NHS Brain Drain: The Exodus of UK-Trained Doctors

The NHS is haemorrhaging doctors and international recruitment alone is not the solution

The NHS is facing a significant crisis - it has a leak. According to an article in the Financial Times, as of 2023, a staggering 18,000 UK-trained doctors are now practising abroad, representing a 50% increase since 2008. To put this into perspective, nearly one in seven UK-trained doctors have chosen to work outside the UK. This is not just a blip—it’s a trend that has accelerated far faster than in our peer countries. In fact, the rate of doctors leaving the UK is nearly three times higher than in countries like France, Italy, Australia, Norway, and Sweden. This is a huge challenge for any government.

It costs £230,000 to train every UK medical student - the majority of which comes from the taxpayer. The taxpayer also pays the salary of UK resident doctors. Resident doctors take up training pathway spaces… and all this is perfectly okay because, in the long term, our country gets amazing resident doctors and consultants, who look after our family and friends. They act as the bedrock of security in our country, aiding us in our most vulnerable moments… right? Well, this premise relies on the nation actually retaining those doctors.

Put simply, any country that trains doctors only for them to leave once they reach the final stage of their careers is facing a crisis. This is undeniable.

The NHS has turned to recruiting doctors from overseas to fill the gaps. This influx of international doctors has become critical in maintaining service levels. As of recent reports, nearly two-thirds of new NHS doctors have been recruited from overseas. However, this solution has its limitations, especially when it comes to retention. While these doctors are invaluable in the short term, only 10% of overseas-trained doctors remain in the UK long term, compared to 75% of UK-trained doctors according to the same FT article.

This imbalance highlights a bigger issue: reliance on international recruits is only a temporary fix for what is a much deeper, systemic problem. The UK is essentially "training doctors for the world," with much of that investment reaping benefits for other healthcare systems. This dynamic is particularly concerning when you consider that many other countries, such as Germany and Sweden, have significantly higher ratios of doctors to their populations. If the NHS is to maintain a sustainable workforce, it must focus not just on bringing in foreign talent, but on retaining its homegrown doctors.

Ultimately, the exodus of UK-trained doctors is a warning bell for the NHS. While recruitment from abroad is a necessary part of the solution, it cannot be the sole strategy. The NHS must focus on making the UK an attractive place for doctors to stay and thrive, both in terms of working conditions and career satisfaction. Only then can we truly secure the future of our healthcare system and make sure that doctors who train here, stay here.

The DDRB: The Band Dictating Our Futures

The DDRB (Review Body on Doctors’ and Dentists’ Remuneration) is that mysterious entity supposedly watching over NHS doctors’ pay—reviewing it annually based on evidence from the government, NHS employers, and our professional representatives. Recommendations from the DDRB, however, are more like polite suggestions than binding orders. The government can nod along or completely ignore them.

Currently chaired by Chris Pilgrim, a man whose expertise lies mostly in the corporate world with a 12-year stint on Npower’s board, the panel’s membership feels oddly assembled. The rest of the gang includes: Professor Melanie Jones, an economics professor; Helen Jackson, who has experience in Human resources and renumeration/executive compensation; Janette McCormick QPM, a senior police advisor; John Matheson CBE, a former NHS finance director; and Dr. Raj Patel, the sole former GP offering a hint of frontline experience.

That’s quite a band dictating the direction of pay in the coming years…

Clinical Confidence and The Philosophy Behind the Discharge Letter

Why medicine is a game of probabilities, not certainties.

Picture this: You’re the SHO in the ED. Outside, ambulances line up in the distance. Inside, patients engage in the A&E waiting game. You’ve just clerked a patient with a relentless headache. Your examination, observations, bloods, and imaging are all unremarkable. After running the case by the consultant, the consensus is clear: likely migraine or vestibular neuritis. Discharge with outpatient follow-up.

But just as you’re about to sign off the discharge letter, the nurse overseeing the bay steps in. The patient’s headache persists, and the nurse is uncomfortable with the idea of sending them home. 

Now, you face a classic epistemological (that’s philosopher-speak for “figuring out how and why we know what we know”) dilemma: What does it mean to “know” this patient is safe to discharge?

Medicine is fundamentally an epistemic game: we gather evidence, apply reasoning, and aim to turn data into justified beliefs about a patient’s condition. But the evidence, is almost always incomplete. Negative scans and investigations don’t provide us with certainty—they provide us with probabilities.

From a knowledge perspective, what matters is whether our belief that the patient is safe to discharge is well-founded, and not whether it is infallible. We aren’t omniscient, but we are responsible for ensuring our conclusions are proportionate to the available evidence.

Our ED SHO has to be careful not to fall into The Fallacy of Endless Doubt: The idea that any residual symptom requires action, even if it’s already been evaluated and explained. This is part of the endless spiral of defensive medicine—mistaking uncertainty for danger.

Our responsibility isn’t to eliminate all doubt. It’s to ensure that our decision is justified based on the best available evidence and sound clinical reasoning. The negative findings from imaging and blood tests are not “nothing”—they are evidence that shifts the probability away from sinister pathology.

Next time you’re explaining your reasoning to a colleague, you can try framing it in our newly learned epistemological terms: “We’ve gathered all relevant data and found no evidence of acute or dangerous causes for this symptom. Without new or evolving signs, there is no evidence to support changing the conclusion we have arrived at. The plan is evidence-based and remains appropriate.”

“As a surgeon, the single most important factor that determines how smoothly my day runs is who my anaesthetist is.”

“In a social setting I say “Hello, I’m X”, at work I say “Hello, I’m X, Consultant ENT Surgeon” - why? because I believe patients require clarity of your role in their care”

“If every speciality is a board game, then surely geriatrics is snakes and ladders. You move forward 3 steps by treating the CAP. The patient has a fall and breaks their hip, gets a HAP, COVID and then delirium. Slide down the snake, climb up the ladder and repeat. Every other square takes you further from discharge.”

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Some things to review when you’re off the ward…

The list of private companies, charities and not-for-profit organisations being awarded contracts for work in the NHS is growing every day. Check out A-Z of all organisations from Medica to Spire Healthcare.

Wes Streeting made headlines this week by expressing his concern that certain mental health conditions are being overdiagnosed, leading to too many individuals being prematurely labelled as ‘not fit to work’.

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The Private Sector’s Selective Takeover

The private sector is infiltrating UK healthcare with ruthless logic: go where the profit is. Elective surgeries are the prime target—predictable, high-volume, and high-reward. Now, a third of hip replacements and a staggering 46% of cataract surgeries (April 2021) are privately performed. Why? Because these procedures are streamlined, low-risk, and come with quick, measurable success—exactly what private providers thrive on.

30% of Child and Adolescent Mental Health Services (CAMHS) are privately supplied. The private sector is looking at areas where the NHS can’t keep up, exploiting the gaps in a struggling system.

The logic is simple: Profitable services are poached by private providers, leaving the NHS to handle the underfunded, complex, and unprofitable cases.