Opinion: How can we attract teachers and doctors to work in deprived areas?

Oliver Patel, Research Assistant, UCL Grand Challenges

What's the problem?

There are stark inequalities in both education and health in the UK, with those from more disadvantaged backgrounds and areas experiencing worse educational and health outcomes. For example, in England, only 33% of pupils who receive Free School Meals achieve 5 or more A*-C at GCSEs (including English and Maths), compared to 61% of those not receiving FSM. In 2014-2016 the gap in life expectancy between the most deprived and least deprived areas of England was 9.3 years for men and 7.3 years for women, and the gap in ‘healthy life expectancy’ was 19 years for both men and women.

The causes of these complex and multi-faceted inequalities can, in part, be explained by unequal provision of – and access to – high quality teachers and doctors. In education, much of the attainment gap opens up in secondary school. One of the biggest reasons for this is inequality in teaching quality, and the uneven distribution of the teaching workforce across the country. Physically attracting teachers to live and work in schools in disadvantaged/deprived areas is a perennial challenge, and has led to a situation where such schools have teachers that are younger and less likely to have an academic degree in their subject area. They also have much higher teacher turnover.

The NHS faces similar challenges. Attracting doctors to live and work in poorer, less desirable areas represents a significant challenge to the system, with the problem most acute in deprived rural and coastal areas. Patients in poorer areas report waiting longer to see GPs and lower levels of satisfaction with the overall GP experience. For example, in England 14% of patients in the most deprived areas are unable to get GP appointments, compared with 10% of patients in the least deprived. Also, there are fewer GPs per person in the most deprived areas, and higher staff turnover. In London there are 33 doctors per 10,000 people, compared to 26 in Wales and Northern Ireland and 22 in the East of England.

Analysis of both issues suggests that they are symptoms of a similar problem, and thus require similar policy responses. Continuity is crucial; the current high turnover of teachers and healthcare professionals in deprived areas has damaging consequences for the quality of service. As such, policy solutions must move away from short term ‘fixes’ and encourage teachers and doctors to both move and work in areas for the long term.

Is money the answer?

One option is to financially reward people for working in challenging areas, and 63% of teachers say that financial incentives increase would encourage them to seek a role in a more challenging school. Bonus payments of $20,000-$25,000 have been used successfully in California to attract high-quality teachers to deprived areas. NHS England also has a scheme of £20,000 salary bonuses to attract GP trainees to work in areas with acute need. In 2017, 93% of places were filled. Another interesting policy proposal is to help teachers in selected deprived areas buy homes, with substantive interest free loans. This would incentivise mobility but also encourage continuity, as the teacher would settle in the area. Such a pilot scheme could also be applied to doctors.

However, the overall evidence on the effectiveness of financial incentives is mixed. Financial incentives may work in the short-term and can be used to modestly boost supply in deprived areas, but they do not solve the long-term, structural problems which lead to uneven regional distribution of teachers and doctors. Also, as soon as the funding stops, people stop moving.

Sustainable solutions

Studies suggest that anything other than a very large amount of money might be insufficient to mitigate against other factors such as stressful work environment, lower quality of life, and moving away from family and friends. Not much can be done about the latter, but if it wasn’t so challenging for teachers and doctors to work in under-served areas, then perhaps more of them would do it. In teaching, for example, many highly qualified young teachers go to challenging schools with a desire to make a difference, but leave shortly after, reporting inadequate support, guidance and mentoring. Also, in Scotland, GPs in more deprived areas reported higher stress and work burden. These findings suggest that more investment and resources are needed to support teachers and doctors in deprived areas so that their work is more manageable. This would lead to decreased turnover and, in turn, improve the quality of these public services in deprived areas.

Improving infrastructure is another way in which highly skilled professionals can be encouraged to move. For example, there are many towns and rural areas which, geographically, are not that far from major urban centres but are lacking in decent transport infrastructure. Improving transport connectivity between cities and more remote areas, as well as within remote places, would bring a plethora of economic benefits: boosting regional economies, improving living standards, and encouraging mobility of highly skilled workers.

Invest in local people

Encouraging local people to pursue careers in teaching or medicine is also crucial. Doctors, for example, are more likely to practice in areas where they completed their training, and medical students from lower socioeconomic groups are significantly more likely to undertake training close to home. Similarly, very few teachers move to new regions to take up new jobs. Those that do move, often move to major urban centres, where there is less demand. As such, outreach initiatives which encourage more people from deprived backgrounds to train to become teachers or doctors, coupled with scholarships and bursaries which make it easier for them to do so, are likely to be effective and could solve the long-term, structural issue of meeting workforce demand in under-served areas.

Upskilling and retraining local non-medical workers, such as community and support staff, and upskilling nurses to work in more advanced medical roles, is another way in which NHS demand can be met. Similar arguments have been made about teaching assistants, of which there are 380,000 in England. Indeed, successful policy initiatives in the US have encompassed upgrading teacher knowledge and skills. Deprived local communities have many capable professionals who want to stay and work in the area–investing in them would pay off in the long-term. Such investment, both in the teaching and medical professions, could help to alleviate the uneven distribution of skills in the workforce across the UK.

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