Retrospective analysis of census data on general practitioners who qualified in South Asia: who will replace them as they retire?

British Medical Journal, Jan 30, 1999 by Donald H Jr Taylor, Aneez Esmail

Abstract

Objectives To determine the number and geographical distribution of general practitioners in the NHS who qualified medically in South Asia and to project their numbers as they retire.

Design Retrospective analysis of yearly data and projection of future trends.

Setting England and Wales.

Subjects General practitioners who qualified medically in the countries of Bangladesh, India, Pakistan, and Sri Lanka and who were practising in the NHS on 1 October 1992.

Main outcome measures Proportion and age of general practitioners who qualified in South Asia by health authority; the Benzeval and Judge measure of population need at the health authority level.

Results 4192 of 25 333 (16.5%) of all unrestricted general practitioners practising flail time on 1 October 1992 qualified in South Asian medical schools. The proportion varied by health authority from 0.007% to 56.5%. Roughly two thirds who were practising in 1992 will have retired by 2007; in some health authorities this will represent a loss of one in four general practitioners. The practices that these doctors will leave seem to be in relatively deprived areas as measured by deprivation payments and a health authority measure of population need.

Conclusion Many general practitioners who qualified in South Asian medical schools will retire within the next decade. The impact will vary greatly by health authority. Those health authorities with the greatest number of such doctors are in some of the most deprived areas in the United Kingdom and have experienced the most difficulty in filling vacancies. Various responses will be required by workforce planners to mitigate the impact of these retirements.

Introduction

There is concern in some circles that the future supply of general practitioners will be inadequate to meet the needs of an NHS led by primary care.[1 2] Others are not convinced and note a lack of definitive evidence.[3] Many of the issues relate to changes in the career paths of general practitioners, particularly young ones.[4-9] Decreased popularity of general practice as a career choice,[6 10] drop outs from medical school,[11 12] and early exits from practice by young general practitioners[7] are some of the key issues.

Another issue that will influence the future supply of general practitioners is the expected retirement of doctors who qualified in South Asian medical schools (in Bangladesh, India, Pakistan, and Sri Lanka) and emigrated to the United Kingdom in the 1960s and 1970s primarily to fill a perceived staff shortage in an expanding NHS. Many of these doctors became general practitioners, and many will be retiring in the next decade. Because of changes in the regulations of medical licensure in the United Kingdom, doctors from South Asian medical schools can no longer be expected to fill general practitioner partnership posts in large numbers, if at all. It is unclear from present evidence whether filling these posts will be particularly difficult, but there is anecdotal evidence that many of them are not likely to be viewed as attractive practice opportunities because of large list sizes and relatively deprived practice populations, especially to young general practitioners moving into the NHS.[8 9]

To provide insight into how difficult these posts may be to fill in the future we identified the proportion of general practitioners practising in 1992 who qualified in South Asian medical schools by health authority and projected the future number of such doctors as they retire. We have described health authorities by their population need and expected impact of retirements among South Asian qualified general practitioners.

Methods

This study is based on data from the general practitioner census, a secondary database that provides a comprehensive data source to study changes in the general practitioner workforce. These data contain information on all qualified general practitioners in England and Wales and are aggregated by the General Medical Services Statistics Division of the NHS Executive (which collects information from health authorities). They have been used in previous studies on the health workforce.(7 13 14) For the years 1990-2 one of the variables collected was country of medical qualification, allowing us to determine the proportion of South Asian qualifiers by health authority. South Asian qualifiers were defined as those doctors medically qualifying in the countries of Bangladesh, India, Pakistan, and Sri Lanka. After 1 October 1992 this variable was no longer collected, but we could track general practitioners identified as being South Asian qualifiers in 1992 over time because of the unique identification number each doctor in the database received.

We also used the general practitioner census to calculate mean list size and the proportion of patients on a general practitioner's list who triggered deprivation payments (bands 1, 2, and 3 aggregated) as of 1 October 1992. The entire database covering 1990-4 was used to determine the mean retirement age over the period; we assumed that general practitioners who left practice at age 55 or older were retiring and would not return to practice. We projected the future supply of South Asian qualifying general practitioners by health authority starting with the actual number of such doctors on 1 October 1992 and assumed that they would retire at the age of 63, the mean retirement age of all general practitioners in 1990-4. Thus, we assumed that retirement age, on average, would not differ across ethnic groups. We assumed no net migration of South Asian general practitioners across health authorities, an assumption supported by past work.[7 13] We projected the number of South Asian qualifiers in 1997, 2002, and 2007. To calculate the proportion of NHS general practitioners represented by South Asian qualifiers in the future, we assumed a constant denominator equal to the total number of general practitioners in 1992; recent work has shown that the total number of whole time equivalent general practitioners in the workforce has remained relatively stable, despite the increase in the number of part timers entering general practice.[7] We further assumed that no South Asian qualifying general practitioners will be recruited into general practice in the future.