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Migration Advisory Committee: response to the call for evidence from the RCP

In response to a request from the UK government's Migration Advisory Committee (MAC), the Royal College of Physicians (RCP) has outlined the existing workforce challenges faced by the NHS, its reliance on recruitment from overseas and our concerns for the UK to attract physicians to the NHS in the future.

EU doctors in the UK

Around one in 10 doctors working in the NHS is from an EU member state. A significant proportion of them are generalists who contribute to emergency care. These posts can be difficult to fill and are not on the Tier 2 shortage occupation list.

Certain specialties are more reliant on doctors from EU member states than others. For example, 11% of cardiology specialists, 11.6% of infectious disease specialists and 13.2% of neurology specialists are from EU member states.

There are also variations across the country, with greater numbers of EU nationals working in London than other regions. For example, 1.7% of EU nationals work in the north-east compared to 10.1% in south London alone.

The UK workforce

The 2015/16 Federation of the Royal Colleges of Physicians of the UK census shows that, prior to the vote to leave the EU, 44% of UK consultant posts were vacant. This was due to either a lack of applications or lack of suitable applicants for the post. In the 2016/17 census this has risen to 45%, which equates to around 691 consultant posts that could not be filled.

Over the past 5 years, acute internal medicine, geriatric medicine and gastroenterology/hepatology have advertised the largest number of consultant posts, but have also had the largest number of failed appointments due to a lack of applicants. There are also significant shortages of ‘generalist’ posts for people with urgent healthcare needs in hospitals.

Only 52% of higher specialty training posts in the medical specialties were filled in 2016 and it seems set to continue. The rota gaps this creates lead to a circle of increased workload and impact on team working and recruitment. Supplementation of the UK workforce at this level is vital for patient safety and the long-term sustainability of the acute NHS sector. These shortages have already contributed to 74% of doctors worrying about the ability of their service to deliver safe patient care in the next 12 months. This could be exacerbated if the UK does not continue to attract doctors from overseas.

The workforce shortages facing the NHS predate the referendum. However the UK’s departure from the EU and possible restrictions on the movement of doctors to the UK from the 27 EU states would have significant implications for the delivery of patient care and the sustainability of the NHS. Already, 21% of doctors who qualified overseas recently told the RCP that they plan to leave the UK in the next 5 years or are unsure of their plans.

Aligning the UK’s immigration system with a modern industrial strategy

While the long-term focus needs to be developing the homegrown healthcare workforce, the RCP wants to see a positive and welcoming migratory system for doctors to ensure a sustainable and safe NHS.

The recent increase in medical school places is welcome but will have a delayed effect as it takes around 13 years to train a doctor. Recruiting skills and expertise from overseas is crucial to the sustainability of the NHS in the interim.

The UK should therefore:

  • guarantee that EU nationals will be able to remain in the UK following our exit from the EU, so that they can continue to provide patients with support and care
  • increase the number of visas available to the Medical Training Initiative that provide trainee doctors from all over the world with the opportunity to work and train in the UK for 2 years before returning to their country of origin
  • establish an MTI-like Tier Five visa programme for doctors from DfID or LI&LMI non-priority countries, particularly those – like Australia – that have similar training programmes to the UK / more doctors than training places
  • establish a scheme to attract students from particular countries to come to the UK on a Tier 4 visa
  • include more specialties on the shortage occupation list, especially those with large shortages, such as geriatrics and respiratory medicine.


RCP MAC response 323.64 KB