The increasing number of doctors choosing greater career flexibility could reduce burnout and improve work-life balance, but health services must adapt to the rapid changes, a report by the General Medical Council (GMC) said.
The NHS is experiencing a prolonged period of high pressure, with industrial action, backlogs in elective care, and a shortage of doctors.
The GMC's 2023 workforce report, published on 13 November, found that satisfaction in the sector had dropped since 2019, accompanied by a "sharp increase" in the proportion of doctors intending to leave and taking "hard steps" to do so. A recent survey by the University of Cambridge suggested that around one in three UK medical students planned to leave the NHS within 2 years of graduating.
The GMC noted that 11,319 doctors left the profession last year—up from 9825 in 2021. However, despite the challenging conditions, the number of doctors joining the UK medical register was rising. In 2022, there were 296,182 doctors with a licence to practice—an increase of 18% since 2018.
Even so, "the ratio of headcount to full-time equivalent is 0.9 in secondary care across all UK countries, and lower in primary care", it said.
Desperately Seeking Flexibility
Increasing numbers of doctors—including students and doctors in training—were seeking more flexibility in their careers, moving away from the traditional postgraduate training model, and instead choosing increased flexibility and less linear career pathways. These included training breaks, working part-time or as locums, undertaking research, or choosing to work as specialty and associate specialists or locally employed doctors.
This diverse and changing landscape in practice should not be viewed as a "threat to workforce stability", according to the GMC. Its Chief Executive, Charlie Massey, emphasised the potential long-term benefits of these changes. "Post-foundation training breaks can reduce the risk of burnout and help young doctors build confidence in their next steps," he suggested. "For some, they help provide certainty over their choice of specialty."
This would ultimately benefit both the wellbeing of individual doctors and the wider healthcare system long term, leading to better patient care, the GMC hoped.
However, Professor Dame Carrie MacEwen, chair of the GMC, emphasised the importance of health services keeping pace with the changing composition, needs, and wishes of the profession. Sir Julian Hartley, chief executive of NHS Providers, said adapting to a desire for greater flexibility for doctors in their training and career paths was a "key part" of retaining skilled and talented people and improving workforce wellbeing, which could result in "better care and outcomes for patients", he said.
UK Must Remain an Attractive Option for Overseas Doctors
Despite a pledge in the NHS England Long Term Workforce Plan to double medical school places, training a doctor took a long time, and even if "smoothly implemented", the benefits would only begin to be seen "a decade from now", the GMC warned.
If planned increases in England were replicated in other UK countries, the healthcare system would still need large numbers of doctors joining from abroad. The UK must therefore remain an attractive option for doctors who had qualified overseas, the GMC urged. This group made up almost two thirds (63%) of the new additions to the register in 2022.
Overseas doctors were "vital" for the UK's health services, and needed to be welcomed, valued, and supported, the report said.
"We may be in a limited window of opportunity to address current issues before they manifest into larger proportions of doctors leaving the profession," the authors stressed. There was "no room for complacency", and the UK's healthcare systems needed to evolve to take advantage of upsides in the broader range of experiences that doctors were building, it emphasised.
