Brexit and Medical Training: 1 — recruitment
The advent of Britain leaving the European Union, alongside the imposition of a unilateral employment contract on the nation’s junior doctors, creates some interesting uncertainties for medical trainees in the UK. In some cases these will take years to pan out. In this series of blog entries I flag up the major areas of likely change if (when?) the UK does sever links with the EU. My first entry considers the likely impact on recruitment to postgraduate medical training.
Overseas Applicants to Medical Training
Data held by the General Medical Council shows that some 10% of doctors licensed to practise in the UK are EU citizens, currently entitled to work in the UK just as they are in their “home” country. Some 1600 of these are GPs (4% of the total number of GPs). Around 20% of the UKs 73,000 fully trained hospital specialists received their primary degree in an EU country.
Of course, it is very unlikely that fully trained doctors would ever be denied the right to work in the UK post Brexit. Britain is a leading importer of doctors worldwide and has a long history of training insufficient numbers of doctors to staff the NHS. Moreover, fully trained doctors are generally on long-term employment contracts and it really isn’t realistic to think that EU migrants with settled employment in any industry are going to forfeit their status in the UK when Brexit arrives.
The same cannot be said, however, of international medical graduates in the NHS training grades. Trainees are far more vulnerable to changes in employment status, not least because they are generally on short-term contracts and forced to move frequently between employers. In 2004–5, during the introduction of the new Medical Training Applications Service (MTAS) as part of the Modernising Medical Careers agenda, many IMGs from outside the EU found themselves suddenly trapped in a catch-22 in which to apply for a training post through MTAS they needed the right to work in the UK, but to get a Highly Skilled Migrant visa, they needed a firm offer of employment. At the time, EU citizens were protected from this situation by the free movement of workers (Directive 2004/38/EC), which established the principle that citizens of any EU countries must not be at any disadvantage compared to home job applicants, and thus EU graduates were able to apply to MTAS in the same way as doctors from the UK.
While some IMGs from outside the EU got sponsorship from individual hospitals, in a cruel twist of fate, MTAS also culled the number of stand-alone, locally recruited clinical fellow posts, making this an increasingly difficult way to get a foothold in the NHS. For many IMGs this multi-faceted onslaught proved too much. Literally overnight the UK lost a large proportion of its medical workforce from the Indian subcontinent; the number of non-EU IMGs applying for a license to practise medicine in the UK has been in decline ever since.
In contrast to 10 years ago, the vast majority of training posts now form part of a rotation or sequence of jobs, so the number of doctors (IMG and home-grown) who do not hold a series of job offers stretching far into the future is actually very small. National structures such as Health Education England and its local offshoots, the Local Education and Training Boards (LETBs), should in theory be able to step in and guarantee employment for EU graduates if they need to apply for work visas to continue in the UK after Brexit. However, whether HEE and the LETBs will make this an easy and straightforward process for EU doctors working in the UK remains to be seen; judging from recent statements in the abortive Conservative Party leadership election, these matters are likely to form subject of negotiations with the EU when the details of Brexit are thrashed out.
For those EU graduates not in a LETB training scheme, however, there is no reason to think that Brexit will play out much different to the MTAS debacle of 10 years ago and there will undoubtedly be a small number of EU medical graduates on short-term contracts in clinical fellow posts or locum work who will find it very difficult to get the necessary evidence of employment to apply for a work visa.
A key difference from 2004, however, is that hospitals then were being told they weren’t allowed to recruit locally, and that all recruitment of junior grades had to be via the new MTAS system, which as already explained was particularly unhelpful to IMGs. Since then, locally appointed clinical fellow posts have become more common again, so that local recruitment to an individual hospital may be a viable route to obtaining a Tier 2 (general) visa — the successor scheme to the Highly Skilled Migrant visa.
Exactly how all this is going to play out remains to be seen, but the headline news is that, post-Brexit, international graduates from the EU are likely to find it far harder to enter postgraduate medical training in the UK. Many will find another route, and it may be that graduates from the EU will have to follow the same sequence that other IMGs do currently, with unpaid “clinical observerships” leading to more formal employment arrangements over a number of months or years. It seems likely that those already within the postgraduate training system will be protected, but the lessons of the MTAS debacle in 2004 is that we shouldn’t even take this for granted.
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