Supporting existing international medical graduates working in the NHS to become consultants and GPs: A realist approach (SUP IMG study)

Background There is a massive shortage of doctors in the NHS, especially at consultant and GP level. In 2022, there were 10,582 vacancies for hospital medical staff across the UK, with only 52% of consultant vacancies filled. Recent figures show that the UK currently needs 6,000 more GPs to meet patient needs. Doctors with overseas qualifications are a large and core part of the medical workforce. Currently, 36% of UK doctors are international medical graduates (IMGs) who trained abroad. In 2021, we completed a mixed-methods study examining drivers and barriers affecting doctors’ migration to the UK, with two important but paradoxical findings. Firstly, the main drivers included employment, training and development opportunities. Secondly, very few IMGs join specialist or GP registers on arrival - just 4.8% in 2019, and few go on to become consultants or GPs (11.6% within 5 years and 27.2% within 10 years). This implies a loss to the potential consultant/GP workforce of more than 70% of IMGs compared to a loss of 25% for UK-trained doctors. We know IMGs can face challenges with career progression related to language, cultural differences, gaining work experience, and direct/indirect discrimination or racism. However, current evidence only lists challenges without telling us to whom and when they apply. This is because the issue of context - the surrounding factors that influence what happens - has been ignored. Research Question Why, when, and how do some IMGs become NHS consultants or GPs when others do not, and what can be done to support IMGs to achieve this? Objectives 1. To conduct a realist review of the literature to develop a programme theory to ascertain for whom, in what contexts, and why, some IMG doctors become consultants or GPs while others do not. 2. To conduct primary research (qualitative and quantitative) using a realist evaluation approach to test our programme theory from the realist review. 3. To provide evidence-based recommendations about practical support measures at the individual, Trust/practice and national levels to increase the number of IMGs that become consultants or GPs. Methods This project will use two realist approaches in sequence. Work package 1 (WP1) will involve a realist review to develop a programme theory detailing for whom, in what contexts, and why some IMGs become consultants or GPs and others do not. WP2 and WP3 will involve a realist evaluation using qualitative interviews (n=80) and longitudinal quantitative data to test the programme theory. WP4 will use co-production through workshops to develop recommendations to improve practical support for IMGs at the individual, Trust/practice and national levels. Timelines for delivery 36 months starting July 2025. Anticipated impact and dissemination The short-term impact is that the programme theory and recommendations will provide a framework for Trusts/practices and national-level organisations e.g. NHS England, the GMC and the Royal Colleges, to tailor and optimise support for IMGs to fulfil their career aspirations. In the long term, once the recommendations have been implemented, we expect the number of IMGs gaining specialty registration to increase, and the number migrating from the UK through dissatisfaction with their career progression to reduce. The findings will be disseminated via links with stakeholders, a final report, high-impact peer-reviewed publications, and presentations at key stakeholder meetings, and conferences.