Memorandum by Dr Graham Winyard (MMC 53)
MEDICAL IMMIGRATION AND MODERNISING MEDICAL
CAREERS
I am writing as a recently retired Postgraduate
Dean to urge you and your committee to include full consideration
of the issue of medical immigration in your deliberations on MMC.
This year, for the first time ever, we face the likelihood of
substantial unemployment among UK medical graduates, with a worse
situation predicted for 2008. This is being widely attributed
to the chaos around the MTAS/MMC collapse, as reflected in your
Committee's intended focus on:
"The extent to which MMC has taken account
of the supply and demand of junior doctors and the number of international
medical graduates eligible for training in the UK;".
However the planning of the supply and demand
of junior doctors and the management of medical immigration are
important issues in their own right whose mis-management would
have resulted in the current problems even if MTAS/MMC had not
been introduced.
In essence what has happened is that ten years
ago this Government decided to expand medical school output specifically
so that the NHS would be less dependent on overseas doctors. It
invested heavily including establishing four new medical schools,
and those extra doctors are now ready to begin specialist training
to become consultants or GPs. Until this year, providing they
were willing to be flexible about their choice of speciality and
geography, UK graduates could expect to access such training without
too much difficulty. Now, as a direct result of the failure by
Government to tailor its broad immigration policy to reflect its
own intentions with regard to medicine, not only are 1,200 UK
graduates unable to progress their careers this year, but next
year, by the same Department of Health estimates, only one in
three will obtain suitable NHS posts. This scale of loss completely
negates the carefully planned medical school expansion.
I raised the issue in September in an article
in the British Medical Journal[2]
but the basic facts are not in dispute being confirmed by the
Tooke report and by the Department of Health's own analysis in
its recent consultation document on the eligibility of doctors
from outside the EEA to compete for specialist training in 2008.
However the impact that this will have on the careers of thousands
of young doctors, and on the attractiveness of medicine as a career,
seem to be going largely un-noticed. It makes no sense at all
to train thousands of extra doctors simply to make many of them
unemployed at a stage when they are still too junior to work usefully
in the NHS. Nor can it be good for long term recruitment to medicine
for it to become a career with a built-in cull after seven years
of training and thousands of pounds worth of debt.
This seems to be a real case of the right hand
not knowing what the left hand is doing across Government. The
simple approach that could have prevented all the above problems
would have been to modify the terms of the Home Office Highly
Skilled Migrants Programme to exclude eligibility for postgraduate
training in medicine. However I understand that it was not possible
to reach agreement with the Treasury and the Home Office. Instead
the Department of Health has had to attempt to introduce unilateral
guidance to achieve the same ends. This has already been subject
to prolonged legal challenge (not yet concluded) during which
thousands of extra doctors from outside the EEA entered this year's
competition pool creating the unemployment levels highlighted
above. But the fact that policy coherence seems to depend on the
outcome of an Appeal Court hearing surely shows that something
has gone seriously wrong here.
I do hope that your committee will be able to
look into this. The pros and cons of detailed career structures
and recruitment processes which will form much of your committee's
MMC deliberations become irrelevant if we cannot get the basics
of managing supply and demand right.
I would of course be happy to amplify any of
these arguments if that would help the committee.
Dr Graham Winyard CBE FRCP FPHM
Retired Postgraduate Dean
November 2007
2 BMJ/22 September 2007/Volume 335. 593 Back
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