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Junior doctors hit back at suggestion those who quit NHS 'should pay back training costs'

Junior doctors and medical students have hit back at the suggestion that they should be tied to working in the NHS for a minimum number of years, or be asked to repay the cost of their training.

The chief executive of the NHS Confederation, Niall Dickson, has called for a “public debate” on whether sanctions should be used to tie graduate doctors to the health service.

Each doctor receives £220,000 worth of “world class” training, he wrote in an article for The Sunday Telegraph. But he said that too many doctors go abroad, either temporarily or permanently. 

This was undermining the NHS, he wrote. 

In response, medical students said this would hit morale and discourage even more students from studying, worsening the health service’s doctor shortage rather than boosting it as intended.

“If we want to retain UK-trained doctors then we must address the underlying reasons why many leave the NHS, which are primarily to do with workload, stress and burnout,” said Mita Dhullipala, co-chair of the medical students committee of the British Medical Association.

“Forcing mandatory service on doctors would really impact morale and potentially discourage students from entering medicine.”

Junior doctors argued that the NHS needs to recognise that staff are going to want more career flexibility in future and many doctors who do go abroad return with new skills.

GP trainee, Dr Nishma Manek, told The Independent she understands the sentiment, in light of the current workforce crisis. 

But she said that morale was already undermined by the 2016 junior doctors contract dispute, when the Government redefined most evenings and weekends as core working hours. 

The decision by Heath Secretary Jeremy Hunt to impose a new contract on England’s 55,000 junior doctors led to a bitter year-long dispute, which prompted eight walkouts by trainee medics. 

He described it as “quite sensible”.

Dr Manek said forcing doctors to work a minimum number of years  “risks putting some off the career altogether”.

She added: “Anecdotally, I know many juniors – myself included – who worked abroad for a year or two before coming back and committing themselves to a career path in the NHS. If there isn’t that sort of flexibility built into our training programmes, I don’t think it’s reasonable to restrict the option of working abroad.”

While the debate over the suitability of NHS funding grows, with Tory MPs this weekend condemning Prime Minister Theresa May’s for failing to act on health and care spending, Mr Dickson said staffing is the major concern for NHS Confederation members – which include hospitals and GP groups.

He said that there are 45,000 unfilled clinical jobs across the NHS in England and, alongside nursing, key roles such as emergency medicine doctors, psychiatrists and GPs are hard hit.

To address this he said the Government should dust off proposed legislation to charge doctors if they leave after being trained in the NHS, as announced by Jeremy Hunt in 2016.

“We could also consider whether it would be reasonable to ask every graduate to give a certain number of years’ service back to the NHS in return for the contribution society has made. For example, it currently costs the UK taxpayer £220,000 to produce a graduate from medical school.

“Earlier this year the Department of Health shelved plans to require newly-qualified graduates to work for the NHS for a minimum of four years. This is certainly worth a public debate – perhaps we could provide a financial incentive for doctors to stay within the NHS for an agreed period after qualification, or indeed provide a disincentive to leave early.”

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