NHS staff shortages leave doctors working in a system that isn’t safe | Letters

Letters from Professor Jane Dacre, president of the Royal College of Physicians, and Dr Antonia Moore, a salaried GP

It seems astonishing to block appropriately qualified doctors from working here when the NHS is under such pressure (Doctors’ visas: Overseas hires thwarted by pay threshold, 24 January).

As our own census shows, as well as recent BMA data, there are huge gaps in rotas. As a result, doctors are unable to deliver the standard of care they were trained to, and patients are at risk.

We may wish there were more homegrown doctors, but there simply aren’t. At the same time, the future remains uncertain for doctors from the EU, and the number of doctors who are able to train in the UK for two years under the medical training initiative (MTI) is capped.

The government now recognises that doctors of all types are in short supply. Yes, we should be training many more here, and we welcome the investment in 1,500 new medical school places. But those doctors won’t be available for years, and patients need them now.

An immediate solution would be to expand the MTI, place doctors on the Home Office shortage occupation list, and actively encourage the ethical recruitment of doctors from other countries. We must start this debate now.

If the government is serious about developing robust partnerships post-Brexit, issues such as these need to be addressed. Because every time something like this happens, our reputation on the world stage diminishes.
Professor Jane Dacre
President, Royal College of Physicians

• The General Medical Council removed Dr Hadiza Bawa-Garba from the medical register, arguing that this was to protect the public and maintain confidence in the medical profession. Crowdfunding will help support her appeal (Drive to fund struck-off doctor’s legal campaign, 29 January), but I wonder how much we will be able to crowdfund to support colleagues in future.

General practice is collapsing. There aren’t enough GPs to provide safe care. GPs are good at managing risk but overload means that risks are less manageable.

If staffing levels are unsafe, what should we do? Do our best in a failing system, admitting near misses, sharing vulnerabilities to help others avoid them in future? All in the knowledge that when something goes wrong, no one will recall the career of excellent care or acknowledge the strident calls you made saying that staffing levels were unsafe. Should we down tools to protect the public and maintain public confidence in the medical profession?

Was Dr Bawa-Garba anxious about returning to work after maternity leave? Was she hoping to be reintroduced to work with necessary support in place? When she realised the consultant wasn’t on site, colleagues absent, IT down, did she consider saying “this isn’t safe so I’m going home”?

What would I do? I am working in a system that isn’t safe: no longer a balance of risk but a balance of least harm. I believe that if I refuse to work, patients will come to more harm because there is no one else to step in. But when I’m up in front of the GMC because of a mistake I’ve made, that will be no defence.
Dr Antonia Moore
Salaried GP, Rochester, Kent

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