‘Medfluencers’ – that’s TikTok influencers who are doctors – are popping up on social media extolling the joys of locum work.
‘Shifts are paid at significantly higher rates than the normal basic pay’, says one to her 55,000 followers; another that her hourly rate as a locum ‘is so vastly different to the normal hourly rate it is crazy’.
Added to the junior doctor strikes, this questionable use of social media and stories of small fortunes being earned has helped change many people’s views of our junior doctors (now officially called ‘resident’ doctors).
But what few of them will know is that over the past two decades, the NHS has not addressed the key problem that is really driving young doctors out of the health service.
That we need more doctors, there is no doubt: it’s estimated we have to train an additional 3,000 to 6,000 doctors a year to keep up with the expected demand from an ageing population.
However, NHS workforce policies, along with an utter failure of leadership from organisations such as the Royal Colleges, the General Medical Council (GMC) and Health Education England, have sabotaged that.
Last month, the GMC published its latest workforce report. Hidden in the graphs and data tables detailing the plans for the medical workforce is a glaring error. The increase in the number of medical students qualifying isn’t matched by the increase in training programmes – with a gap of thousands.
When a doctor is newly qualified, they undertake two years of foundation training – this involves six, four-month jobs in different areas, to get a broad experience, readying them to start formal training programmes to become the GPs and consultants we need.
Junior doctors are ditching their NHS jobs in favour of lucrative locum salaries before spreading the word on TikTok. Pictured: Dr Monika Sharma
Dr Summer Kennedy tells her 1,792 followers that her hourly rate ‘is so vastly different to the normal hourly rate it is crazy’
Except they are not starting those training programmes. In 2022, only 22 per cent of new doctors did what was meant to happen: enter a training programme after their foundation jobs.
There are currently 11,757 doctors who have completed their foundation training but have not gone into a training programme. That’s literally thousands of highly qualified doctors who could treat our loved ones, and cut the amount hospitals spend on locums while training to be specialists.
And the reason? There aren’t enough training positions. So we have brilliantly trained UK doctors who want to work in jobs we’re desperate to fill, but with no training jobs for them.
For example, for every psychiatry training job, there are over nine applicants.
I have a friend who wants to be a psychiatrist: she’s an amazing doctor, but there are only two jobs starting each year for a psychiatry training programme in Cornwall, where she lives.
So instead she – like so many others – works as a locum (in her case, as a locum psychiatrist).
Sure, this is for much more money but with little training to help her become a better, consultant psychiatrist. She is now contemplating accepting a job offer in New Zealand, where she will also get that consultant-level training.
If she goes, not only will it cause family upheaval for her, it will be an awful waste of the money the NHS spent training her to be a doctor and putting her through foundation training.
In a TikTok video, Dr Lizkerry Odeh talks about how the pay from locum shifts is significantly higher than the normal basic pay
Crucially, it will be a disaster for our patients who need her skills now and in eight years when she could be a consultant.
The problem is the formal training programme numbers are set not by hospitals, but by the NHS. One sticking-plaster solution hospitals use is creating ‘non-training’ jobs. But while these are often identical to formal training jobs, they can’t lead to the doctor becoming consultants.
And with no formal training programmes to go into, many young doctors leave the country and take their skills, expertise and potential to countries such as Australia and New Zealand. Meanwhile, we still need the patients to get treated, so waste millions on locums.
Some of the best junior doctors we have leave the NHS and non-training jobs are filled by non-UK-trained doctors – they now make up the majority of new doctors in the NHS.
Because of all these changes, our workforce is becoming less and less experienced: 9 per cent of doctors on the GMC register have been on it for a year or less, compared with fewer than 6 per cent less than a decade ago. This lack of experience affects the quality of care that our patients receive.
And it is set to get worse. The number of medical students is significantly increasing but there are no formal plans to expand training programmes by an equivalent amount.
You couldn’t make it up. We are at risk of spending millions on training brilliant new doctors who will provide great service for patients… in Australia.
It’s even worse for some specialisms: some doctors, such as anaesthetic doctors, have to apply for a basic training programme, then, after a set of exams are passed, apply for a senior training programme.
Crazily, the number of jobs for these two schemes don’t match, so after five years of training, they can’t complete the final step to become a consultant.
This recently happened to a whole cohort of anaesthetic doctors. Many of my friends left the NHS at this stage of their career to move to (yes, you guessed it) Australia.
Between 2019 to 2023 there was a 6 per cent drop in the number of doctors training to be anaesthetists.
If you wonder why there is such a backlog of operations, don’t blame the doctors or nurses for not working hard enough and instead question the decisions on the medical workforce made by those at the top of the NHS.
Even worse is what is happening to other doctors who have completed their postgraduate training. We have fully qualified GPs who cannot get jobs despite the dire need for those GPs. They are quitting the NHS or doing locum shifts as a junior doctors again.
That’s because so much of the budget allocated to GP surgeries cannot be spent on GPs but must be used on alternatives to doctors such as physician associates (PAs).
At the same time, a narrative is being spun that there is a shortage of doctors – so we need to expand the alternatives to doctors such as PAs. As Good Health has long reported, there are real concerns about PAs taking on more responsibility than they’re qualified for – in some cases with tragic results.
Back to our trainee doctors. There is an alternative to this fiasco: let hospitals run their own training programmes. I set up a scheme in my hospital to do this 12 years ago, breaking with convention.
We now have more than 75 of these doctors, often combining clinical work with teaching and research. If only we were allowed to convert those jobs to training jobs, it’s the kind of scheme that could be replicated nationally.
Our junior doctors have been let down by those in charge of workforce planning and education, as have our patients and we, the taxpayers. We must change how we do things; we can’t afford not to.
@drrobgalloway
