tipped towards closure. Any practice shutting would leave a damaging hole in local patient care and rip out a key part of the local community. We need to prevent this from happening.

There is a clear solution. We need to have long-term, sustained investment across a range of GP services. Practices need to be backed with proper resources, better premises and an expanded workforce. Most importantly we have to protect those practices on the edge. If we don’t, patients will suffer.

As well as the Pulse campaign, the BMA have also started Your GP Cares because of the crisis. If general practice starts to crumble then the rest of the health service will collapse, with disastrous consequences for patient care. General practice is in crisis – the Government must listen to Pulse and BMA’s campaign.

Dr Kailash Chand is deputy chair of the BMA and a retired GP


From the FMS Global News Desk of Jeanne Hambleton Posted 31July 2014

We have had to resign our contract after both our senior partners took early retirement in the past two years, leaving me and a colleague as the sole remaining partners. We have been unable to replace them – the first person we recruited decided not to take the job, and the second left after 18 months.

The partners are only supposed to do six sessions between the two of us, but since January we have had to work the week. We use locums where we can, but our drawings have gone down to the extent where it is costing us more for locums than it would for a partner.

We have had lots of good locums, but none of them want to take up permanent positions. One of the challenges is our premises – most new GPs prefer hospital-style surgeries, but we are based in a Victorian house. It is not ideal, but we are not in a position to move to purpose-built premises. We have exhausted all the options suggested by NHS England.

The initial plan was to look at a merger with another practice, but a large surgery nearby pulled out at the very last minute, citing recruitment as their worry. Then a group of five practices said they might be able to help by lending us a GP. But when it came down to it, they did not have the capacity themselves

Resigning was a horrible decision. We had to have redundancy conversations with our staff, some of whom have been working here for 30 years. It makes me feel like a failure. It is eased a bit by lovely feedback from patients and staff, but it has been difficult fitting in all the clinical work and trying not to cry.

Our notice period will be up in the middle of September. NHS England have had a number of expressions of interest, but if they cannot find anyone suitable by then the practice will close and our list of 6,000 patients will be dispersed. But I know we are not the only ones in the area experiencing problems; if other practices cannot recruit either, they will be swamped.It is a knock-on effect. 

The bigger question is, where are the doctors? It is clear this is a national problem. We have got more work coming out of secondary care into primary care, but the money is not coming with it. GPs are overworked, there is a retirement bulge coming, and we are lacking in recruits.

Dr Holly Hardy is a GP in Knowles, Bristol.

My comment

Is it not time one of the national newspapers  took on this  fight  for survival  for the GPs and their patients? This does sound like  lonely battle  in need of some troops who care. Norman Lamb MP is good at inequalities and health. He was helpful with fibromyalgia.  I think some correspondence to Readers Letters in the national press might help to highlight this growing problem.


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