Pulse February 2019 issue - Page 20

Feedback Letter of the month Reimagining the UK’s shortage of GPs Dr G. Richard Olds is president of St George’s University in Grenada, West Indies. Dr Olds is a tropical disease specialist and is former vice-chancellor for health affairs and founding dean of the School of Medicine at the University of California, Riverside Anyone with even a casual interest in current affairs will tell you that the UK has a serious doctor shortage. While it’s true to say the UK needs more doctors in absolute terms, far more serious is the UK’s maldistribution of doctors, both by specialty and by geographic area. The current system is producing doctors who disproportionately avoid general practice and who don’t want to work in areas with the greatest need. In the short term, recruiting from overseas may help to plug the gap – and the easing of UK visa restrictions for doctors will certainly help. In the long term, however, countries must increase domestic capacity in an effective way for the outcomes desired. The biggest determinants of where a student goes on to practise are where they finish their training and where they are actually from. So creating more postgraduate general practice training places in the geographic areas of greatest need, and recruiting medical students from these areas in the first place, will improve outcomes in terms of getting GPs practising where they are most needed. Outcomes could be improved further if medical students were more likely to become GPs from day one, which comes down to how universities design their selection criteria. Foreign-born GPs are bearing the brunt of public anger Anonymous GP, England I have lived here for 17 years. Having gone through the tedious visa process, I have been a British national for six years. I worked in various underserved fields of medicine in underserved areas of the UK, before becoming a GP seven years ago. Recent years have been difficult for me as a GP and not only due to the pressures facing all GPs. There is another factor Pulse February 2019 When I founded a new medical school to address the chronic shortage of doctors in inland Southern California, we selected from the pool of qualified candidates those who had done community and voluntary work, spent time in the Peace Corps volunteer programme, or travelled furthest relative to their peers in terms of their schooling – all of which are good predictors of how likely a graduate is to end up practising primary care in their community. This has proved remarkably successful. We employ similar measures at St George’s University, my current institution. As a result, around 70% of our graduates go into primary care. Crucially, because they were chosen based on their likelihood to want to work in these kinds of clinical environments, they are more likely to be fulfilled in their careers and less likely to leave – another important issue facing general practice in the NHS. What you’re saying about GPs being left waiting for hours by ambulances • ‘Suspected subarachnoid hemorrhage – three-hour wait, numerous calls and patronising paramedics’ • ‘I felt a warm glow about the NHS the day I waited 3.5 hours until 10pm for an ambulance to arrive with my patient with pneumonia’ • ‘Always assumed that’s what they did’ • ‘Are MDOs really saying we should consider taking patients in our own cars? Beyond dangerous’ Read last month’s issue at pulsetoday.co.uk/issue but have a house, car and live in luxury while being born here I live in penury?’ At a time when GPs are already under increased pressure, we foreign doctors also face anger and a lack of trust, as well as a constant fear of complaints, from the same patients we try to help every day. Can overseas-trained British doctors ease the GP shortage? that I did not believe I would still face after 17 years of living and working here: that I was not born here. Initially I dismissed it as Brexit related but some of my patients have started mentioning it openly, and I’ve discussed it with other foreign-born GPs with similar backgrounds. The factors are a complex mixture of increasing poverty, lack of public services and some media outlets blaming immigration for these problems. Patients make comments such as ‘when I saw your name I did not think you would be a good doctor, but now seeing you I think I was wrong’, or ‘how come you are from a different country INSIDE My short-term plan to boost GP morale Norris, page 46 Dr Sam Elmais is an FY2 doctor entering general practice training next year. He is a director of Medlink, an agency that supports people applying to medical schools UK medical universities’ ruthless selection process deters many potential doctors and GPs due to a lack of places. Hundreds of UK nationals every year are therefore flocking to study medicine in English in European universities. But medical schools abroad put students off primary care, where a lot of professors disparage it. However, there are many positive attributes of life as a GP in the UK, and these should be used to lure graduates to the speciality. Many who studied abroad are older than usual and have families, so the flexibility of general practice makes it more appealing than hospital work. Students must be informed that UK general practice is more highly regarded, respected and even better paid compared with that in Europe. While the Government struggles with its bureaucracy and immigration laws, we can begin to attract the hundreds of foreign-educated UK doctors and fix this recruitment crisis from within. 20