Abstract
Background: The UK is dependent on international doctors, with a greater proportion of
non-UK qualified doctors working in its universal health care system than any other
European country, except Ireland and Norway. The terms of the UK exit from the
European Union can reduce the ability of European Economic Area (EEA) qualified
doctors to work in the UK, while new visa requirements will significantly restrict the
influx of non-EEA doctors. We aimed to explore the implications of policy restrictions
on immigration, by regionally and spatially describing the characteristics of general
practitioners (GPs) by region of medical qualification, and of the populations they
serve.
Methods: Cross sectional study on 37792 of 41865 general practitioners in England, at
30 September 2016. Age, sex, full-time equivalent (FTE), country and region of
qualification and geography (organisational regions) of individual GPs. Additionally at
the practice and geography level, patient list size by age groups, average patient
location deprivation, the overall morbidity as measured by the Quality and Outcomes
Framework (QOF), and the average payment made to primary care per patient.
Results: Non-UK qualified GPs comprised 21.1% of the total numbers of GPs, with the
largest percentage observed in East England (29.8%). Compared to UK qualified GPs,
European Economic Area (EEA) and elsewhere qualified GPs had higher FTE
(medians: 0.80, 0.89 and 0.93, respectively) and worked in practices with higher
median patient location deprivation (18.3, 22.5 and 25.2, respectively). Practices with
high percentages of EEA and elsewhere qualified GPs served patients who resided in
more deprived areas, had lower GP to patient ratios, and lower GP to cumulative QOF
register ratios. A decrease in pay as the percentage of elsewhere qualified GPs
increased was observed; a 10% increase in elsewhere qualified GPs was linked to a
£1 decrease (95% CI: 0.5 to 1.4) in average pay per patient.
Conclusions: A large percentage of the UK general practice workforce, are non-UK
qualified GPs who work longer hours, and serve a larger number of patients in more
deprived areas. Following Brexit, difficulties in replacing this valuable workforce will
primarily threaten the care delivery in deprived areas.
non-UK qualified doctors working in its universal health care system than any other
European country, except Ireland and Norway. The terms of the UK exit from the
European Union can reduce the ability of European Economic Area (EEA) qualified
doctors to work in the UK, while new visa requirements will significantly restrict the
influx of non-EEA doctors. We aimed to explore the implications of policy restrictions
on immigration, by regionally and spatially describing the characteristics of general
practitioners (GPs) by region of medical qualification, and of the populations they
serve.
Methods: Cross sectional study on 37792 of 41865 general practitioners in England, at
30 September 2016. Age, sex, full-time equivalent (FTE), country and region of
qualification and geography (organisational regions) of individual GPs. Additionally at
the practice and geography level, patient list size by age groups, average patient
location deprivation, the overall morbidity as measured by the Quality and Outcomes
Framework (QOF), and the average payment made to primary care per patient.
Results: Non-UK qualified GPs comprised 21.1% of the total numbers of GPs, with the
largest percentage observed in East England (29.8%). Compared to UK qualified GPs,
European Economic Area (EEA) and elsewhere qualified GPs had higher FTE
(medians: 0.80, 0.89 and 0.93, respectively) and worked in practices with higher
median patient location deprivation (18.3, 22.5 and 25.2, respectively). Practices with
high percentages of EEA and elsewhere qualified GPs served patients who resided in
more deprived areas, had lower GP to patient ratios, and lower GP to cumulative QOF
register ratios. A decrease in pay as the percentage of elsewhere qualified GPs
increased was observed; a 10% increase in elsewhere qualified GPs was linked to a
£1 decrease (95% CI: 0.5 to 1.4) in average pay per patient.
Conclusions: A large percentage of the UK general practice workforce, are non-UK
qualified GPs who work longer hours, and serve a larger number of patients in more
deprived areas. Following Brexit, difficulties in replacing this valuable workforce will
primarily threaten the care delivery in deprived areas.
| Original language | English |
|---|---|
| Journal | BMC Medicine |
| DOIs | |
| Publication status | Published - 16 Nov 2017 |
