This type of open-minded dynamism will be needed post-pandemic, too. The NHS is likely to lurch from Covid-19 straight into a second global health crisis: a shortage of doctors. According to one forecast, there could be a deficit of 400,000 doctors by 2030 spread over 32 OECD countries, as population ageing and medical innovations cause demand for health services to soar. To make matters worse, 30% of UK-registered doctors could be up for retirement in as little as five years.
How would Britain fare in a global competition for doctors? Already, it ranks 27th out of 36 OECD countries for number of physicians per 1,000. Meanwhile, it loses on net around 800 doctors a year to Australia, Canada, the USA and New Zealand. Middle-income nations such as India are rapidly industrialising and strengthening their grip on homegrown talent. That could leave an increasing proportion of foreign medics having to be imported from the world’s poorer states, such as war-torn Sudan (the number of Sudanese doctors working in the UK grew from 564 in 2012 to 936 in 2018). The political optics of wealthy nations human-capital stripping such countries are, to put it mildly, not great.
In 2018, the government added 1,500 medical school places a year. That was a necessary measure, although not enough on its own – these students won’t begin to emerge at the other end of the pipeline as fully trained consultants for at least a decade.
In my research paper for the IEA, Is There a Doctor in the House?, I have laid out a series of low-cost policies that could quickly future-proof the UK’s clinical workforce and put it on the right side of this next global health crisis.
Firstly, the NHS could scrap laws that prevent suitably trained non-medics from upskilling and substituting for doctors. For example, Physician Associates (PAs) – who exist somewhere between nurses and doctors on the skills spectrum – are already a key part of the government’s plans to support GPs and plug workforce gaps in primary care. Yet, inertia and professional protectionism have so far prevented PAs from being able to legally prescribe drugs. One PA, with whom I spoke for my research, told me she had previously prescribed drugs as a nurse practitioner. Since re-training as a PA, however, she has had to put down the prescription pad – even though she is demonstrably capable of using it safely.
Secondly, the NHS could make it easier for science graduates to fast-track into extended-nursing posts. The current system is leaving thousands of young people with biological sciences degrees to languish in underemployment or unemployment. If they were allowed to train as advanced critical care practitioners or surgical care practitioners, they could put their knowledge into action, while easing the workload of overburdened doctors and nurses.
Finally, wage negotiations could be devolved to local Trusts. A socialist ideology pervades the NHS, creating the mistaken belief that wages reflect a person’s worth; therefore, the argument goes, all doctors should be similarly renumerated. In fact, wages should be determined in such a way as to balance the local conditions of supply and demand. Clearly, since shortage specialties – such as emergency medicine, histopathology and psychiatry – consistently fail to fill, while ‘sexier’ specialties – such as neurosurgery, public health and radiology – are always swamped by potential suitors, something has gone badly wrong.
As the NHS emerges from the pandemic, it will have to reckon with a gigantic backlog of cases. This could thrust the problem of doctor shortages to the forefront of public debate. At the same time, a shrivelled tax base and gargantuan government debt will make efficiency savings urgent. Fortunately, with open-minded dynamism alone – of the type the NHS has already displayed during the pandemic – staffing shortages could be quickly and cheaply abated.