Introduction
There are significant vacancies of qualified medical professionals across the UK.1 This has partially been filled by locum doctors causing a major financial burden on the NHS.2 To address workforce shortages, the British government has proposed to open five new medical schools to expand national intake by 25%.3 The step rise in medical workforce is unlikely to be felt before 2025.3 International medical graduates (IMGs) currently contribute significantly towards the NHS care provision.4 Recently there has been an increase in the number of IMGs applying to take the UK medical licensing examinations.5 Recruitment of more new entrant IMGs may be the short- to medium-term solution to the junior doctor shortfall. However, IMGs seeking first-time employment in the NHS face multiple challenges.6 A robust orientation programme would anticipate and mitigate such challenges and facilitate smooth transition into productive working in the NHS.7 There is no standardised orientation programme available for IMGs working in departments of general internal medicine (GIM) in the NHS.
Methods
We performed quality improvement interventions of recruitment and a clinical orientation programme (COP) for new entrant IMGs in our organisation employed between December 2017 and April 2019 and developed a framework to anticipate outcomes of these interventions using the realist evaluation methodology.
Results
Twenty-three IMGs were recruited, 96% successfully completed the COP with a mean contract duration of 13±5 months. To date, 83% of eligible IMGs have successfully completed their formal annual appraisal. Over the intervention period from academic year 2017/2018 to 2018/19, the mean junior doctor position occupancy has risen from 54±3 junior doctors to 73±4 (p<0.001). There has been a £1.9 million reduction in agency and locum junior doctor spend in the division. Exception reporting by trainee junior doctors has fallen by 56%. Formal complaints from patients and their families have fallen by 11%. Length of stay has reduced from 9.3±16.4 days to 8.9±15.6 (p=0.035) over the same intervention study period. For the first time since its inception, the Care Quality Commission has rated our organisation including the medicine division as ‘Good’ (from ‘Requires Improvement’) during the academic year 2018/2019. Context-mechanisms-outcomes configurations detailing the methodology of the behavioural changes implicit to the quality improvement work are shown in Table 1.
Methodology of behavioural changes
Conclusion
Our recruitment strategy and structured COP provides a stable, trained, and financially sustainable junior doctor workforce. Application in broader NHS settings is recommended.
Conflicts of interest
None declared.
- © Royal College of Physicians 2020. All rights reserved.
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