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Free Movement of Doctors in the EU
The UK Consultant Physician Perspective
Issues
• The different settings• The need for an EU supported workforce• Specific issues in hospital care
The settings
Out of hours GP care
• High profile• Often employ non-UK professionals• Local NHS provider responsible for assuring
professional competencies (including language)• Responsible for large numbers of hospital admissions
Foundation year 1
• Free movement from EU• Need for shadowing• Gaps left if doctors fail to perform• How comparable are basic medical qualifications
across EU?
Locum hospital jobs
• Large demand for locums• Often short notice• Evidence of concerns about competencies of
external locums• No consistent method to assess/assure
competencies• EWTD has limited internal locums
Consultants
• Specialist qualifications vary across EU• EU focus on length of training not competencies• UK specialists often have different skill mix to EU
specialists, e.g. in acute medicine• UK seen as attractive place to work as a specialist
The need for an EU supported workforce
• Vacancy rates in junior doctors• Difficult to fill specialist posts in particular areas of
the UK• The right of free movement across borders
Vacancy rates
F1 F2 CT ST SAS
Number of posts in survey 836 561 903 1292 412
Post vacant 1.0% 3.0% 5.0% 8.6% 5.2%
Sick leave 1.5% 3.5% 2.2% 2.6% 2.3%
Annual leave 10.7% 10.4% 13.1% 8.6% 4.1%
Study leave 0.6% 3.3% 4.4% 6.0% 1.6%
Compensatory rest 7.1% 11.6% 11.7% 7.2% 2.4%
On MAU 10.1% 15.0% 13.2% 12.3% 3.0%
On base ward or in clinic 68.9% 53.3% 50.4% 54.7% 81.3%
Sickness rates
T otal epis odes of s ic k leave taken
0
5
10
15
20
25
30
35
40
HO S HO R E G
T ra ining g ra de
Epis
odes
8/2006 - 8/2007
8/2007 -8/2008
Tra ining
Hard-to-fill specialties
MerseyLondon &
KSSTrent Northern
South Western
Peninsula
West Midlands
Yorkshire
Acute medicine - 0.9 1.0 0.8 1.0 2.3 1.6
Cardiology 7.5 6.4 - 3.0 - 5.5 5.0
Dermatology 4.0 6.8 - 2.0 - 1.8 -
Endocrinology 2.1 2.5 2.0 2.0 1.0 2.8 3.0
Genito-urinary medicine 0 3.4 - - - 0 1.0
Gastroenterology 2.3 5.1 2.5 4.4 1.5 4.8 -
Medical microbiology - 1.9 - - - - 1.0
Nuclear Medicine - 0.8 - - - 0 -
Rehabilitation Medicine 0 2.0 - 0 0 0.3 0.3
Renal Medicine 1.5 2.7 2.0 1.0 - 4.0 4.0
Respiratory Medicine 3.0 2.9 6.0 2.3 - 4.0 3.3
Rheumatology - 4.3 - 2.0 0 1.7 2.8
How often do you use locums?
Strongly agree
Agree Neutral DisagreeStrongly disagree
Internal locum cover is easy to organise 1.6% 6.3% 12.7% 46.0% 33.3%
External locum cover is easy to organise 1.6% 4.8% 6.5% 30.6% 56.5%
Internal locums are usually reliable 25.8% 71.0% 3.2% 0% 0%
External locums are usually reliable 1.6% 19.4% 45.2% 30.6% 3.2%
Internal locums are usually high quality 23.8% 57.1% 17.5% 1.6% 0%
External locums are usually high quality 0% 9.7% 41.9% 40.3% 8.1%
Patient care is usually worse when internal locums are employed
1.6% 3.2% 9.5% 66.7% 19.0%
Patient care is usually worse when external locums are employed
9.7% 33.9% 43.5% 12.9% 0%
Specific concerns for hospital care
• Ensuring adequate competencies and language skills for locums and specialists
• Revalidation• Costs of skills/language assessments for hospitals
under current economic pressures• Optimising out-of-hours care to limit the number of
inappropriate hospital admissions
Language – who is responsible for checking?
" Persons benefiting from the recognition of professional qualifications shall have a knowledge of languages necessary for practising the profession in the host member state"
2005/36/EC Article 53
The HPRO card
Questions