The regulator says doctors are increasingly moving away from the traditional postgraduate training model and instead building greater flexibility into their careers. They are opting for training breaks, working part-time or as locums, undertaking research, or choosing to work as specialty and associate specialist (SAS) or locally employed (LE) doctors, the Council says.

Rather than viewing this changing landscape as a threat to workforce stability, however, the report argues that it could in fact help reduce burnout and dissatisfaction, improve work-life balance, support informed career decisions, and increase the likelihood of doctors remaining in UK practice.

It’s hoped that the changing career patterns can benefit both the wellbeing of individual doctors and the wider healthcare system long term, leading to better patient care. The GMC is already working with partners in all four UK countries to consider solutions to support greater flexibility in career and training pathways.

GMC chief executive Charlie Massey said: “Many of these changes will have long-term benefits. We know, for example, that post-foundation training breaks can reduce the risk of burnout and help young doctors build confidence in their next steps. For some, they help provide certainty over their choice of specialty.

“Workforce thinking needs to keep pace with these changes. The ability to provide good patient care, now and for the foreseeable future, depends on the ability to respond quickly to changing career pathways, and to think clearly about making the most of the resources available.”

In the last year, the numbers of SAS and LE doctors have also increased dramatically – at four times the rate of the rest of the workforce. Between them, SAS and LE doctors now make up almost a quarter (24 per cent) of licensed UK practitioners.

“Patients benefit hugely from their knowledge and experience, and their flexibility is vital,” said Massey. “Too often, these doctors are treated as a single homogenous group, which does not help our health services get the most out of their skills. More needs to be done to ensure these professionals are recognised for their skills, feel valued, and are supported to progress their careers.”

International recruitment

The GMC report stresses that the UK must remain an attractive option to doctors who qualified overseas for the foreseeable future, owing to policy changes around commitments to increase UK medical school places not likely to be felt for several years. Doctors who qualified outside the UK made up just under two-thirds (63 per cent) of the 23,838 new additions to the register in 2022, finds the report. International medical graduates made up over half (52 per cent) of new joiners, while doctors who graduated from within the European Economic Area were a smaller component, at 10 per cent. It’s projected that in 2037, 39 per cent of UK doctors are likely to have qualified overseas.

“Doctors from overseas bring skills and experience, and are vital to the UK’s health services,” added Massey. “There is already a lot of good work going on around induction and support, but the more we and our health services can collectively do to support doctors arriving in the UK, the better the chance of retaining their services for longer.”

The report reveals that the number of doctors joining the UK medical register is rising and has increased by 18 per cent since 2018. While the number of doctors leaving the profession increased last year – from 9825 in 2021 to 11,319 in 2022 – the proportion of the workforce leaving (4 per cent) is still only returning to pre-pandemic levels. However, the GMC is aware of increasing numbers of doctors taking hard steps towards leaving UK practice.

Diversity and inequalities

Commenting on the report, Sir Julian Hartley, chief executive of NHS Providers, said: “Adapting to a desire for greater flexibility for doctors in their training and career paths is a key part of efforts by the NHS to retain its skilled and talented people, and to improve the wellbeing of the workforce, which leads to better care and outcomes for patients. Trusts are committed to helping medical staff and others’ careers to flourish amid the pressures, particularly in urgent and emergency care, faced by the NHS workforce today.”

He also welcomed the increasing diversity of the NHS medical workforce but noted that health service leaders recognise that more needs to be done to tackle inequalities and discrimination in the workplace.

Suzie Bailey, director of leadership and organisational development at the King’s Fund, agreed that the expansion of flexible working is positive for the NHS workforce.

A King’s Fund survey on GP trainees’ career plans one year after qualifying found that 41 per cent of GP trainees intend to work five to six clinical sessions a week out of a possible ten. But in the most recent NHS Staff Survey, less than half of staff said their organisation is committed to helping them balance their work and home life. 

“The NHS has been fortunate to benefit from overseas doctors coming to work in the English health service,” Bailey added. “However, the worsening global shortage of healthcare staff could mean England’s continued reliance on international recruitment is unsustainable.

“The workforce crisis is at the heart of many of the challenges facing NHS and social care services in England. To solve this crisis, there is a need for action to make working in health and social care a more attractive career.”

The GMC’s report, ‘The state of medical education and practice: workforce report 2023’, can be downloaded here.