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

(*) Table sorted by percentage change (1992 to 2007) in full time unrestricted general practitioner who qualified in South Asia; constant denominator assumed.

The figure shows the proportion of general practitioners by health authority in 1992 that will be lost because of the retirement of South Asian qualifiers against the Benzeval and Judge measure of health authority level population need.[15]

[Figure ILLUSTRATION OMITTED]

Discussion

The proportion of general practitioners practising in the NHS who qualified in South Asian medical schools is a relevant health workforce topic because the Indian subcontinent has been a traditional source of medical immigrants for the NHS that is no longer viable given changes in medical licensure. Roughly one in six general practitioners practising in 1992 qualified in South Asia; two thirds will have retired by 2007. In some health authorities over half of the general practitioners qualified in South Asia, meaning replacement of such doctors will be a major issue that will remain beyond the next decade. Will these posts be difficult to fill?

Difficult posts to fill?

South Asian qualifiers are more likely to be practising in health authorities that have relatively high patient needs, and South Asian qualifiers have higher than average numbers of patients on their medical list who live in areas designated as deprived. This means that filling their posts may prove to be difficult once they retire as they seem to be located in areas likely to be considered relatively unattractive locations for general practice. Some general practitioners, however, may view large lists and deprivation payments as means of increasing income, raising questions about the quality of care in some high need areas.

There are several reasons why many of the posts vacated by retiring South Asian general practitioners may be less attractive openings; many of the projected vacancies will be in the inner city conurbations, which have traditionally been unattractive to newly qualified general practitioners. (This is probably one of the reasons that many South Asian qualified doctors moved into these areas in the 1970s and 1980s.) Despite deprivation payments, the remuneration attainable by inner city general practitioners is often less than that attained by doctors practising in more stable suburban areas.[16] Finally, the heavier administrative burden resulting from a more mobile population with an excess of mental health problems (including drug abuse), the difficulty in attaining targets for immunisation and cervical screening, and the higher property values in many inner city areas (especially London) may make it difficult to attract new principals.

At present the number of general practitioners moving into a heath authority is closely related to the number of open posts because of the centralised control of practice location maintained by the Medical Practices Committee. No health authority had a net loss of more than seven general practitioners over the period 1990-474 Health authorities with a higher proportion of South Asian qualified general practitioners, however, will have to deal with a much larger number of potentially unattractive vacancies in the future, and it is difficult to see how these posts will be filled in the short term in the most heavily affected areas.