Supply and Demand for Doctors

The NHS rarely look to the economics of free markets to understand their own circumstances. After all, the NHS is in the public hands and not part of the commercial economy - but can the same principles help us understand how to solve the NHS Staffing Crisis?

Demand and Supply

Demand for doctors is high and increasing. The factors at play are straight forward – the population is growing and ageing, whilst lifestyle choices expose us to greater healthcare risks. The supply of doctors is also high and increasing HOWEVER it is not increasing as quickly as demand for healthcare and we therefore have a growing gap between supply and demand.

Given this very basic analysis of the ‘market’ for doctors, the key is closing the gap by reducing demand for doctors, increasing the supply of doctors or both.

Reducing Demand

Since population increase and ageing seems almost certain to continue then more needs to be done to improve public health and encourage healthier lifestyles. We live in a country which offers vaccinations against all major controllable disease but does relatively little to control obesity, alcohol, substance and cigarette consumption. We work longer hours than many countries around the world and our service-sector lead economy lends itself to sedentary lifestyles. In order to close the gap between supply and demand, the government needs to do more to change lifestyles to reduce the demand for doctors

Increasing Supply

There are a finite number of doctors that can work in the NHS since they all need to be GMC Registered. The register consists of doctors who train at medical schools in the UK and international doctors who join after sitting international medical exams and English language tests. This means we have two options:

1. Increase UK trainees. Successive governments continually make this pledge so why doesn’t it work? In part because it takes a decade or more to train a senior doctor and it is inherently difficult to predict how many we should train now to cope with service demand a decade from now. Also in part because governments rarely look to long term problem solving in the knowledge that future governments are likely to reap the political rewards of their actions.
2. Increase International Recruitment. So long as it is done in an ethical way and doesn’t detract from the healthcare needs of the source country then international recruitment is arguably the quickest fix for increasing the supply of doctors. The NHS is still the destination of choice for many international doctors but more needs to be done to simplify the process for their medical exams, language testing, licencing, recruitment, visa processing and relocation.

A note on Locums.

Hiring locum doctors neither adds or takes away from the problem – it just moves it around. The reason they are so expensive is purely down to the same reasons set out above – demand exceeds supply. The main way to reduce locum expenditure is to reduce demand for them by increasing the supply of permanent/fixed term staff.