Primary care is in dire need of GPs, but the visa system sends thousands of newly qualified GPs out of the country. International trainees’ visas expire as soon as they get their CCT. In NHS England’s own words:
‘After completing their training, these GPs either need to return overseas, find employment with an employer that holds a skilled worker visa or if they have already been in the UK for five years or more apply to normalise their status as a UK resident.’
All that might be fine, except for the fact that fewer than 20% of GP surgeries are registered Skilled worker Visa (formerly Tier 2 Visa) sponsors, and it’s a bureaucratic, 8-12 week process to become one.
About half of GP trainees are International Medical Graduates (IMGs), and although those newly qualified overseas GPs are desperately needed, thousands won’t be able to work because there aren’t enough visas to go around.
That needs addressing urgently.
The GP shortage
The primary care staffing crisis is deep and ongoing.
- A GP is now responsible for an average of 2,297 patients, up by 360 on September 2015
- An average GP surgery is responsible for 9,801 patients, up from 7,465 in September 2015
- 65% of GPs are considering leaving their practice for a private role
- 58% of GPs are considering reducing their working hours
- 20% of GPs under 30 years old quit last year
At the same time, the IIF is placing new targets on surgeries to book appointments within two weeks, and the latest GP Contract is imposing new access requirements which will only increase the pressure on practices.
It would be a bad idea at any time to make it hard for NHS-trained doctors to practise in the UK, but in the current climate, it’s a travesty.
The visa reform that primary care needs
Major changes to immigration law aren’t easy to make, and they’d be the subject of intense debate. However, reforming the Visa regime for GPs doesn’t require sweeping change. It may only involve making specific changes or allowances.
The current system is unsophisticated and clumsy. It offers no logical pathway for international GPs to practice in the UK, and creates artificial workforce attrition. To change that, it would be largely uncontroversial to propose the necessary legislation, and relatively easy to pass it. Here are some suggestions.
A ‘Bridge’ visa
There’s currently a jarring halt to doctors’ visa status. As soon as they get their CCT, they lose their visa. Not every doctor who wishes to stay will have been able to find a sponsor for a Skilled Worker visa before their current visa expires.
From Autumn 2023, the government will allow newly qualified GPs a four-month visa extension. The extension might be in the right spirit, but it’s probably far too short a period for most to find a sponsor.
Something a little more substantial like a year-long post-CCT visa would relieve a lot of time pressure and let more GPs find sponsors.
An automatic visa
In Summer 2022, the government refused to offer indefinite leave to remain to IMGs post-CCT. That was disappointing, because
- It could encourage more GP trainees to come to the UK
- Those GPs have already demonstrated a commitment and a work ethic that would be valuable in the UK workforce and in primary care
However, at that same moment, the government dismissed the idea of providing visa extensions, which it subsequently did offer. It may yet change its mind.
Visa sponsorship relaxation
There’s no need to change all Skilled Worker visa standards, but we could make it easier for General Practice to sponsor international GPs who qualified in the UK.
Many practice managers don’t have the time to apply for a sponsorship licence, but would welcome the chance to employ a GP from overseas with a British CCT. It could be possible to make every GP surgery a licenced sponsor of a GP who meets those conditions.
Reforming for better access, health outcomes, and a safer workforce
Change of this kind always takes some political will, but surely getting more GPs in and getting waiting times down would be an enormous victory for any party.
The current system communicates to international GPs that unless they hear otherwise, they’re not welcome. To change that they need to jump through further hoops. Surely the assumption ought to be that we want an encourage them to stay and join the GP workforce? It would relieve the pressure on the GPs that we do have, help fulfil NHS England’s access targets, and deliver better health outcomes for patients.
If you’re a practice manager looking for the ideal GP, or a GP looking for the ideal surgery, call 0330 024 1345 or email hello@mcghealthcare.co.uk.
