1. Free Movement of Doctors in the EU The UK Consultant Physician Perspective

2. Issues The different settings The need for an EU supported workforce Specific issues in hospital care

3. The settings

4. Out of hours GP care High profile Often employ non-UK professionals Local NHS provider responsible for assuring professional competencies (including language) Responsible for large numbers of hospital admissions

5. Foundation year 1 Free movement from EU Need for shadowing Gaps left if doctors fail to perform How comparable are basic medical qualifications across EU?

6. Locum hospital jobs Large demand for locums Often short notice Evidence of concerns about competencies of external locums No consistent method to assess/assure competencies EWTD has limited internal locums

7. Consultants Specialist qualifications vary across EU EU focus on length of training not competencies UK specialists often have different skill mix to EU specialists, e.g. in acute medicine UK seen as attractive place to work as a specialist

8. The need for an EU supported workforce Vacancy rates in junior doctors Difficult to fill specialist posts in particular areas of the UK The right of free movement across borders

9. Vacancy rates F1F2CTSTSAS Number of posts in survey8365619031292412 Post vacant 1.0%3.0%5.0%8.6%5.2% Sick leave 1.5%3.5%2.2%2.6%2.3% Annual leave10.7%10.4%13.1%8.6%4.1% Study leave0.6%3.3%4.4%6.0%1.6% Compensatory rest7.1%11.6%11.7%7.2%2.4% On MAU10.1%15.0%13.2%12.3%3.0% On base ward or in clinic68.9%53.3%50.4%54.7%81.3%

10. Sickness rates

11. Hard-to-fill specialties Mersey London & KSS Trent Northern South Western Peninsula West Midlands Yorkshire Acute medicine-0.91.00.81.02.31.6 Cardiology7.56.4-3.0-5.55.0 Dermatology4.06.8-2.0-1.8- Endocrinology2.12.52.0 1.02.83.0 Genito-urinary medicine03.4---01.0 Gastroenterology2.35.12.54.41.54.8- Medical microbiology-1.9----1.0 Nuclear Medicine-0.8---0- Rehabilitation Medicine02.0-000.3 Renal Medicine1.52.72.01.0-4.0 Respiratory Medicine3.02.96.02.3-4.03.3 Rheumatology-4.3-2.001.72.8

12. How often do you use locums?

13. Strongly agree AgreeNeutralDisagree Strongly disagree Internal locum cover is easy to organise 1.6%6.3%12.7%46.0%33.3% External locum cover is easy to organise 1.6%4.8%6.5%30.6%56.5% Internal locums are usually reliable 25.8%71.0%3.2%0% External locums are usually reliable 1.6%19.4%45.2%30.6%3.2% Internal locums are usually high quality 23.8%57.1%17.5%1.6%0% External locums are usually high quality 0%9.7%41.9%40.3%8.1% Patient care is usually worse when internal locums are employed 1.6%3.2%9.5%66.7%19.0% Patient care is usually worse when external locums are employed 9.7%33.9%43.5%12.9%0%

14. Specific concerns for hospital care Ensuring adequate competencies and language skills for locums and specialists Revalidation Costs of skills/language assessments for hospitals under current economic pressures Optimising out-of-hours care to limit the number of inappropriate hospital admissions

15. Language – who is responsible for checking? " Persons benefiting from the recognition of professional qualifications shall have a knowledge of languages necessary for practising the profession in the host member state" 2005/36/EC Article 53

16. The HPRO card

17. Questions