No ID, No Problem: Welcome to the NHS

The GMC let hundreds of doctors practice without fully verifying their identities—what does this do to public trust?

A couple of weeks ago, we made what some described as a crying plea: That the prosperity of our profession depends on one key element: trust.

Some called it hyperbolic. But is not the case. Medicine, more than any other profession, rests on an invisible social contract between doctor and patient. This contract is built on belief, the belief that the person sitting across from you is competent, ethical and regulated by a robust system that ensures those two things are true.

When that belief is fractured, chaos ensues. Patients begin to second-guess clinical decisions, they take Google’s advice over their doctor’s, they don’t take their medications and, perhaps, seek second opinions, sometimes from unverified sources.

A Fresh Blow To The Profession

Last week, that trust took another serious blow. Headlines across the country reported that hundreds of doctors were cleared by the GMC to practise in the UK without full verification of their identity documents. An investigation from The Times found 505 doctors currently on the GMC register who had never had their identification conclusively verified.

The optics are even worse with the media having quickly picked up on individual cases: a consultant doctor struck off in the US for sexual misconduct with a patient, another doctor stripped of his Nordic licenses for repeatedly misreading scans. Both now working in the NHS. In the public eye, this becomes further evidence that the gatekeepers of our profession have fallen asleep on the job.

However, this issue goes beyond the trust of the public however. For the majority of us who entered this profession through the most stringent, audited and arduous process imaginable, from UCAS applications and fitness-to-practise declarations through repeated DBS checks, to multiple rounds of OSCEs and revalidation, it feels like a slap in the face.

The GMC’s Defence

The GMC has tried to explain this as a legacy of COVID-19. During the pandemic, they argue, the process of in-person checks had to be paused to expedite the licensing of international doctors at a moment of crisis. Since then, they claim to have retroactively verified thousands of these doctors, leaving just 341 cases ‘outstanding’. To some this might sound reasonable, but for us at On-Call it raises some other questions.

If the GMC can so easy relax something as fundamental as identification (Medical licenses, Medical School certificates etc) in a time of crisis, what else can be suspended in the name of expedience and what does it tell us about the value placed on staffing versus safety/safeguarding.

This is certainly not about hounding international medical doctors, the vast majority of which have the right documents and play a huge part in the running of our healthcare system. This is about whether our own regulator can be trusted to uphold the same standards it demands of us.

Moreover, there are other examples that further highlight the GMC’s sloppiness and desire to cut corners. For example, the GMC allows translations of essential documents to be provided by the applicant, requiring only that they be “accurate.”

There’s no evidence that the GMC independently verifies these translations. Given the volume of international applicants, it’s implausible that each translation is individually vetted for authenticity. This is a cost-saving measure for them, perhaps, but one that introduces clear risk.

Rebuilding the Social Contract

We can’t undo the damage that the headlines have done, but what we can do is demand that the GMC publish a full, independent audit of its registration process post-pandemic to put the public and its own doctors at ease. When public confidence erodes, it doesn’t ask which doctor was verified, it discredits the entire profession.

No-One Is Watching (aside from Infection Control Maybe)

“Andy, could you pop an art-line into the new lady in bed 3?”

You glance down at your name badge… yes, you are Andy, and apparently also the ITU SHO. It’s your first unsupervised arterial line, but it’s just the Seldinger technique, right? (Famous last words.)

First attempt: needle in, skin punctured, ultrasound guiding you. You think you’ve hit a vessel. You feed in the guidewire, then meet resistance that you can’t push through.

“Mrs Fernández, I’m going to have another go, if that’s okay.”

Attempt two draws an audience. The F1, PA and medical student gather nearby to watch. This time, everything flows better. Needle in, Guidewire inserted, catheter follows, guidewire out. Victory, until you realise not a drop of blood fills the syringe.

You trudge back to the ITU consultant to confess. On the way, your mind ponders. Who saw? Are you cut out for this speciality? Will they remember this when a new procedure comes about? Will they still respect you?

Now think about this: when was the last time you watched someone fumble a procedure? Do you even remember who it was or why they weren’t successful? Probably not. The memory’s long gone, or blurred beyond recognition.

That’s the asymmetry. We live our lives under a spotlight of our own making, convinced others are watching with the same intensity we watch ourselves. They’re not. You are the main character of only one story: yours. No one is keeping score. No one is going home to discuss your failed art line over dinner.

And yet, this illusion, this “spotlight effect”, costs us. How many times have you hesitated to try again, haunted by the memory of the last time you didn’t succeed?  

To Buy, Or Not to Buy?

Why Mortgages and Rotational Training Don’t Mix Well

Where does home buying sit on the medical career ladder?

Unless you’ve been living under an affordably-priced rock, you’ll be well aware of the current problem with housing. The days when a doctor could leap onto the housing ladder with a few locum shifts and some optimism are long gone.

Training and Timing

Specialty training bottlenecks have introduced new levels of uncertainty into doctors’ lives, from where they’ll live to whether they will even stay in the same region next year. The area where this uncertainty manifests in the greatest way is our ability to plan when and where to buy a home.

The obvious thing to note is that there is no single “right” answer here. Everyone’s personal circumstances such as partners, children, career path, financial security, will dictate what makes sense. That said, there are a few common patterns that many doctors follow that we will explore later on.

Even once you’re settled and ready to buy, the real ‘hidden’ costs are still catching people out. Compare The Market looked at the average hidden costs of moving house in 2024, including legal fees, surveyor reports, removals, and mortgage arrangement fees and found the figure to be £5,837. That’s before the addition of everyone’s favourite tax, Stamp Duty.

Renting: A Necessary Flexibility

For many, renting isn’t a sign of delay, it’s a much needed lifeline for their unique circumstance. In 2007, the average first-time buyer in the UK was 28. In 2024, it climbed to 33.8 and rising. The notion of “Why pay your landlord’s mortgage?” often comes from a generation who bought during a period of significant property price increase. Since 1952, the average UK house price has risen by more than 150 times, from under £2,000 to nearly £290,000 today.

For doctors who aren’t in the financial situation to buy or are suffering the reality of rotational training, renting is protective. The rotational nature of training, with 4–12 month jobs scattered across vast deaneries, makes long-term home ownership risky.

A leaking roof? Call the landlord. A broken boiler? Not your weekend problem. In that sense, renting is often a sanity-saving decision whilst you are dealing with a punishing rota. Buying a property comes with significant upkeep and that home that once seemed like a proud milestone can quickly become another source of stress.

Beyond The Mortgage

It’s tempting to think that paying rent is “throwing money away.” But in the early years of a mortgage, most repayments actually go toward paying off the interest, not equity or value in the home. Finance nerds call this the ‘Amortisation effect’ or principle. It is only over the long run that your payments go towards owning more of your home.

If your rent is significantly cheaper than an equivalent mortgage, you could, in theory, invest the difference. We say this as a reminder that it’s worth recognising that the financial advantage of buying isn’t always immediate or guaranteed.

And while the NHS does offer relocation expenses, they come with eligibility criteria and limitations. They may not cover all associated costs and certainly won’t cover the emotional cost and time lost of packing up and leaving a home you once dreamed of settling in for the long term.

When Does Buying Make Sense?

Buying starts to make financial sense when you reach a degree of career stability, both geographically and financially. As a rough guide, it’s wise to plan to stay in a property for at least five years before selling, to offset the fixed costs of purchase (listed above) and avoid being caught out by short-term market fluctuations.

For most doctors, this kind of stability tends to appear around the consultant or post-CCT GP stage, when income is predictable and location fixed. However, with the current training bottlenecks and delayed progression to CCT, many may not want, or be able, to wait that long, particularly those with partners or children.

For those in ST3+ or ST1 run-through programmes, buying can be feasible if the geography makes sense. For example, before diving in, study your rotation carefully: Where are they sending you? Are the hospitals within reasonable commuting distance, or will one year see you driving two and a half hours across the deanery? A mortgage won’t make that drive any shorter.

No One Size Approach

Ultimately, as you would’ve guessed, there’s no one-size-fits-all answer. Buying and renting are both valid, depending on your career stage, financial situation, and personal priorities. What matters is planning deliberately.

The On-Call team suggest that you seek advice from an independent mortgage broker familiar with NHS income structures, including unique aspects of our career such as locum work and our pay progression. They can help you assess what’s realistic, and prevent you from overcommitting.

“It can’t just be me having a torrid time when it comes to diagnosing all the Salter Harris fractures that come through A&E. I’m sat tracing the cortex of this radius like a madman but still end up missing them.”

“To any doctor who’s managed to buy a house in London, please teach me your ways. Lottery or Premium bond jackpot win? Secret inheritance? Married rich? I’m about two Rightmove scrolls away from having to packing up and leave this beautiful, unaffordable city.”

“I love consoling all the doctors who are anxious about the age they will enter speciality training. I just gently put my hand on their shoulder and say: I did F1 at 42, you’ll be okay. Tends to work quite well”

“I actually don’t mind working nights, shame my body and sleep schedule despises them.”

What’s on your mind? Email us!

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

Nicotine addiction is spiralling out of control with the WHO estimating that more than 100 million people, including 15 million children are now using e-cigarettes. It has never been easier to access e-cigarettes. The tobacco industry is fighting back a decline in tobacco use by the creation of these new nicotine products. Read the full article here from the BBC.

The UK is launching a new cloud platform enabling large‑scale AI trials in NHS cancer screening initiatives across trusts and specialties. This effort is intended to accelerate real‑world evaluation of AI in screening contexts, whilst balancing this innovation with oversight and validation.

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Nine Sessions Later: The Myth of the Full-Time GP

The work and pay of a GP are measured in sessions. One session is roughly (GPs, please don’t throw your phones just yet) equivalent to a morning or afternoon in the practice. The BMA model contract defines a session as lasting around four hours and ten minutes. By that logic, to hit the ‘full-time’ mark of 37.5 hours a week, you’d need to work nine sessions.

Every GP reading this will probably tell you that a morning session never lasts only four hours, and the data seems to back them up. Eleven years of research show that the average time spent on consultations plus the associated paperwork is six hours and twelve minutes. So, after just six sessions you’re already working the equivalent of a full-time week.

And yet, if a GP works six sessions, they’re considered “less than full time.” So, either we reduce the workload per session, or we rethink what “full time” actually means.

UK GPs are overstretched, seeing around 45–50 patient consultations a day. The problem is highlighted when we compare that to Sweden’s 14, Switzerland’s 25, Italy’s 25, and Austria’s 30.

But don’t worry, it could be worse. Spare a thought for Turkey’s GPs, who somehow manage an average of 80 consultations a day. Someone get them some tea. And a baklava.