A diagnosis that demands more doctors

December 12, 1997

We all care about our health and need to be sure there will be enough doctors to serve us in the future. All evidence points to a growing imbalance between demand for doctors and the domestic supply. We urgently need to address this problem.

Successive governments have asked the Medical Workforce Standing Advisory Committee to advise on the number of medical students the United Kingdom needs. Our third report calls for steps to improve the recruitment and the retention of doctors. It suggests an increase of about 1,000 in the annual intake of students to medical schools, a growth of about 20 per cent. We also recommend holding the number of overseas undergraduate students constant during the period when the medical school intake increases.

These recommendations will have major implications for the National Health Service and higher education, and significant costs will be incurred. We arrived at the recommendations by considering likely health patterns and the demand for healthcare in the future and then assessed the demand for doctors and compared with the future likely supply. Evidence from a wide range of interested parties and existing analysis and research studies helped to inform our thinking.

The committee projected doctor supply and demand over 25 years, taking account of changes in medical staffing policies and other influences on demand, such as changes in working hours. There are, however, still many uncertainties over the ways in which healthcare and the healthcare environment, and consequently the demand for doctors, will develop. Further consideration has to be given to the likely effects on the demand for doctors of such things as policy changes, demography, working patterns and economic factors.

During the past 20 years doctor numbers have grown at an annual average of 1.8 per cent. Our conclusion was that the demand for doctors might well grow at between 1.4 per cent and 2 per cent each year, with a central estimate of 1.7 per cent. Before reaching our prediction about demand for doctors, we thought about a number of factors. We looked at the question of how much of the growing demand for health care would be met by doctors, we looked at likely increases in the productivity of the medical workforce, and decided that current developments were unlikely to result in a slowing of the demand for more doctors.

The gap between the demand for doctors and the domestic supply exists already, and is filled by growing numbers of overseas doctors. The home share of doctors is 76 per cent and falling. We believe it must not be allowed to fall further - indeed we strongly reaffirmed the need to move towards a greater reliance on UK doctors. This belief is supported particularly by the pressing need to ensure security of supply in the longer term.

Our conclusion that a substantial increase in medical school intake is needed urgently rests on the principle that the home share cannot be allowed to fall any further.

Quite evidently we need a range of robust measures to correct the imbalance between demand and domestic supply. These measures must enable the country to respond to short and medium-term changes as well as to long-term needs.

Increased demand must be met by increasing supply, through a combination of improved recruitment and retention of doctors, although we have to accept that these steps are likely to alleviate, not resolve, the growing gap between home supply and demand. We also urgently need an increase in the intake to medical schools and limited further recruitment of overseas doctors.

How do we set about achieving our aims? Clearly, the Medical Workforce Standing Advisory Committee's recommendation to increase medical school intake has significant implications which will need careful examination by government. Equally clearly, any increase in medical school intake has to be done in a way which gives the best combinations of cost, quality and flexibility. Options for increasing intake include expanding medical schools, expanding the spread of clinical teaching facilities, building on postgraduate medical facilities to also cover undergraduate education, introducing shorter medical courses and, possibly, inaugurating one or more undergraduate medical schools.

No decisions have yet been taken on the question of increasing medical school intake. However, I would expect government to consider the committee's recommendations carefully in the context of a policy environment that includes the comprehensive spending review. I also expect government to give careful consideration to the committee's views on the balance between home and overseas doctors in the medical workforce.

Getting the right number of doctors is vital. I look forward to a positive government response to the committee's recommendations before long.

Sir Colin Campbell is chairman of the Medical Workforce Standing Advisory Committee.

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