But data on use, frequency, and consequences for NHS incomplete and haphazard
Currently impossible to fully understand risks of opting for surgery abroad, warn researchers

The postoperative complications of medical tourism may be costing the NHS up to £20,000 per patient, suggest the findings of a rapid review of the available data, published in the open access journal BMJ Open.

But data on the use, frequency, and consequences for the NHS are incomplete and haphazard, making it currently impossible to fully understand the risks of opting for surgery overseas, warn the researchers.

The number of medical tourists has risen steadily over the past several decades, a trend that shows no sign of abating, note the researchers. And treatment of any postoperative complications usually falls to the home country’s health service and can be further complicated by inadequate information about the initial surgery, they add.

Amid an absence of systematically collected data, the researchers wanted to gauge the costs and savings to the NHS of medical tourism as well as the type, frequency, and complications involved, plus any subsequent treatment, care, and use of NHS resources.

They reviewed research databases for relevant studies as well as ‘grey literature,’ such as conference proceedings, discussion papers, editorials, and government, industry, and institutional reports, published between 2012 and December 2024.

Studies that described cases of emergency and urgent surgery abroad; treatment for cancer, infertility, and dentistry; and transplant surgery were excluded from the analysis.

In all, 90 full text articles were selected for review, of which 38 reports describing 37 studies, were eligible for inclusion: 19 described complications due to metabolic/bariatric surgery; 17 complications due to cosmetic surgery; and one complications arising from eye surgery.

The case series and case reports included 655 patients treated by the NHS between 2011 and 2024 for complications arising from metabolic/bariatric (385), cosmetic (265), or eye (5) surgery tourism.

Twenty three studies reported the destination country. Overall, 29 countries from every continent were reported, but Turkey was the most common destination (61%). Most patients were women (90%), and the average age was 38, but ranged from 14 to 69.

The most commonly reported procedures were sleeve gastrectomy–removal of part of the stomach to create a smaller ‘sleeve’–breast surgery enlargement, and ‘tummy tuck’ (abdominoplasty).

Twenty two studies (371 patients) reported some details on complications. No deaths were reported in the included studies, but at least 196 patients (53%) experienced moderate to severe complications.

Treatment for these was not clearly reported in most of the studies, however, and only 14 studies reported on the associated costs, which ranged from £1058 to £19,549 per patient in 2024 prices.

Eight studies (159 patients) reported length of hospital stay for the treatment of complications from metabolic/ bariatric surgery tourism. The combined average length of stay was just over 17 days; the longest was 45 days.

The combined average length of stay for the treatment of cosmetic surgery complications was just under 6 days; the longest was 49 days. For eye surgery tourism, over 50 outpatient appointments and 4 surgical procedures were reported.

Very few studies reported on the use of other resources, such as day case procedures, surgery time, clinic appointments or number and type of diagnostic tests.

The certainty of the evidence obtained from most of the studies was low, primarily because most of the studies were retrospective, with data obtained from medical notes, which can be incomplete or wrongly coded; few studies included demographic details or previous medical history; and not all outcomes were reported by all the studies, explain the researchers.

But this suggests that both the complications arising from medical tourism for elective surgery and the associated costs are likely to be underestimated, they add.

“There are areas of the UK, such as Wales and the South West of England, which are almost unrepresented [in published evidence]. We did not identify any studies that related to other surgical specialties, such as orthopaedic surgery, and we did not identify any eligible studies conducted in primary care or that considered longer-term follow- up,” they point out.

“We still do not know how many people resident in the UK go abroad for elective surgery or how many people subsequently experience complications. Without these data, we cannot fully understand the levels of risk that people seeking surgery abroad are taking,” they emphasise.

“A systematic approach is needed to collecting information on the number of people who travel abroad for elective surgery and the frequency and impact on the UK NHS of treating complications,” they insist.

“Awareness-raising campaigns and interventions are warranted to inform members of the public in the UK considering going abroad for surgery about the potential for complications.” they add.

“Those seeking medical treatment abroad should be made aware of which complications the NHS is responsible for treating, and costs for which the patient may be potentially personally liable, including non-emergency treatment,” they suggest.

13/01/2026

Notes for editors
The authors have previously posted a non-peer reviewed, unedited version of this study for feedback from the research community, on a recognised preprint server.
Research: Complications and costs to the UK National Health Service due to outward medical tourism for elective surgery: a rapid review Doi: 10.1136/bmjopen-2025-109050
Journal: BMJ Open

External funding: Health and Care Research Wales Evidence Centre

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Rapid review
Subjects: People

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Half a million patients being cared for in temporary spaces, which evidence suggests is becoming a permanent fixture in many hospitals

Most (79%) of NHS trusts in England are treating patients in corridors or makeshift areas in emergency departments including “fit to sit” rooms, x-ray waiting areas, and in one case a café, finds an investigation published by The BMJ today.

Data obtained by The BMJ show that such practices have resulted in at least half a million patients being cared for in temporary spaces and that in some trusts one in four patients in accident and emergency (A&E) departments were cared for in corridors last year.

Corridor care refers to the practice of providing care to patients in hospital corridors or other non-designated areas, owing to overwhelming demand.

Senior doctors say this is having a catastrophic effect on patient care, with end-of-life conversations being held in corridors. One describes the situation as “heartbreaking” and “undignified.”

Freedom of Information (FOI) requests by The BMJ show the extent to which A&E corridor care is becoming normalised, with examples of trusts installing portable sinks on corridors, along with heating, lighting, plug sockets, and toileting facilities to provide long term care to patients in these settings.

Some organisations have even created dedicated “corridor nurses” for shifts, with one trust hiring extra staff to help oversee patients in the “temporary escalation chairs.”

Wes Streeting, the health and social care secretary, promised in October 2024 to “consign corridor care to history where it belongs” and the government recently pledged to publish national data on the situation “shortly,” although NHS England first committed to this back in January.

Ian Higginson, vice president of the Royal College of Emergency Medicine, says: “We hear of persistent stories of patients having cardiac arrests on corridors or of an inability to get resuscitation equipment to patients because everything’s in the way.”

He added: “For staff it’s a real source of moral injury. If this was happening in any other place, in any other walk of life, there would be an absolute outcry. It’s a complete scandal.”

Yet despite the obvious harm corridor care causes to patients and the staff who treat them, evidence shows that temporary caring spaces are becoming a permanent fixture in many hospitals.

For example, Dorset County Hospital said that it had adapted a corridor by adding portable sinks, heating, lighting and plug sockets. University Hospitals of Liverpool told The BMJ it had converted a room on a corridor into an additional toileting facility for patients, and Dartford and Gravesham said it had “dedicated nursing staff to care for patients on corridors.”

The three trusts reporting the highest number of patients in corridor care were Liverpool University Hospitals (37,735, or 18.7% of attendances), Barking, Havering and Redbridge in east London (35,224, 24% of all attendances) and Northern Care Alliance in Greater Manchester (33,987, 11.3% of attendances), although they all cover two or more emergency departments within one organisation.

Lynn Woolsey, chief nursing officer at the Royal College of Nursing, says: “These figures reveal the tragic reality of the frontline, where patients are left in unsafe and undignified conditions and nursing staff are prevented from providing person centred care. The figures are shocking, yet they are the tip of the iceberg. We know that corridor care is not limited to emergency departments.”

“As we head into winter, this situation is only set to worsen,” she adds.

A spokesperson for the Department of Health and Social Care said: “No one should receive care in a corridor in a chair or trolley – it is unacceptable and undignified. We are determined to end this, which is why we’re publishing corridor waiting figures so we can take the steps needed to eradicate it from our health service.”

17/12/2025

Notes for editors
News: Eight in 10 trusts are caring for emergency department patients in corridors, BMJ investigation finds doi: 10.1136/bmj.r2636
Journal: The BMJ

Link to infographic/NHS trust calculator: How many people does each NHS trust treat in corridors? https://public.flourish.studio/visualisation/26745402/

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Almost all emergency departments routinely deploying this approach

At any one time, nearly 1 in 5 emergency department patients in the UK is being cared for in corridors, waiting rooms, and other non-standard ‘overflow’ spaces—an approach known as escalation area care—suggest the results of a large observational study, published online in Emergency Medicine Journal.

Almost all emergency departments in the UK are routinely deploying this approach, which contravenes national guidance, the findings indicate.

Amid the high prevalence of emergency department overcrowding in the UK, escalation area care is reported to be widespread, but there is no high quality evidence describing its prevalence, say the researchers.

This is especially important as escalation area care is known to compromise patient safety, generate substandard and undignified experiences for the patient, and is thought to be a factor in the heightened risk of death among patients enduring long waits in emergency departments, they add.

To gauge its true prevalence, the researchers studied clinical activity in 165 out of 228 type 1 emergency departments—those providing consultant-led, 24-hour services with full resuscitation facilities—at 5 different time points across 10 days in March 2025.

Local reporting teams relied on electronic health records, department management systems, and real-time observations to record the number of patients in escalation areas.

They also recorded the number of patients awaiting an inpatient bed; the number of cubicles or chair spaces in each emergency department (stratified by resuscitation room and non- resuscitation room status); whether there were children and patients with a presenting mental health issue in escalation areas; and the availability of resuscitation cubicles.

An escalation area was defined as ‘any area not routinely used unless the capacity of the usual emergency department geographical footprint is exceeded’ and they included: an ambulance queueing to offload for more than 15 minutes; a repurposed clinical area; a non-clinical area, such as a hospital corridor or waiting room; and a doubled-up cubicle.

The data showed that the treatment of emergency department patients in escalation area spaces was a regular and common occurrence.

The total number of patients in escalation areas across all 5 time points totalled 10,042, or 18% of all 56,881 patients in the participating emergency departments. And the proportion of sites reporting patients in escalation areas ranged from 70% to 90%.

A break-down of the total proportion of patients treated in the various types of escalation area in use showed that repurposed clinical spaces (31.5% to 39%) and non-clinical spaces, such as waiting rooms and corridors (53% to 58%), made up the lion’s share.

Overall, the time point with the highest number of patients in emergency departments (15, 933) was Monday at 7pm. The highest proportion of patients in escalation areas was Thursday at 7 am (the end of the clinical night shift), when more than 1 in 5 (21%) of all UK emergency department patients were being cared for in these locations, despite this being the period with the lowest total number of patients (7056).

Both children and patients with a mental health presentation were being cared for in these spaces across all 5 time points. Among the emergency departments seeing children, 5% to 23% reported treating them in escalation areas. And the proportion treating patients with a mental health presentation in these spaces ranged from 26% to 35.5%.

Regionally, the proportion of patients in escalation areas was consistently highest in Northern Ireland and lowest in the Southwest of England. And this proportion was highest in adult only emergency departments and smaller local emergency hospitals, and lowest in major trauma centres.

The number of patients waiting for an inpatient bed consistently exceeded the number of patients being cared for in escalation areas.

And the proportion of sites without any immediate resuscitation cubicle capacity ranged from 10.5% to 26%, “representing a significant patient safety issue,” note the researchers.

They conclude: “National guidance from NHS England states that escalation area use is not acceptable; this study demonstrates that it is widespread and routine. The same guidance states that children and those with mental health problems should never experience escalation area care; this study demonstrates that this is occurring regularly.

“Admitting patients awaiting an inpatient bed from the [emergency department] would largely solve the escalation area care problem… Healthcare policy makers must address this issue or openly accept escalation area care and its associated harms as a standard experience in UK emergency care.”

In a linked editorial, the immediate past and current presidents of the Royal College of Emergency Medicine, suggest that the findings are likely to be an underestimate.

“The authors of this paper have successfully quantified the extent to which crowding leads to patients being treated in inappropriate spaces. If anything, their findings will be an underestimate.”

They point out: “Most recently, the harm associated with crowding has been quantified, such that for every 72 patients who wait 8–12 hours before admission there is one excess death.”

The study provides further evidence on the cause of overcrowding in emergency departments, they highlight. It’s not the volume of patients coming in, but the flow out.

“Basically, if all the patients who required admission were taken out of the equation, the [emergency departments] in the study (remember that is most of the [emergency departments] in the UK) would not have been overcrowded. The issue is the exit block, and the policy focus needs to be on that,” they insist.

They add that the research didn’t measure the effects on patients and staff of escalation area spaces, but it stands to reason that this can’t be the best quality care.

“Despite NHS England’s guidance on ‘providing safe and good quality care in temporary escalation spaces’, it simply isn’t possible to offer proper care in corridors and cupboards. Patients describe loss of autonomy, unmet expectations, and feelings of increased vulnerability. Many of these patients are elderly, frail, and vulnerable. Many have visual or hearing impairment, or are confused. Many have extensive nursing needs,” they write.

“The disconnect between guidance from politically driven organisations, such as NHS England, and the real world is starkly exposed here,” they add.

10/12/2025

Notes for editors
Research:  Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross- sectional snapshot study Doi: 10.1136/emermed-2025-215301
Commentary: Another brick in the wall: why ‘corridor care’ is an oxymoron and why it is important to understand it Doi: 10.1136/emermed-2025-215664
Journal: Emergency Medicine Journal

External funding: Royal College of Emergency Medicine (research)

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

About the journal
Emergency Medicine Journal is one of 70 journals published by BMJ Group. The title is co-owned with the Royal College of Emergency Medicine
https://emj.bmj.com/

Externally peer reviewed? Yes (research); No (commentary)
Evidence type: Observational (research); Opinion (commentary)
Subjects: People

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Tools already widely used amid few institutional policies and regulatory guidance
Medical education must adjust curricula + training to mitigate risks, warn experts

Overreliance on generative AI risks eroding new and future doctors’ critical thinking skills, while potentially reinforcing existing data bias and inequity, warns an editorial published in the online journal BMJ Evidence Based Medicine.

GenAI tools are already being widely used amid few institutional policies and regulatory guidance, point out the authors, who urge medical educators to exercise vigilance and adjust curricula and training to mitigate the technology’s pitfalls.

The use of AI is now used in a vast array of different tasks, but along with its burgeoning potential comes an increasing risk of overreliance on it and a host of potential issues for medical students and trainee doctors, note the authors from the University of Missouri, Columbia, USA.

These include:

●       automation bias—uncritical trust of automated information after extended use

●       cognitive off-loading and outsourcing of reasoning—shifting information retrieval, appraisal, and synthesis to AI, so undermining critical thinking and memory retention

●       Deskilling—blunting skills, which is especially important for medical students and newly qualified doctors who are learning the skill in the first place and who lack the experience to probe AI’s advice

●       reinforcing existing data biases and inequity

●       hallucinations—fluent and plausible, but inaccurate, information

●       breaches of privacy, security, and data governance—a particular issue for the sensitive nature of healthcare data

The authors suggest various changes to help minimise these risks, including grading the process, rather than only the end product in educational assessments, on the assumption that learners will have used AI.

Critical skills assessments that exclude AI need to be designed, using supervised stations or in-person examinations—especially important, for bedside communication, physical examination, teamwork,  and professional judgement—suggest the authors.

And it may be prudent to evaluate AI itself as a competency, because “data literacy and teaching AI design, development, and evaluation are more important now than ever, and this knowledge is no longer a luxury for medical learners and trainees,” they add.

Medical trainees need to understand the principles and concepts underpinning Ai’s strengths and weaknesses as well as where and how AI tools can be usefully incorporated into clinical workflows and care pathways. And trainees also need to know how to evaluate their intended performance and potential biases over time, they emphasise.

“Enhanced critical thinking teaching is especially needed, which can be achieved by building cases where the AI outputs are a mix of correct and intentionally flawed responses…. Learners would then accept, amend, or reject, and justify their decision with primary evidence- based sources,” suggest the authors.

Regulators, professional societies, and educational associations around the globe also need to play their part, by producing and regularly updating guidance on the impact of AI on medical education, urge the authors.

They conclude: “Generative AI has documented and well-researched benefits, but it is not without pitfalls, particularly to medical education and novice learners. These tools can fabricate sources, encode bias, lead to over-reliance and have negatively disruptive effects on the educational journey.

“Medical programmes must be vigilant about these risks and adjust their curricula and training programmes to stay ahead of them and mitigate their likelihood.”

02/12/2025

Notes for editors
Editorial: Potential risks of GenAI on medical education Doi: 10.1136/ bmjebm-2025-114339
Journal: BMJ Evidence Based Medicine

External funding: None declared

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Opinion
Subjects: Doctors

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Almost 9 in 10 trusts use contracts that deny doctors training and fair pay progression
Experts warn that the NHS is effectively “behaving like a gig economy employer”

Thousands of locally employed doctors (LEDs) – many of them international graduates and from ethnic minority backgrounds – are trapped on insecure NHS contracts with no access to training, career progression, or national safeguards, reveals an investigation published by The BMJ today.

LEDs are the fastest growing group of doctors in the UK, driven mostly by those who graduated outside the UK. From 2019 to 2023, the number of LEDs in England and Wales rocketed by 75% to 36,831 doctors.

Freedom of Information (FoI) data obtained by The BMJ show that almost nine in 10 UK acute trusts use local contracts – some dating back as far as 2002 without safeguards introduced in 2016 – letting them set terms without guarantees on pay, hours, teaching, or supervision.

Although guidance states that doctors should spend no longer than two years on local contracts, The BMJ has found alarming evidence of senior doctors effectively stranded in these unsuitable contracts for 10 years or more.

Data gathered from FoI requests found that around one quarter of doctors on local contracts had been employed by their trust for more than two years. Doctors from ethnic minority backgrounds were more likely to be in this position, our data found.

One such doctor, a surgeon with a degree from South East Asia, told The BMJ that she had been on an LED contract for over 17 years. When she raised these issues with her line manager, she was told that she could either accept the situation or quit.

Another doctor working in plastic surgery in the North West on a trust grade registrar contract said: “This is a stagnant post—there is no scope for growth. That’s the problem with the locally employed doctors—the local trust, they have their own rules, and we’re just doing the gap filling role in the service delivery system here.”

Another doctor who has been on a local contract since 2016 said: “I’m kind of trapped in this LED contract. It’s been so annoying, and it’s been going on for years. It’s so unfair.”

And an international medical graduate from Pakistan, working in Yorkshire on a local contract for more than two years, said: “Many of our trust grades have not had appraisals for the past two years. The trainees do get their appraisals. We don’t have teaching opportunities, and we don’t have time for learning. We can’t be stuck like this.”

Many of these doctors feel unable to challenge their employment status due to factors such as family responsibilities, financial pressures, visa constraints, career progression concerns, and the fear of uncertainty.

The BMA’s deputy chair of council, Emma Runswick, describes The BMJ’s findings as “further stark evidence of the way that locally employed doctors are exploited in a contractual ‘wild west,’” with dire terms and conditions and a lack of clear development opportunities.

Others describe the situation as a “two tier system” for doctors in the NHS and warn that the NHS is effectively “behaving like a gig economy employer.”

Partha Kar, consultant endocrinologist and former Royal College of Physicians elected councillor, wants to see a national framework that holds trusts to account. There should be no such thing as a non-training doctor, he says, and everyone should have access to clinical and educational supervision and the ability to progress their career.

A spokesperson for the Department of Health and Social Care says that LEDs are “an integral and highly valued” part of the NHS and that it is aware of reports from doctors that “trusts are not appropriately treating staff . . . This is completely unacceptable, and we are committed to improving working conditions through the implementation of elements of the SAS pay deal.”

NHS Employers also says that LEDs are “valuable” to the NHS and should be supported to help develop their careers. But nationally agreed contracts, although recommended, are not always suitable, says its chief executive, Danny Mortimer.

Rob Fleming, specialist anaesthetist and member of a campaign group, the SAS Collective, says the NHS must be stopped from “behaving like a gig economy employer.” He concludes, “We believe that locally employed doctors should be offered the appropriate permanent SAS contract for their work. As well as employment rights, this would give these folks the professional identity they are currently being denied.”

Notes for editors
Investigation: Revealed: NHS “exploits” thousands of doctors trapped in dead end contracts doi: 10.1136/bmj.r2383
Journal: The BMJ

Funding: BMJ Investigations Unit

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Investigation
Subjects: Locally employed doctors

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New BMJ series explores how AI is reshaping traditional doctor-patient interactions and considers its implications for healthcare

AI is fast becoming a third party in the consultation room, reshaping the traditional two way doctor-patient relationship with important ethical and practical implications, say experts in The BMJ today.

A new BMJ series provides insights into this technological shift, introducing the concept of ‘triadic care,’ where clinicians, patients, and AI jointly shape clinical encounters.

Yet while this technological evolution has transformative potential for healthcare, the presence of AI can affect the dynamic of trust, empathy, and communication that forms the cornerstone of person-centred care.

As such, safe and effective adoption depends on strong governance and institutional readiness to safeguard trust, ensure patient safety, and maintain clinical standards, say authors.

In an editorial to accompany the series, Sandeep Reddy and colleagues point out that regulatory approaches are emerging globally but remain inconsistent, and many healthcare institutions still lack fundamental AI governance structures, deploying AI tools without adequate oversight, which “poses significant risks to patient safety and clinical quality.”

​Technology companies developing healthcare AI also bear significant responsibility for safe deployment, yet accountability remains limited, they add.

Coordinated governance frameworks are essential, they write, while healthcare institutions should establish comprehensive AI governance structures before widespread deployment, and regulatory bodies need flexible guidelines that can keep pace with AI while upholding rigorous safety and efficacy standards.

Technology companies must also be held to high standards of transparency regarding post-market surveillance and adopt clear accountability mechanisms, they add, while professional associations and licensing bodies must mandate AI literacy training for healthcare professionals and revise liability frameworks to reflect triadic care.

Without urgent and coordinated action, they warn that the benefits of AI “risk being undermined by avoidable harms and loss of public trust.”

In the first article of the series, David Navarro and colleagues explore how AI is already used by both clinicians and patients in consultations, leading to a shift from knowing answers to helping patients interpret AI generated information in context.

They suggest that simple infrastructure, such as documentation standards and transparent technology, can make this shift observable and safe, and say research must examine how AI transforms the doctor-patient relationship and develop frameworks for this evolution.

Other articles will consider the patient experience and the competencies that clinicians need to use AI transparently and effectively within the clinical encounter.

“This series is a step in helping clinicians navigate AI in practice,” says Jocalyn Clark, The BMJ’s International Editor. “The BMJ is committed to publishing evidence and commentaries to further support clinicians in adapting to this technological shift and integrating AI into routine care.”

18/11/2025

Notes for editors
Link to series page: https://www.bmj.com/collections/gen-AI

The post AI is a ‘third party’ in the consultation room, say experts first appeared on BMJ Group.

1 in 3 consultant jobs unfilled in some parts of the NHS, data shows
£674m spent on locums in 2024/5 with negative effects on staff morale and patient care

The NHS is reaching a crisis point in consultant recruitment as 1 in 3 consultant posts lie vacant in some parts of the UK and recruiting managers regularly wait over 12 months to secure a candidate, leading to increased locum costs, finds a new report published by BMJ Careers today.

Data obtained under the Freedom of Information Act reveal that these shortages are costing the health service upwards of £674m on locum consultants and are negatively affecting staff morale and patient care. Relying on expensive agency staff also risks derailing work to cut waiting lists.

One resident doctor at a north London trust said: “It’s a complete nightmare – the doctors who are left working have to work at 150%, patients have to wait longer to be seen, and by the end of the shift doctors are running on fumes.”

Phil Johnson, Director of BMJ Careers, says: “The word ‘crisis’ can be overused, but at a time when activity is increasing, the new Labour government is pledging to “eliminate” agency spending and slash international recruitment at the same time, it is time to acknowledge a tipping point has been reached.”

Analysis by BMJ Careers found that nearly 33,000 consultant jobs were listed on the NHS Jobs website between 2022 and 2025 in England and Wales – enough to staff more than 66 large hospitals. Over a third of those vacancies were in Greater London and the South East and a quarter were for psychiatry positions. Other in-demand specialties were surgery, paediatrics and radiology.

BMA consultants committee co-chairs Dr Shanu Datta and Dr Helen Neary said these data counter the government’s narrative that the NHS has more doctors than ever. “Simply put – we do not have enough consultants to meet the needs of patients or run services to the standard they should be.”

Today’s report also sheds new light on how consultants feel about job-seeking. A BMJ Careers survey of 107 consultants, carried out earlier this year to inform the report, found very few (4%) are actively looking for work, but a substantial minority (47%) were open to changing jobs, despite not ‘actively looking.’

Of those who are open to looking for work or actively looking, a substantial minority said they feel increasingly disillusioned with NHS working conditions and were interested in relocating outside the UK.

BMJ Careers also surveyed 116 recruiting managers about the challenges they face when recruiting consultants. Half said their need to recruit consultants will increase in the coming year but only 5% expect their budget to increase, while 61% said consultant vacancies were having a significant negative impact on waiting times and 54% on quality of care.

Meanwhile, over a quarter (27%) said they regularly or always have to source candidates from overseas to fill difficult consultant vacancies, and many spoke of measures put in place by their employer to control staffing costs.

The long term solution to the recruitment crisis is to restructure specialist training to create more homegrown consultants in shortage areas and remove bottlenecks, says the report. In the meantime, it outlines how recruiters can attract consultants, such as offering enhanced job plans and more flexible working to help them grow their career.

“To keep consultants working in the NHS, they must be valued, both financially and professionally,” add Dr Datta and Dr Neary. “Pay is part of this but providing more time to innovate and improve services for patients is also key.”

A spokesperson for NHS England told BMJ Careers: “While agency spend is at a record low with trusts on track to save £1 billion over two years, we want to go further still.” They added: “ .. we are working with the government on a 10 Year Health Workforce Plan which will detail the numbers of staff we need now and in the future.”

A Scottish Government spokesperson said: “Since 2006, the number of consultants has increased by 71% and now stands at over 6,200 Whole Time Equivalents.” They added: “We work directly with health boards to reduce the use of medical agency staff, encouraging alternative staffing options, as well as ensuring any locum use represents best value.”

A spokesperson for the Welsh Government commented: “The NHS in Wales now has more doctors than at any point in its history.” They added: “Spend on agency and locum medical and dental staff fell by approximately £16 million between 2023-24 and 2024-25, and we anticipate further reduction this year.”

30/10/2025

Notes for editors
Report: Consultant doctors: Solutions for a medical recruitment crisis, BMJ Careers 2025

The post The NHS is reaching a crisis point in consultant recruitment, new BMJ Careers report warns first appeared on BMJ Group.

Over half of Gates Foundation grants to WHO have targeted polio and vaccination; but key WHO priorities like non-communicable diseases and strengthening health systems remain underfunded

The World Health Organization’s (WHO’s) priorities are being skewed by its increasing reliance on donations from organisations such as the Gates Foundation (previously known as the Bill and Melinda Gates Foundation), which must be spent on specific health challenges favoured by the donors, suggests a study published in the journal BMJ Global Health.

Between 2000 and 2024, more than half of the US $5.5 billion donated by the Gates Foundation to WHO was directed toward vaccine-related projects and polio, while relatively little funding was spent on other issues considered to be important by WHO.

The Gates Foundation has become the WHO’s second biggest source of funding in recent years contributing 9.5% of WHO’s revenues between 2010 and 2023. Its largest funder was the United States, but earlier this year the US announced it would withdraw from WHO from January 2026. Germany and the UK were third and fourth largest WHO funders, respectively.

Although it is widely assumed that the Gates Foundation’s financial power allows it to exert influence over WHO’s work programme, little research has been undertaken to track exactly how its grants are spent.

To address this, the authors extracted data from the Gates Foundation website on all its grants to WHO between 2000 and 2024 to determine the number and value of grants, and the diseases, health issues and activities they funded.

Between 2000 and 2024, the Gates Foundation made 640 grants worth US $5.5 billion to WHO. In total 6.4% of all grants made by the Gates Foundation during this period went to WHO.

More than 80% of the Gates Foundation’s grants to WHO (US $4.5 billion) were targeted at infectious diseases and almost 60% (US $3.2 billion) were spent on polio. More than half of the Foundation’s money (US $2.9 billion) was used to fund vaccine programmes and related projects.

Relatively little funding from the Gates Foundation was directed towards non-communicable diseases, strengthening health systems, and broader determinants of health, despite their importance to WHO strategy and global health more generally.

Just US $11.8 million (0.2%) was spent on water and sanitation and US $37.4 million (0.7%) on health systems strengthening. Less than 1% of the Foundation’s funding went towards non-communicable diseases, despite them being responsible for 74% of global deaths with 77% of these deaths occurring in low- and middle-income countries.

WHO’s budget comes from two sources – assessed contributions from member states, calculated according to a country’s wealth and population, plus voluntary contributions or extra-budgetary funding from member states and non-state organisations. Around nine-tenths income comes from voluntary or extra-budgetary funding, and almost all of this money is ‘earmarked’, i.e. given on the condition that it funds activities and projects defined by the donor.

The way WHO is funded limits its ability to fulfil its strategic goals, the authors say.

“Assessed contributions from member states are nowhere near the level needed to fund its strategic priorities, so WHO must rely on earmarked voluntary contributions from donors,” they say. “Consequently, activities and areas that donors favour receive more resources than are required while those they are not interested in do not get enough.”

And the situation could worsen if the United States – WHO’s largest donor – carries through with its threat, announced in January 2025, to withdraw from WHO.

While it is easy to blame major donors like the Gates Foundation for undermining WHO’s independence by pursuing its agenda through WHO, the authors say: “We should not, however, lose sight of the fact that it is the member states’ failure to increase assessed contributions in line with WHO’s needs over the last four decades that has created a situation in which the organisation is forced to rely on voluntary contributions from donors.”

They add: “WHO has asked for more flexible and sustainable funding, warning that without fundamental changes to the way it is financed, it will be unable to achieve its strategic aims. If the member states continue to ignore these exhortations, then WHO will remain vulnerable to the influence of external donors and will struggle to address the full spectrum of contemporary global health challenges.”

28/10/2025

Notes for editors
Research: Who’s leading WHO? A quantitative analysis of the Bill and Melinda Gates Foundation’s grants to WHO, 2000-2024 doi: 10.1136/ bmjgh-2024-015343.
Journal: BMJ Global Health

External funding: None declared.

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

About the journal
BMJ Global Health is one of 70 journals published by BMJ Group. The title is owned by BMJ. https://gh.bmj.com/

Externally peer reviewed? Yes
Evidence type: Quantitative analysis
Subjects: WHO spending

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Safeguards are needed to protect evidence-based practice

Imposter participants threaten the integrity of health research and, by extension, the policies and clinical decisions built on it, warn experts in The BMJ today.

Eileen Morrow and colleagues at the University of Oxford say the research community “must acknowledge the problem and dedicate resources to testing and implementing safeguards .. to ensure that the data guiding clinical care reflect the real patient voice.”

Imposter participants are individuals who provide deceptive or inaccurate data in order to take part in health research or automated computer ‘bots’ which mimic human behaviour and responses.

The issue has grown in recent years as online recruitment has become central to modern health research and can impact all types of studies, from surveys to randomised controlled trials.

The motivations of imposter participants remain unknown, explain the authors. Although some reports suggest that monetary benefit is a driver, not all studies offer financial incentives, so other motives, such as boredom, curiosity, or even an ideological intent to disrupt research, may also play a role.

Yet their impact is demonstrable. A 2025 review showed that 18 of 23 studies which looked for imposter participants in their data sets, found them, with rates ranging from 3% to a high of 94%.

Researchers should routinely integrate imposter participant detection and prevention into online research, while considering the potential effect on their study population, write the authors.

Common safeguards include identity verification procedures or CAPTCHA tests (asking participants to complete a task such as to read and type distorted letters).

At a minimum, they say studies should transparently report which safeguards were used and acknowledge their limitations, and journals should encourage consistent and transparent reporting of these safeguards.

Funders and institutions should also invest in infrastructure and training to help researchers keep pace with evolving tactics, while clinicians and policymakers should be cautious when interpreting studies that use online recruitment if imposter participant prevention is not mentioned.

They conclude: “Imposter participants are more than a nuisance; they are a systemic threat to health research. Their effect is demonstrable and their detection inconsistent. In an age where online recruitment underpins everything from randomised controlled trials to surveys, they risk undermining the integrity of health research and the decisions built on it.”

15/20/2025

Notes for editors
Editorial: Threat of imposter participants in health research doi: 10.1136/bmj.r2128
Journal: The BMJ

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? No
Evidence type: Editorial, opinion
Subject: Health research

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Findings from Georgia suggest program goals have not yet been met

The introduction of work requirements for certain adults enrolled in the US health insurance program Medicaid has so far failed to boost insurance coverage or employment rates, finds a study published by The BMJ today.

It shows that health insurance coverage and employment did not increase after Georgia implemented Medicaid expansion with work requirements. Work requirements are due to be rolled out across the US in 2026 as part of the “One Big Beautiful Bill Act.”

Georgia was the first state to expand Medicaid with work requirements under the Pathways to Coverage program in 2023, but little is known about the impact of this approach on insurance coverage rates and employment.

To find out, researchers drew on data for 17,451 working-age adults (aged 19-64 years) with low incomes who completed the US Census Bureau’s Household Pulse Survey between 2021 and 2024.

They included 3,303 adults in Georgia (intervention state) and 14,148 in five neighboring states – Alabama, Florida, Mississippi, South Carolina, and Tennessee – that did not expand Medicaid (controls) in the analysis.

The results show that 15 months after the implementation of Pathways to Coverage, Medicaid coverage did not change substantially in Georgia (35.5% to 32.4%) when compared with neighboring control states (39.6% to 39.3%), resulting in no differential change in Medicaid coverage between these states.

There was also no significant change in employment among adults with low incomes in Georgia compared with those in control states.

In an additional analysis that aimed to isolate the effects of work requirements, Medicaid coverage decreased in Georgia by almost 12 percentage points compared with South Dakota  – a state that expanded Medicaid without work requirements – and there was no change in employment between these states.

Possible explanations include the fact that many working-age Medicaid beneficiaries either already work or are unable to work, explain the authors, and a burdensome eligibility and enrollment process.

They acknowledge several limitations, such as relying on self-reported outcomes, a low survey response rate, and a focus on changes in outcomes during the program’s first 15 months, so further research is needed to understand the long term implications.

Nevertheless, they conclude: “In this study, we found that Pathways to Coverage did not change Medicaid coverage or the uninsured rate during its first year compared with states that did not expand Medicaid to adults with low incomes, suggesting the program’s goal of increasing insurance coverage [and employment] has not yet been met.”

These findings have important policy implications given US policymakers’ recent decision to mandate Medicaid work requirements nationwide beginning in 2026, they add.

30/09/2025

Notes for editors
Research: Insurance coverage and employment after Medicaid expansion with work requirements: quasi-experimental difference-in-differences study doi: 10.1136/bmj-2025-086792
Journal: The BMJ

External funding: Donaghue Foundation, American Heart Association, Sarnoff Cardiovascular Research Foundation

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

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