{"id":63069,"date":"2026-05-06T07:37:41","date_gmt":"2026-05-06T06:37:41","guid":{"rendered":"https:\/\/www.promedical.co.uk\/?p=63069"},"modified":"2026-05-06T07:37:41","modified_gmt":"2026-05-06T06:37:41","slug":"geography-is-destiny-in-workforce-planning-why-wales-loses-graduates-why-cct-retention-is-better-and-what-scotgem-suggests","status":"publish","type":"post","link":"https:\/\/www.promedical.co.uk\/healthcare-leadership\/geography-is-destiny-in-workforce-planning-why-wales-loses-graduates-why-cct-retention-is-better-and-what-scotgem-suggests\/","title":{"rendered":"Geography is destiny in workforce planning: why Wales loses graduates, why CCT retention is better and what ScotGEM suggests"},"content":{"rendered":"

A workforce can grow and still fail patients if the workforce is in the wrong places.<\/span>\u00a0<\/span><\/p>\n

The GMC\u2019s Workforce report 2025 brings that into focus by tracking doctors at three career stages:<\/span>\u00a0<\/span><\/p>\n

    \n
  1. after graduating from medical school<\/span>\u00a0<\/span><\/li>\n
  2. after completing foundation training (F2)<\/span>\u00a0<\/span><\/li>\n
  3. after completing specialty training (CCT)<\/span>\u00a0<\/span><\/li>\n<\/ol>\n

    The results show stark differences between the UK nations and a particularly serious challenge for Wales at the earliest stages.<\/span>\u00a0<\/span><\/p>\n

    This blog explains what the report shows about geographic retention and movement, why early-career retention is the bottleneck, and what the\u00a0ScotGEM\u00a0rural-medical-education case study suggests about designing \u201cstickiness\u201d into the pipeline.<\/span>\u00a0<\/span><\/p>\n

    \u00a0<\/span><\/p>\n

    The first movement shock happens right after graduation<\/span>\u00a0<\/span><\/h3>\n

    For doctors who graduated in 2020, the report tracks the proportion who remained licensed and in the same UK country by 2024.<\/span>\u00a0<\/span><\/p>\n

    By 2024:<\/span>\u00a0<\/span><\/p>\n

      \n
    • England: 81% remained in England<\/span>\u00a0<\/span><\/li>\n
    • Scotland: 51% remained in Scotland<\/span>\u00a0<\/span><\/li>\n
    • Northern Ireland: 44% remained in Northern Ireland<\/span>\u00a0<\/span><\/li>\n
    • Wales: 31% remained in Wales\u00a0<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

      That means Wales\u00a0retains\u00a0under a third of its medical graduates in the same country five years later.<\/span>\u00a0<\/span><\/p>\n

      This is not \u201ca small leak.\u201d\u00a0It\u2019s\u00a0a structural outflow.<\/span>\u00a0<\/span><\/p>\n

      The report frames this as movement for the first foundation post (F1) being a key point where many graduates move across borders.\u00a0<\/span>\u00a0<\/span><\/p>\n

      \u00a0<\/span><\/p>\n

      Foundation helps,\u00a0but Wales still loses close to half by five years<\/span>\u00a0<\/span><\/h3>\n

      The report then examines doctors who completed F2 in 2019 and tracks their retention in the same country through 2024.<\/span>\u00a0<\/span><\/p>\n

      By 2024:<\/span>\u00a0<\/span><\/p>\n

        \n
      • England: 88%<\/span>\u00a0<\/span><\/li>\n
      • Northern Ireland: 75%<\/span>\u00a0<\/span><\/li>\n
      • Scotland: 61%<\/span>\u00a0<\/span><\/li>\n
      • Wales: 54%\u00a0<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

        So\u00a0retention improves after foundation compared with post-graduation, but:<\/span>\u00a0<\/span><\/p>\n

          \n
        • Wales still\u00a0retains\u00a0only 54% of that cohort after five years,<\/span>\u00a0<\/span><\/li>\n
        • Scotland\u00a0retains\u00a061%,<\/span>\u00a0<\/span><\/li>\n
        • England is much higher at 88%.<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

          This suggests a critical policy truth:<\/span>\u00a0<\/span><\/p>\n

          If you lose doctors\u00a0immediately\u00a0after graduation, foundation\u00a0can\u2019t\u00a0fully repair the pipeline.<\/span>\u00a0<\/span><\/p>\n

          The \u201ccapture point\u201d for retention is earlier than many plans assume.<\/span>\u00a0<\/span><\/p>\n

          \u00a0<\/span><\/p>\n

          CCT retention is strong,\u00a0which reveals where the real problem is<\/span>\u00a0<\/span><\/h3>\n

          At the third stage (CCT), retention is higher across all countries.<\/span>\u00a0<\/span><\/p>\n

          For doctors who gained a CCT in 2020, by 2024 the share still licensed and in the same country was:<\/span>\u00a0<\/span><\/p>\n

            \n
          • England: 93%<\/span>\u00a0<\/span><\/li>\n
          • Northern Ireland: 93%<\/span>\u00a0<\/span><\/li>\n
          • Scotland: 86%<\/span>\u00a0<\/span><\/li>\n
          • Wales: 84%\u00a0<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

            This is the report showing you where the system performs better: once doctors complete specialty training, most\u00a0remain.<\/span>\u00a0<\/span><\/p>\n

            So\u00a0if you want to improve geographic distribution, the biggest leverage is not necessarily late-career \u201cgolden hellos.\u201d It\u2019s:<\/span>\u00a0<\/span><\/p>\n

              \n
            • how doctors choose (or are\u00a0allocated) to foundation and early training locations,<\/span>\u00a0<\/span><\/li>\n
            • how experiences in those locations shape attachment and future choices,<\/span>\u00a0<\/span><\/li>\n
            • and how credible long-term pathways are in those regions.<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

              \u00a0<\/span><\/p>\n

              The Wales lesson: retention is a pipeline design issue, not a loyalty issue<\/span>\u00a0<\/span><\/h3>\n

              It\u2019s\u00a0tempting to interpret \u201cWales retains 31% of graduates\u201d as an individual loyalty problem.<\/span>\u00a0<\/span><\/p>\n

              But workforce data almost never supports that framing. More likely explanations include:<\/span>\u00a0<\/span><\/p>\n

                \n
              • availability and distribution of foundation and specialty posts<\/span>\u00a0<\/span><\/li>\n
              • partner employment opportunities<\/span>\u00a0<\/span><\/li>\n
              • training pathway availability in desired specialties<\/span>\u00a0<\/span><\/li>\n
              • perceptions\u00a0of service pressure and support<\/span>\u00a0<\/span><\/li>\n
              • geographic ties and housing affordability<\/span>\u00a0<\/span><\/li>\n
              • the \u201cgravity\u201d of larger training centres elsewhere<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

                The report\u00a0doesn\u2019t\u00a0test these causes directly. But it does something more useful: it shows the pattern clearly enough that leaders can no longer deny it or treat it as minor.<\/span>\u00a0<\/span><\/p>\n

                \u00a0<\/span><\/p>\n

                Rural workforce: what\u00a0ScotGEM\u00a0suggests about building retention into education<\/span>\u00a0<\/span><\/h3>\n

                The report includes a case study on the Scottish Graduate Entry Medicine (ScotGEM) programme, designed to attract and\u00a0retain\u00a0doctors in rural and remote areas by incorporating rural living and study placements from the second year onwards.\u00a0<\/span>\u00a0<\/span><\/p>\n

                Key early outputs:<\/span>\u00a0<\/span><\/p>\n

                  \n
                • 155\u00a0ScotGEM\u00a0graduates have joined the UK workforce since the programme began producing qualified doctors in 2022.<\/span>\u00a0<\/span><\/li>\n
                • By 2024:<\/span>\u00a0<\/span>\n
                    \n
                  • only 2 doctors (1%) had left<\/span>\u00a0<\/span><\/li>\n
                  • 133 (87%) were working in Scotland<\/span>\u00a0<\/span><\/li>\n
                  • 19 (12%) were working in England<\/span>\u00a0<\/span><\/li>\n
                  • 1 (1%) was working in Wales\u00a0<\/span>\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n

                    The report notes that 87% in Scotland after 1\u20132 years is higher than the 70\u201371% retention after 1\u20132 years for the 2020 Scottish medical student cohort (from the national retention data).\u00a0<\/span>\u00a0<\/span><\/p>\n

                    It also reports early evidence that larger proportions of\u00a0ScotGEM\u00a0graduates were working in more rural boards such as Tayside, Highland, and Dumfries and Galloway compared with the distribution for all doctors in training and all licensed doctors working in Scotland.\u00a0<\/span>\u00a0<\/span><\/p>\n

                    This is early-stage evidence,\u00a0but it points to a practical principle:<\/span>\u00a0<\/span><\/p>\n

                    If you want doctors in rural areas, you may need to educate and socialise doctors in rural areas.<\/span>\u00a0<\/span><\/p>\n

                    Not as a short placement. As a meaningful part of professional formation.<\/span>\u00a0<\/span><\/p>\n

                    \u00a0<\/span><\/p>\n

                    Critical interpretation:\u00a0ScotGEM\u00a0is promising,\u00a0but\u00a0don\u2019t\u00a0overclaim<\/span>\u00a0<\/span><\/h3>\n

                    It\u2019s\u00a0important not to turn early data into certainty.<\/span>\u00a0<\/span><\/p>\n

                    Limitations include:<\/span>\u00a0<\/span><\/p>\n

                      \n
                    • small cohorts (155 graduates is meaningful but not large)<\/span>\u00a0<\/span><\/li>\n
                    • short follow-up time (1\u20132 years post-qualification is\u00a0not the same as\u00a010 years)<\/span>\u00a0<\/span><\/li>\n
                    • multiple confounders (student\u00a0selection, rural background, programme identity, cohort culture)<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

                      The report itself frames this as \u201cvery early evidence.\u201d\u00a0<\/span>\u00a0<\/span><\/p>\n

                      But early evidence is still useful for design thinking: it suggests that retention and rural distribution can be influenced,\u00a0not merely \u201choped for.\u201d<\/span>\u00a0<\/span><\/p>\n

                      \u00a0<\/span><\/p>\n

                      What workforce leaders should do with this data<\/span>\u00a0<\/span><\/p>\n

                      The report implies three policy directions that are hard to escape:<\/span>\u00a0<\/span><\/p>\n

                        \n
                      1. Fix early-career retention before you obsess over late-career retention<\/span>\u00a0<\/span>\n
                          \n
                        • CCT retention is already comparatively strong. The biggest losses occur earlier,\u00a0especially for Wales.<\/span>\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n
                        • Make training pathways geographically credible<\/span>\u00a0<\/span>\n
                            \n
                          • If doctors\u00a0have to\u00a0leave a country to access desired training or progression, they will. Workforce planners should map where training opportunities are scarce and which specialties drive outflows.<\/span>\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n
                          • Invest in place-based medical education models<\/span>\u00a0<\/span>\n
                              \n
                            • ScotGEM\u00a0offers a model of how education design can increase geographic attachment. The report notes similar initiatives in Northern Ireland (Ulster University) and Wales (Swansea and Bangor) aimed at rural\/remote exposure.\u00a0<\/span>\u00a0<\/span><\/li>\n
                            • The strategic goal\u00a0isn\u2019t\u00a0simply \u201crural placements.\u201d\u00a0It\u2019s\u00a0place-based professional identity.<\/span>\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ol>\n

                              \u00a0<\/span><\/p>\n

                              Conclusion: retention is not one problem,\u00a0it\u2019s\u00a0three different problems at three stages<\/span>\u00a0<\/span><\/h3>\n

                              The report shows:<\/span>\u00a0<\/span><\/p>\n

                                \n
                              • big movement after graduation (especially Wales)<\/span>\u00a0<\/span><\/li>\n
                              • improved but still leaky retention after foundation (again, Wales and Scotland)<\/span>\u00a0<\/span><\/li>\n
                              • strong retention after CCT across all countries<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

                                So\u00a0the workforce question becomes clearer:<\/span>\u00a0<\/span><\/p>\n

                                What would it take to make doctors\u2019 first choices and early experiences align with where the system needs them most?<\/span>\u00a0<\/span><\/p>\n

                                If leaders can answer that, the later-stage workforce becomes easier. If they\u00a0can\u2019t, no\u00a0amount\u00a0of late-stage incentives will fully compensate for losing doctors at the start of their careers.<\/span>\u00a0<\/span><\/p>\n

                                Source: GMC Workforce Report 2025\u00a0<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

                                A workforce can grow and still fail patients if the workforce is in the wrong places.\u00a0 The GMC\u2019s Workforce report 2025 brings that into focus by tracking doctors at three career stages:\u00a0 after graduating from medical school\u00a0 after completing foundation training (F2)\u00a0 after completing specialty training (CCT)\u00a0 The results show stark differences between the UK…<\/p>\n","protected":false},"author":26,"featured_media":63072,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"none","footnotes":""},"categories":[25],"tags":[],"class_list":["post-63069","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-healthcare-leadership"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts\/63069","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/users\/26"}],"replies":[{"embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/comments?post=63069"}],"version-history":[{"count":1,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts\/63069\/revisions"}],"predecessor-version":[{"id":63073,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/posts\/63069\/revisions\/63073"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/media\/63072"}],"wp:attachment":[{"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/media?parent=63069"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/categories?post=63069"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.promedical.co.uk\/af-api\/wp\/v2\/tags?post=63069"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}