NHS Doctors To ‘Learn On The Job’

Anyone moving to the UK and registering with a GP recently, might conclude that the NHS stood for ‘Non Health Service’ - unless of course they’d crossed the Channel in a dinghy, and were currently being put up in a stately home, with guaranteed access to a doctor twice a week. Unfortunately, the NHS is far from ‘the envy of the world’, and is almost impossible to access for its long-suffering sponsor, the taxpayer. First of all, there are the ongoing walkouts. Despite our nurses repeatedly telling us that they ‘do not want to strike’, they do a remarkably good impression - with emergency services and intensive care units also forced to close down. Then there are the junior doctors, with an inflated sense of their own importance, coupled with hyperbolic demands for a 35% pay rise.

Even were that not the case, the reality is the NHS has been a shambles for as long as I can remember - albeit, not all of the reasons are of its own making. The government’s supreme overreaction to Covid has bankrupted the economy, causing the cost of living crisis. With everyone feeling the pinch, an immigration crisis, and a record waiting list of over 7 million patients, it is understandable that the nation’s healthcare provider would be under the cosh - particularly as the number of fully-qualified GPs has fallen since 2019 from 28,486 to 27,306.

However, that only takes us so far. Post Covid, GPs do not appear keen to get back to work, intent instead on making appointments as unattainable as possible. My twin brother (no joke) has recently moved back to the UK after a sojourn abroad, and has explained the process to me (for the record, he is living in East Anglia): registration with a GP is lengthy and unnecessarily bureaucratic, but doable. However, you start to encounter problems when you want to actually make an appointment. He attempted to do so at the surgery post registration, and was told with a straight face ‘you cannot do that in person, you have to do it online’ - standing at the counter of an NHS surgery in 2023, you cannot make an appointment. Meanwhile, the 8am telephone scramble has been upgraded to a scrambled email system, whereby would-be patients write to their GP explaining the urgency of their medical condition - presumably some sort of a raffle is held, and if the practice likes the sound of your symptoms they might get back to you.

The broader picture however, is that the NHS is simply unfit for purpose. The overarching problem being that it is based upon a lie: ‘free at the point of use’ - except of course, it is not free. But the concept, so engrained in the nation’s psyche, corrupts everything the NHS does: its colossal waste; its inability to get value for money; its lack of accountability; its ever-expanding bulwark of non-jobs such as ‘play and communication’ workers, and ‘energy and carbon’ manager; its preponderance of admin staff; and its inability to avoid health tourism. In short, it is little surprise that public satisfaction with the ‘service’ has hit an all-time low.

Healthcare doesn’t have to be this way. Top of many lists of the world’s best healthcare is South Korea, coincidentally a country with which I have a fair amount of experience. This is how things work over here: every high street in the country is full of independent clinics - stomach doctors, ENT doctors (ear, nose & throat, similar to GPs in UK), orthopaedic doctors etc. Registration takes about five seconds, because everyone carries an ID card (I know, I don’t particularly like the idea either, but they are useful). You get to see a world class doctor usually within about five minutes - longer than a quarter of an hour would raise an eyebrow. X-rays, injections, CT and MRI scans, and a full range of other treatment are performed immediately on site. You should be in and out within half an hour.

Of course, such a service comes at a cost - but you’d be surprised by its competitiveness. In Britain, the average salary is around £28,000 p.a.. Given the differing tax bands, this would equate to about £5,134 in annual tax - 22.8% of which goes on health - giving us £97.5 per month for the NHS. In South Korea, the insurance scheme you contribute 50% to alongside your employer works out (at least in my experience) to about half that - no comparison. The system is in fact so good, I have seen grown men (albeit, American) cry when they realise how little they have to pay.

Fear not however, the NHS is poised to step up its game in a big way. First and foremost, patients are going to be encouraged to bypass the GP system altogether, and seek common medical advice directly from the pharmacies themselves. By the winter, pharmacists will be enabled to prescribe antibiotics and antiviral drugs for common conditions such as sore throats, ear infections and sinusitis, a move expected to save the NHS 15 million GP appointments per year. But there’s more.

The latest, extraordinary scheme to ‘save the NHS’, is to establish ‘apprenticeships’ for A-level students. As the NHS faces the ‘worst staffing crisis in history’, with 124,000 vacancies across its workforce, an expansion of the present nurse apprenticeship scheme could be extended to apprentice doctors as early as September.

Under government proposals, NHS trusts would be given funding (a drop in the ocean at £1.2 billion) to run the five-year apprenticeships, at the end of which successful candidates would become junior doctors. It is considered that the alternative to the traditional medical-degree route would benefit those preferring to ‘earn while they learn’; obviate the need for a crippling £80,000 worth of student debt, allow those enrolled to start work on the wards almost straight away (under supervision), and even provide opportunities for those without the traditional medical degrees. It is estimated that if successful, one in ten junior doctors, and up to a third of nurses could qualify in such a fashion.

The plans have been dubbed ‘A radical new approach’ by NHS Chief Executive, Amanda Pritchard, and radical they certainly are, although they do raise a number of questions. It is likely that such a program could create a two-tier system of healthcare professionals - with those employed via the apprenticeship route considered inferior. It is also highly probable that such employees would be frowned upon by traditional medics, those saddled with ridiculous amounts of debt for the same employment opportunities.

It could result in further problems on the wards, with doctors able to give even less of their time to patients, having to supervise the work of the untrained - and it could raise further issues when it comes to questions of malpractice. The most obvious problem I envisage however, is that such a scheme can only mean a dumbing down of the standards of excellence demanded by healthcare professions. Why would the brightest and best choose an apprenticeship scheme, when they could accept an Oxbridge placement? And what will the employment prospects of such graduates be, if they are potentially seen as second-class doctors?

The most dangerous point surely, is the advent of some form of affirmative action or positive discrimination, similar to that witnessed in America with black and hispanic medical students widely accepted on lesser grade point averages than white students. Furthermore, at the other end of the scale, the ridiculous prejudice against talented Asian students - the so-called ‘Asian tax’, which not only deprives the brightest students of places at elite institutions, but more crucially deprives the public of the best levels of care. For instance, would hospitals be forced to take a quota of these ‘second-class’ medics to receive government funding?

These myriad concerns were well summarised by leader of the British Medical Association, Dr Latifa Patel:

'Innovative approaches to education and training are welcome but there are huge question marks over how far medical apprenticeships can solve this crisis. We don't know if medical schools and employing organisations are going to be able to produce medical degree programmes to meet individual apprenticeship needs while also meeting the same high standards of training experienced by traditional medical students.We have little evidence on whether the apprentice model will work at scale, and whether employers will want to take the investment risk with no guarantee of a return.’

While it is laudable to think outside the box, and it is encouraging to see that steps are being taken to drag the NHS into the 21st Century, the apprenticeship scheme may be a step too far. Ultimately, it will be necessary for the NHS to undergo serious reform - or be scrapped entirely, in favour of some form of insurance-based system. The problem for the UK is that politically the NHS is considered such a ‘scared cow’, that it is electoral suicide for any party leader to float such an idea. Even the outspoken Nigel Farage, who has regularly called for a debate on the matter, has been forced to deny he ever intended to privatise the system.

Sadly then, the likelihood is that the NHS will limp along, evermore inefficient, evermore costly, and evermore uncompetitive in a world which has moved on from the childish notion of ‘free at the point of use’. Whether the government will go ahead and saddle it further with a lesser calibre of doctor remains to be seen.

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