York doctor Mike Holmes says GP surgeries are cutting hours

In the week after the NHS junior doctors have taken further strike action, it becomes even clearer that our NHS workforce is overstretched to what feels like an unsustainable level. We need more healthcare workers, not just in the UK, but across the world and we need to work together to achieve this, so our existing workers stay in the NHS and moreover that we can deliver the level of health care that is now both expected and demanded by the public.

Over the last couple of weeks I have had the privilege to hear perspectives in a number of contrasting settings that demonstrate the challenge we are facing.

Two weeks ago I was in Geneva attending a Global Forum on Human Resources for health, organised by the World Health Organisation (WHO). The forum had the theme of Protecting, safeguarding and investing in the health and care workforce and examined the work done across the world on healthcare workforce development. It was the largest global gathering of health workforce professionals, health policymakers and multisectoral partners, so it was so interesting to be there. The Director General of WHO made key statements after listening to the contributions from countries across the world, calling for us to all work together to increase the number of health care workers.

WHO estimates that we are short of 10 million health care workers across the world, which is astounding. In England last year, 3,229 doctors resigned from the NHS, with many citing burnout as the reason. The British Medical Association (BMA) estimated that a third of junior doctors planned to leave the NHS to work abroad last year, with Australia and New Zealand the most favoured destinations. Poor pay and working conditions were cited as the top reasons for them wanting to leave the health service.

Prof Mike Holmes

Our GP training programme in England has around 4,000 places per year but only half the places are filled by UK graduates the rest are recruited internationally. In parts of our region over 70% of GP Trainees are International medical graduates. On one hand this is fantastic…for us….but of course there are both human consequences and global consequences particularly for low income countries and their citizens…and in Geneva I heard this first hand from their representatives.

In York I have met with local influencers to discuss these issues too. We are already looking at reducing opening hours of our surgeries due to workforce issues – clinical and non-clinical. The reality is we are not training enough people, we are not able to invest in them and they are not enjoying the job – it is too busy and, at times, too unpleasant as they interact with a public who are not getting the service they are led to expect by the very people who are disinvesting in the service.

The need to train more doctors and nurses is really important if we are to create a sustainable NHS and very timely as we approach its 75th anniversary. The needs of a growing, aging, medically complex and demanding population are very different to the needs of the population in 1948.

Investment in General Practice and community care is paramount if we are to address this demand and the level of need. I think the country is slowly realising this – I genuinely hope it is not too late.

We sometimes take things for granted and in my lifetime the NHS has fallen into that category. My experiences recently suggest that it might be too late before we realise that we must do that. We have heard loudly in the past that general practice is the cornerstone of the NHS – I hope we are not about to find out what happens when a cornerstone is eroded away. As local NHS budgets are slashed again this year I remain very worried that this is exactly what is about to happen.