Not just another primary care workforce crisis …

Abstract

Listen

Translate article

There is a baffling disconnect in the position of Irish and Purvis on the primary care workforce crisis.1 On the one hand, they say: ‘The supply of newly qualified GPs is unlikely to match demand without international recruits and returners to the GP workforce.’ On the other hand, many readers of this Journal will be astonished to learn the obstacles faced by UK-trained GPs who wish to return to England (but not Wales or Scotland, see below) after working as GPs for a period over 2 years in countries such as Australia, New Zealand, and Canada. Briefly, they have to register for a local returners scheme, take a knowledge-based multiple choice question (MCQ) in London, wait for the results of that, then apply to do a basic objective structured clinical examination (OSCE) in London, wait for the results of that, then have a clinical interview with a regional educational supervisor and then, if all is deemed satisfactory, be signed off as fit to work, all the while idle at their own expense over a period of up to 6 months. This returners policy has been implemented by the Committee of General Practice Education Directors (COGPED), a body to that Irish and Purvis belong, with no attempt to distinguish at entry between a doctor who has been, say, on maternity leave and not working for 5 years and one who has been doing mainstream first world general practice in a comparable health economy. Arguments that the latter individual requires ‘refamiliarisation’ with the NHS are specious as no such ‘refamiliarisation’ is offered during the period they remain idle, their clinical skills atrophying. Further, knowledge of NHS procedures and protocols is not assessed by the MCQ and OSCE, which are basic clinical exams. Many would argue, too, that ‘refamiliarisation’ is not as complex a task as COGPED would have us believe and could easily be dealt with in many ways such as online learning modules or a short face-to-face course. I suggest that Irish and Purvis reflect on the absurdity of COGPED's position and that if they are serious about tackling the workforce crisis they put in place a workable scheme for experienced UK-trained GPs returning from working in comparable health economies. Meanwhile, both Wales and Scotland take a far more pragmatic approach and will assess returning GPs on their merits via a clinical interview and do not require the MCQ and OSCE, with the attendant period of costly, enforced idleness, as standard. Either Irish, Purvis, and their colleagues on COGPED will put in place a more sensible regime to relicense UK GPs returning from abroad or we really will be in the workforce mire. In England, anyway.