The state of medical education and practice in the UK: Workforce report 2023 (GMC, 10 November 2023)

Summary

The UK’s healthcare systems are experiencing a prolonged period of high pressure, with industrial action, backlogs in elective care persisting, and a shortage of doctors that ongoing high vacancy rates evidence. This report by the GMC analyses trends in the medical workforce across the UK. It uses a variety of sources to provide insights for policymakers and workforce planners, as well as offering deeper analysis on specific themes.

Content

Conclusions and key insights for workforce planning

• The number of licensed doctors continues to grow rapidly, with those joining outnumbering those leaving by more than two to one since 2019. However, there are still high vacancy rates and workforce pressure.
• Over half (52%) of new joiners in 2022 were international medical graduates (IMGs). 
• Even if the ongoing and planned increases to UK medical school places are complemented by a replication of NHS England’s NHS Long Term Workforce Plan (LTWP) in all UK countries—and if those future UK graduates were to replace future IMG joiners—the UK’s healthcare systems would still need large numbers of doctors to continue joining from abroad. Welcoming, integrating, and retaining all doctors who join from abroad will be crucial to meeting the UK’s future healthcare needs.
• The proportion of doctors leaving the workforce has only returned to the pre-pandemic level of just under 4%. But there are worrying signs. A growing proportion of doctors plan to leave the profession as a result of high levels of dissatisfaction and high risk of burnout. We may be in a limited window of opportunity to address current issues before they manifest into larger proportions of doctors leaving the profession.
• The growth in the specialty and associate specialist (SAS) and locally employed (LE) doctors group appears to be mainly driven by those taking up LE roles as opposed to SAS roles. In 2021, there were more than double the number of LE doctors (22,576), compared with SAS doctors (10,349), working in England and Wales.
• The LE doctors cohort has grown because of both IMG joiners and the increasing proportion of doctors who are taking longer periods of time away from formal postgraduate training after their second foundation year (F2).
• As well as taking time away from training after F2, there are training stages within programmes that many doctors take longer to complete than the minimum possible time. Our data show that undertaking research and gaining experience in a different post partly explain why some training levels take longer than others.
• The UK’s healthcare systems must evolve to take advantage of the upsides in the broader range of experiences that doctors are building. Adding flexibility to the evidential requirements for joining the Specialist Register or GP Register will be important and legislative changes mean that is now in progress.