The move to cut funding support for GP practices that employ newly qualified trainee doctors from outside the European Economic Area (EEA) – in the process potentially forcing many of those doctors to up sticks and leave the UK – couldn’t have come at a worse time, coinciding as it does with the beginning of the annual flu vaccination drive, largely delivered by GPs and now predicted to play a vital role in holding back the second wave of covid-19.

According to online newsletter Pulse, this support – covering sponsorship licence application fees, visa sponsorship certificates and immigration skills charges for the first two years for any non-EEA GP that practices employ – was curtailed in April when Health Education England (HEE) stopped reimbursing practices for these costs. HEE opted instead just to reimburse non-EEA GPs directly to cover their personal visa application fees.

These changes are expected to have a negative impact on practices’ ability to recruit and retain staff as they will increase costs. More than a third of GPs accepted onto specialty training this year will still need visa sponsorship once that training is completed.

They could also result in an exodus of medical professionals trained within the health service. NHS England’s online guidance offers little reassurance on this touchy subject, coldly stating, “After completing their training, these GPs either need to return overseas, find employment with an employer that holds a tier 2 visa sponsorship licence or… apply to normalise their status as a UK resident.”

GP numbers are on the decline generally, despite a claimed 15 per cent rise in those entering training. NHS Digital’s latest general practice workforce survey showed that the number of GPs overall was down by 1.8 per cent year-on-year, while the tally for fully qualified GPs (excluding registrars) had dropped by 2.3 per cent over the same period, figures described in one media report as being of “serious concern” by BMA GP committee chair Dr Richard Vautrey.

Hinting at the likely link between recruitment issues and covid-19, Vautrey added that NHS Digital’s statistics were “hardly surprising when we consider the immense pressures family doctors are under… now and before the pandemic hit… before covid-19, GPs were contending with chronic underfunding, rising patient demand and toppling workloads – all of which have been exacerbated by the virus”.

That link was made more urgent last week by the Royal College of GPs, which wrote to Dido Harding, head of the privately run NHS Test & Trace programme, warning that staff absences in surgeries – caused by GPs being forced to stay off work because they were unable to get tested for the virus – could hit the imminent flu vaccination drive that many hope will stop the NHS becoming overwhelmed this winter.

Reporting on the college’s letter, the Guardian highlighted a recent study in the Lancet which suggested around 1,200 GPs may have contracted the virus each month during the height of the first wave of covid-19 earlier this year.

But given the income generated by GP visas – recent research by the Labour Party shows that NHS trusts across the UK have had to spend £15m on visa charges since 2017 – it’s hard not to conclude that cash generation may rank as highly as the nation’s health on the government’s list of priorities for the NHS.

And those hoping for a speedy reversal of HEE’s decision should perhaps recall the government’s U-turn on the NHS immigration health surcharge for overseas health and care staff earlier this year.

A month later the Doctors Association UK found that many NHS workers were still being required to pay the charge.

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