Safety fears over doctors who trained outside EU – open up more medical student and GP training posts urgently

Chris Smyth in The Times 18th April 2014 reports: Safety fears over doctors who trained outside EU

Of course there are also safety fears about EU trained doctors, but the report did not address this as the EU legislation gives them a right to be here in the UK if they can pass the language and communication standards needed. The governments need to open up more medical student and GP training posts urgently..

Foreign-trained doctors are less competent on average than their British counterparts, according to an assessment that is the most rigorous to date and has prompted calls for stricter standards.

Half the 1,300 overseas doctors who qualify to work in the NHS every year would fall short if the bar were set at the same level as it is for British doctors, researchers said. They found that those trained outside the European Union performed notably worse on key exams and performance reviews.

Patients groups said that the skills gap would damage trust in doctors and warned health chiefs not to rely on sub-standard staff to fill rotas.

Regulators acknowledged that the findings raised serious questions about the licensing of foreign doctors, who make up more than a quarter of the NHS medical workforce.

More than 80 per cent of foreign-trained doctors do worse than the average British doctor in exams to join the professional bodies for GPs and hospital doctors, a study published in the British Medical Journal found.

For example, about 55 per cent to 60 per cent of British-trained doctors pass exams to become a member of the Royal College of Physicians first time, compared with 35 per cent to 40 per cent of those trained outside the EU.

Researchers said that this was more to do with medical knowledge than language skills or racial discrimination, adding that one in ten foreign-trained doctors was British and performed just as badly as others who attended medical schools overseas. The top-performing foreign-trained doctors proved just as good as the best British ones.

Doctors from outside the EU who want to practise in Britain must pass a General Medical Council exam meant to ensure that they are at the same level as graduates from UK medical schools.

Academics at University College London and the University of Cambridge linked up the results of the tens of thousands of doctors who took the exam in the past decade with their performance in exams to join the Royal College of Physicians or the Royal College of GPs. These were then compared with the results of British-trained doctors taking the same membership exams.

“The pass rates are quite a lot lower,” Professor Chris MacManus, who led the study commissioned by the General Medical Council, said. “Only about 20 per cent of international medical graduates are at the level of the median UK graduate. You look at the questions [on the exam] and think: ‘I wouldn’t want a physician who doesn’t know the answer to that’.”

Katherine Murphy, chief executive of the Patients Association, said: “Patients need to know that they are receiving high-quality care from competent doctors who know what they are doing. This evidence will only undermine the trust patients have for their doctor.

“Many hundreds of doctors from other countries around the world make a valuable and important contribution to healthcare in the UK. However, it is essential that all staff in the NHS are fully qualified to carry out the work that they are employed to do . . . Recruiting foreign doctors must always be for the benefit of the patients and not for merely meeting the required staffing ratios or for filling the gaps in the NHS.”

Each year 1,300 foreign-trained doctors qualify to practise in the UK — about 16 per cent of all new doctors.

The study also showed a big variation in the results of graduates of UK medical schools, with Oxford and Cambridge top and Liverpool performing worst on average.

“The best international graduates are easily the equivalent of the best UK graduates and there are some pretty ropey UK graduates on the register,” Professor MacManus said.

In a second paper also published in the British Medical Journal, researchers at Durham University found that foreign-trained doctors were about 60 per cent more likely to fail annual reviews designed to assess their competence. “That’s important because some people might say, ‘What do exams mean in the real world?’. But this other paper shows doctors working with them on the ground are making [similar] judgments,” Professor MacManus said.

Potential reasons for the performance gap could include poorer medical training in some countries or the worst doctors choosing to emigrate to Britain. India supplies by far the largest number of overseas doctors to the NHS, followed by Pakistan, Nigeria, Egypt and Ireland.

“We have no idea about the medical schools they come from and inevitably they’re going to be very varied,” Professor MacManus said. “We know that in India they have some of the best medical schools in the world, they are superb . . . but some of the worst ones have no quality assurance.”

Maureen Baker, chairwoman of the Royal College of GPs, said that raising the pass mark for the General Medical Council exam would push up the quality of overseas doctors. “In the interests of patient safety and fairness to international medical graduates, we recommend that the current [overseas] standard-setting process is reviewed as a matter of urgency,” she said.

Niall Dickson, chief executive of the General Medical Council, said: “We are determined to do what we can to maintain high standards of medical practice in the UK, regardless of where doctors receive their training. That is why we are reviewing the way in which we assess the knowledge and skills of those seeking to practise here … this research does raise important questions — not only for us as a regulator, but for UK governments and for the profession too.”

Patients are afraid to complain about poor language, communication and skills as they fear their future care will be prejudiced. Whilst a GP and before I retired, in our practice of 12,000 patients, there were always a half dozen encouraged to apply for medicine by their careers officers. All were capable, but the restriction on places as Medical School meant most were disappointed – annually. The current shortfall in doctors and standards is due to successive governments not addressing the future demographics and preferring the lower cost of overseas “mercenary” doctors to our own. Politicians will only plan for 4 years, which gives a perverse incentive to ration places…The poor manpower planning means we have at least another 10 years when we are going to be short of GPs and other specialists. The tragedy of disappointed youth is compounded by the low performance of the bottom 10-15% of overseas doctors, but it looks as if we need to import them again – in bulk.

Medical Student Debt – Time to change policy on Medical Student Recruitment.


This entry was posted in A Personal View, Community Health Councils, Patient representatives, Perverse Incentives, Political Representatives and activists, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

5 thoughts on “Safety fears over doctors who trained outside EU – open up more medical student and GP training posts urgently

  1. Pingback: RCGP is cleared of ethnic discrimination in clinical skills assessment | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  2. Pingback: Medical Schools: your chances – applications-to-acceptance ratio was 11.2. | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  3. Pingback: The drop-out club for doctors: Why medics are leaving the NHS | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  4. Pingback: Health services are “vacant” – and have many GP vacancies despite oversubscription to Medical School over many years | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  5. Pingback: No Problem – we will “log out”… | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s