Britain’s National Health Service (NHS) needs fixing before its campaign to lure expat general practitioners (GPs) back home will work, say expat GPs.
The NHS has spent the last few years trying to win back GPs who live and work in Australia with NHS experience with the promise of speedy inductions, dramatic scenery, short commutes, cheaper house prices, cultural familiarity and a silver bullet for homesickness.
In its most recent gambit, NHS Education for Scotland (NES), will dispatch a team of experts to Perth’s Ottawa Medical Conference in March, where they will meet GPs face-to-face and discuss their concerns about returning to practice in Scotland.
The social media push has also been impressive, with targeted Facebook ads regularly popping up.
In an appeal to the heart, Dr Anthea Lints of NHS Education for Scotland, who heads the GP returner initiative and is an experienced GP said: “Scotland offers returning GPs an unbeatable combination of lifestyle and career opportunity. Returning GPs are highly prized and sought after as their overseas experience and resilience so often brings a new vigour to general practices.
“Excellent career opportunities combine with the very attractive lifestyle afforded by Scotland, a land of stunning and highly accessible natural beauty, with historic and vibrant cities, a distinct and rich cultural identity, an abundance of outdoor activities and world-class food and drink,” Dr Lints said.
“For GPs working overseas, there are a multitude of reasons for returning to general practice. Being closer to family, the pull of home and cultural familiarity, access to different lifestyle and career opportunities or a desire to put down roots before retirement.”
Also promised is a straightforward, quick on-the-job induction for those who have kept their skills up and streamlined processes under the GP Returner program for doctors who have had a career break. Doctors with no former NHS experience may also be eligible under the NES Enhanced Induction Programme.
Returning GPs can work in urban, rural or remote practices in the Scottish Highlands and Islands.
But Dr Edwin Kruys Chair of the Royal Australian College of General Practitioners, Queensland, who emigrated from the Netherlands a decade ago, says there were systemic issues within the NHS that were dissuading doctors from returning.
“I asked a few [expat] GPs around the country about it and all of them said the NHS first needed to fix its own problems,” Dr Kruys said. “The only reason people are going back is because of family reasons, or wanting to go back anyway.”
The expat GPs said their main concerns were: cuts to the UK’s primary healthcare budget, too much bureaucracy, long waits for scans, heavy patient caseloads and salaries that did not reflect the workload.
This view appears to be echoed by a British Medical Journal (BMJ) article last week, which said that general practice share of the NHS budget had continue to fall over the last ten years, from a high of 11 per cent in 2006 to under 8.5 per cent now and added: “Many practices will see further reductions over the next three years.”
The article, “If general practice fails, the whole NHS fails” quotes recent research which showed that the level of stress among GPS were unprecedented since surveys began in 1998 “with increasing workload and overwhelming regulatory burdens.”
“GPs now do an estimated 370 million consultations each year, 60 million more than five years ago. Seeing 60 patients a day is not uncommon,” the article said.
“Confidence in the sustainability of general practice is critically low, and GPs are finding it harder to recruit trainees and to find partners to replace those who are increasingly retiring in their 50s.”
It talks about cuts to general practice funding in Scotland since 2006 and a subsequent “clear rise” in emergency admissions.
Last month the BBC reported that at least 100 English practices had applied to NHS England to suspend new patient registration because they could not safely treat them.
Dr Kruys said: “These are the things that they conveniently don’t mention in the recruitment process but GPS are not crazy. They look at social media and newspapers. The NHS has got such a bad reputation at this point in time.
“GPs are stressed because of more bureaucratic rules and regulations and lots of doctors are fleeing the country.
“It’s more relaxed here, more rewarding, not just financially but also more autonomy, less rules in how you run a practice. [Doctors here] can do more themselves which leads to greater satisfaction for the patients and the doctors.”
In Australia if you work more, you earn more, whereas the UK system (capitation) offers a set amount of money for a certain number of patients. Dr Kruys says that the capitation amount often stays the same year on year but patient target numbers jump.
“That’s what’s happening at the moment and that’s just causing burnouts and stresses and people leaving the country,” he said.
Anecdotally, he said the flow of doctors was much more pronounced from the UK to Australia, not vice versa, “There’s no recruitment campaign by the Australian government to get doctors back from the UK. I guess that says enough.”
An NES spokesperson said: “It is not always a question of being easier in Australia as both health care systems have elements of pressure – the factors that may trigger a GP to return to the UK can often be related to family, career, and culture and not intrinsically linked to the work itself. Locums here in the UK are earning well just now.
“Not having a billing system is a distinct advantage as are patient lists (where a patient is allocated to a single practice and cannot shop around within the NHS) which provides continuity of care.”
The spokesperson said that once scans were done the results tend to be pretty quick.
Dr Brian Morton, Chair of the Australian Medical Association Council of General Practice, agreed that the Scottish recruitment drive was unlikely to have too many takers but he said it may do in the future.
“The reading is that the UK, their health system is in crisis. There are a lot of changes to the health system,” Dr Morton said.
Dr Morton said the revalidation system UK doctors had to go through every five years to continue to practice and be licensed was arduous and Australian doctors also had more freedom.
British GPs used to be better paid than their Australian counterparts but this had changed.
However, he said that despite the high quality of care, high life expectancy and good health outcomes, Australia was “heading the same way” as Britain; with pressure to see more patients, low consultation rates paid and GPs being devalued by government.
“The way things are heading, there will be personal dissatisfaction and if that’s built on top of homesickness or family needs to move back there might be movement,” Dr Morton said.
“Maybe we will see a move and lose our UK graduates back to Scotland.”
He said he did not want UK doctors to go back because he valued them for their good attitudes, hard work and competence.
But Dr Kruys is sanguine about the Scottish poaching mission and says there are some lessons the UK’s NHS could teach Australia, for example paying GPs a fixed amount to treat people with chronic illnesses, like diabetes, providing them with an incentive “to sort them out.”
“I really hope they solve their problems because I feel for their GPs. They’re stressed and they need help but I think they first need to fix some of their problems so that doctors don’t go away.”
He suggested charging a small amount to those patients who can afford it, as happens in Australia, provided vulnerable patients and those with chronic diseases are protected.
The BMJ article advocated for new roles to take the strain off clinical staff, a funding injection, slashing bureaucracy, better relationships between GPs and specialists, improved social care and training more nurses and more GPs.
Asked if he would he be tempted to up sticks and head for bonny Scotland, Dr Kruys said: “The castles in Scotland … it’s a beautiful country but nothing beats Australia.”