Treat the causes of doctors’ exodus to encourage them to stay in Britain

SIR – Tom Tugendhat is right to be concerned about the exodus of expensively trained junior doctors from the NHS (Comment, September 23). As a junior doctor, may I explain how this has come about?

This problem is swollen by the Government’s plans to introduce a new contract for junior doctors. Changing the definition of “social working hours” to include weekday evenings until 10pm and Saturdays means doctors will no longer receive additional pay for working at these times. Most junior doctors work antisocial hours, so this money could comprise almost a third of our salary.

Training as a doctor also comes at a considerable personal cost. Typically, we graduate with more than £60,000 of student debt. We can be posted to train anywhere in the country. We also pay thousands of pounds for registration, indemnity insurance, compulsory training and exams.

Foundation and specialty training takes a further 5-10 years, so junior doctors make up the majority of hospital doctors. This pay cut also comes as specialty training places have been reduced, which means that many doctors are unable to pursue their career of choice in Britain.

Dr Alexander Brazier

London SE13 SIR – My local GP practice is closing and NHS England wants to “redistribute” patients across other surgeries. It is claimed there is a shortage of GPs, yet one of my young relatives, who has excellent exam grades, has been discouraged from applying to medical college because of the “pressure on available places”.

Now we learn that we are losing the GPs we train in Britain at vast expense. We are left to fill the gap with doctors from other countries, which can ill afford to lose them. GP training and service needs urgent review.

Harold Hughes

Kingston upon Thames, Surrey for a fixed period of time, as in the Armed Forces. He gives the example of a fighter pilot serving 12 years to pay back a training cost of £4 million – in other words, £333,333 a year.

By this measure, a GP who has cost £500,000 to train should be tied to NHS work for 18 months. A newly qualified doctor would have to work for the NHS for less than a year.

Most NHS doctors have repaid their debts in spades. The way to retain staff is to treat them well, not to enforce an indentured servitude.

Dr Nick Bunting

Boston, Lincolnshire SIR – Kate Laycock (Letters, September 21) describes part of a GP’s work as “out-of-hours”. I didn’t know there were defined hours in which people could be ill.

If there is a problem with GPs’ pay, then solve it without using this strange term. Working hours vary according to the nature of the job.

Elizabeth Jones

Buckland St Mary, Somerset