Introduction A shortage of doctors is currently one of the biggest challenges faced by the healthcare workforce in the United Kingdom (UK). While plans are in place to increase the number of medical school places, in the short-term this gap will need to continue to be filled by the international recruitment of doctors. The aim of this study is to identify key factors that explain the patterns of migration of doctors to the UK, in order to aid the development of policies to recruit and retain a sustainable workforce. Methods We analysed General Medical Council (GMC) secondary data on the patterns of migration of internationally trained doctors (2009-2019). Qualitative interviews were conducted with 17 stakeholders by videoconferencing which were audio-recorded, transcribed and thematically analysed using NVivo. Results In 2019, 34.5% of UK doctors were trained internationally mainly in India, Pakistan, Italy, Nigeria, Greece, Romania and Egypt. Most new registrations by internationally trained doctors from 2009-2019 did not have a specialty at the time of initial registration (96.2% in 2019). Only a relatively small number of these doctors go on to gain specialist or GP registration (11.6% within 5 years and 27.2% within 10 years of registration). The stakeholder interviews highlighted training opportunities and career progression as the main drivers of migration. The barriers internationally trained doctors face regarding specialty training included differences between UK and destination health systems, systematic bias, bureaucracy and selection processes not being accessible. Conclusion This study makes a contribution to the literature by identifying recent patterns in the migration of doctors to the UK. The UK’s dependence on internationally trained doctors has important global implications as source countries are losing skilled health workers which is undermining their health systems. In keeping with the WHO Global Code on the International Recruitment of Healthcare Personnel, policymakers need to consider how to reduce the UK’s reliance on internationally trained doctors, particularly from countries on the safeguard list whilst continuing the drive to increase medical school places. Additional support is required for internationally trained doctors, to ensure that they get on the training programmes they seek, enabling their career progression.

Background A positive doctor‐patient relationship is a crucial part of high‐quality patient care. There is a general perception that it has been changing in recent years; however, there is a lack of evidence for this. Adapting to the changing doctor‐patient relationship has been identified as an important skill doctors of the future must possess. This study explores (1) multiple stakeholder perspectives on how the doctor‐patient relationship is changing and (2) in what ways medical graduates are prepared for working in this changing doctor‐patient relationship. Methods We conducted a national qualitative study involving semi‐structured interviews with multiple stakeholders across the United Kingdom. Interviews lasting 45–60 minutes were conducted with 67 stakeholders including doctors in the first 2 years of practice (ECD's), patient representatives, supervisors, deans, medical educators and other health care professionals. The interviews were audiorecorded, transcribed, analysed, coded in NVivo and analysed thematically using a Thematic Framework Analysis approach. Results The main ways the doctor‐patient relationship was perceived to be changing related to increased shared decision making and patients having increasing access to information. Communication, patient‐centred care and fostering empowerment, were the skills identified as being crucial for preparedness to work in the changing doctor‐patient relationship. Graduates were reported to be typically well‐prepared for the preconditions (communication and delivering patient‐centred care) of patient empowerment, but that more work is needed to achieve true patient empowerment. Conclusion This study offers a conceptual advance by identifying how the doctor‐patient relationship is changing particularly around the ‘patient‐as‐knowledge‐source’ dimension. On the whole ECD's are well‐prepared for working in the changing doctor‐patient relationship with the exception of patient empowerment skills. Further research is now needed to provide an in‐depth understanding of patient empowerment that is shared among key stakeholders (particularly the patient perspective) and to underpin the design of educational interventions appropriate to career stage.

Brexit threatens to disrupt the fabric of British foreign policy thinking. For decades policymakers identified membership of the European Community as one of two pillars of British influence (the other being the 'Special Relationship' with the United States).Together, they allowed Britain to exercise power on a global as well as regional scale. These assumptions were repeated so often that the UK was regularly criticised for lacking policy imagination and avoiding hard choices when the interests of Europe and the United States conflicted. Brexit presents an unavoidable dilemma for policymakers as they chart a new course for British foreign policy. Interpretivism, as set out by Bevir and Rhodes (2003), offers a route to understanding how actors interpret and respond to such dilemmas, via reference to traditions. This article uses their approach to examine the expression of beliefs about Brexit and British foreign policy. In particular, it focuses on two datasets, one a 'control sample' of commentary since 2016, the other, the parliamentary debates on the first EU Withdrawal Bill in December 2018 and January 2019. We find a contrasting willingness to evoke traditions in a substantive fashion to understand and justify political choices. In particular, parliamentarians utilise one particular tradition, pragmatism, to marginalise the expression of abstract belief. In the process, they reduce discussion to a technocratic exercise that is unable to manage the conflicts Brexit has brought about. Meanwhile, those MPs that are most creative in their expression of traditions tend to be from smaller regional parties or on the political periphery. The resulting deadlock is evidence of the importance of traditions to interpreting and managing dilemmas of social change.Brexit posed a series of fundamental dilemmas for British foreign policy. Once the British public had voted in 2016 to leave the European Union, policymakers faced pressures to reevaluate from first principles the nature of British identity, its international relationships, its patterns of global interactions, and its priorities (Beech, 2020;Blagden, 2017). Such a call