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