An investigation by The BMJ shows 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 shows 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 investigation has found 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, the data found.

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 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.

In response, a spokesperson for the DHSC said 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'.