Doctor exodus

sir – Last year, 6,950 registered doctors applied to the General Medical Council for a certificate to work abroad (report, January 8). Some will have gone for educational purposes (as I did) and will return, but many will stay. This is a significant loss to this country, especially when you consider that next year there are only 7,500 medical school places available nationally.

This is a situation in which only money will talk. There should be an immediate 50 per cent increase in the fees paid by medical students to reflect better the cost of the course, but with a full loan available. Each year of work for the NHS should attract a 10 per cent reduction in both the loan and interest.

Such changes would in effect give those who stay a tax-free pay rise as junior doctors, and increase the amount paid by those who leave. They would also affect another group: those who qualify but never practice, having discovered the marketability of a medical degree in other lines of work. Dr Michael Pegg

Esher, Surrey

sir – Why is the NHS in a parlous state? Consider the cost of the following.

A band-7 nurse with more than 30 years’ experience in A&E requests a reduction in hours to three or four days a week. The response of management: this is not possible, due to insurmountable problems. The result: the nurse retires and then returns to work (because the hospital is short-staffed) for her chosen hours at a higher rate of pay.

This is achieved by thousands of personnel by going on the “bank”, an agency supplying workers to cover staff shortfall. The cost to directorates is exorbitant, so it’s not difficult to see where management, often through intransigence, is wasting vast sums. Angela Dunn

West Moors, Dorset