Recruitment and retention of staff is one of the most important roles of any health service. Yet in the UK, there are a range of barriers and challenges to fulfilling this vital task. Factors such as rota gaps, early retirement, medical student dropout rates, pension changes, poor working environment and Brexit have all impacted NHS recruitment and retention in one way or another. So, what needs to happen to ensure that we have enough doctors in our NHS, both now and in the future, to provide safe, quality care?

Recruitment and retention

Excellent training is essential in providing excellent patient care. Doctors in training support a significant level of core hospital services, and they are important in identifying concerns in service provision and standards of patient care. Our trainees will become future NHS leaders, meaning that they must be supported throughout their careers with good succession planning and mentorship. In addition, they must be valued for the essential work they do, including adequate provision for rest breaks and good working conditions.

We support the increase in medical school places to meet future service requirements, but this will take over a decade to impact on the numbers of doctors and current staffing levels still need to be addressed. The Royal College of Physicians of Edinburgh is keen to support initiatives aimed at recruiting international and European medical staff – and in Scotland, we have been working with the Scottish Academy of Medical Royal Colleges to build up the network of international doctors.

Many medical trainees who come to this country to work do so under fixed-term programmes, to further develop their clinical skills and contribute directly to patient care in the NHS. The fact that the NHS and our patients benefit from the skills of international doctors while they are in the UK makes it a truly win-win situation. Those doctors often return home with greater skills and experience. Some countries, such as Malaysia, actually have nearly full medical employment, which goes some way to explaining why there are as many as 2,200 Malaysian doctors currently working in England.

The NHS has always been part of a global health economy, and I am proud that this college, along with other medical royal colleges, is part of the International Medical Training Fellowship programme (IMTF). The programme benefits individual doctors, the NHS and countries around the world, and helps them to tackle health challenges and share expertise. With the Nuffield Trust predicting the number of unfilled posts in the NHS to rise to 250,000 by 2030, programmes that are mutually beneficial like this should be expanded.

Similarly, the current NHS spend on locum and agency staff is in excess of £300m in Scotland and £1bn in England, and this money could be used more effectively to employ more permanent staff. At a time when we have so many gaps in clinical service rotas, we must move from a capped system for the number of trainee doctors at least in the short term.

Safe staffing

There is a need for safe and sustainable staffing levels throughout the NHS. The Scottish Parliament, for example, has recently passed the Health and Care (Staffing) (Scotland) Act, also known as the “Safe Staffing Bill”. The Act places, on a statutory footing, the use of an existing but enhanced workforce planning method. Ultimately, the aim of the legislation is to ensure safe and appropriate staffing levels using clear, evidence-based methodologies, but at present this has limited application in medicine and mainly reflects nursing staffing ratios.

The medical workforce gap is an issue affecting all four nations of the UK. All political parties must commit to developing and implementing safe staffing levels for all professions within hospital settings, based upon best evidence. Workforce planning must seriously reassess the size and structure of the consultant workforce, taking account of changes such as the rise of part-time working, extended working, and the needs of an ageing population.

What does the future hold?

As the NHS continues to experience rising demand, it is absolutely vital that we continue to recruit and retain a world class workforce to deliver the best possible patient care. In order to do this, we must ensure that effective workforce plans and policies are in place. But we must also make sure that our workforce is valued. All NHS medical staff – including medical consultants – should feel valued no matter what their background, level of experience, or specialty.


1. This article was written for and featured in the July/August edition of National Health Executive:

Paul Gillen

Contact: Paul Gillen 0131 247 3658