NHS doctors–thankless job?

BAPIO and BIDA delegation with Sir Bruce Keogh, Medical Director of NHS for England
BAPIO and BIDA delegation with Sir Bruce Keogh, Medical Director of NHS for England

By Anjana Parikh


Indian-origin doctors in Britain are planning to meet Prime Minister David Cameron soon and ask him to intervene over the recent study that questioned the standards of their medical skills.

Members of the British Association of Physicians of Indian Origin (BAPIO) and British International Doctors’ Association (BIDA) recently met Sir Bruce Keogh, medical director of NHS for England.

Professor Rajan Madhok, chairman of BAPIO, said: “Sir Keogh highly appreciated the contribution of international doctors especially Indian medicos working in the UK. He showed his concern over the recent study on foreign doctors. He assured that he’s prepared to work with us, address our issues and support in our endeavour.”

According to the study commissioned by General Medical Council (GMC), most doctors whose names are removed from the medical register or suspended following complaints from patients are trained mostly in Asia, Egypt and Nigeria.

The study published in the British Medical Journal claims that half of foreign doctors would not be able to practise in Britain if they were subjected to the same level of scrutiny as Britain-trained doctors.

The study had been part of the evidence presented in court by the Royal College of General Practitioners (RCGP) to counter BAPIO’s argument of a racial bias against ethnic minorities within the country’s medical examination system in a High Court case, which concluded earlier this month.

Expressing dismay over the questions about competency and standards, BAPIO called for a “full independent review” of the role of international medical graduates in the NHS. Indian doctors are the largest group in the NHS of those who qualified outside the European Union.

Professor Madhok, “It’s a very disappointing and we are deeply disturbed with the commissioning of the study, the fundamental premise of the researchers and the many grossly misleading assumptions proffered as conclusions.”

He maintained that such a development is “sad and tarnishing the reputation of the NHS both in the UK and abroad, and comprising with the patients’ care”.

“NHS needs to review this kind of discrimination and put forward a systematic programme of work to know what exactly the problem is. It’s the responsibility of the politicians and senior members of the NHS to look into this matter,” suggests Dr Madhok.

According to the members of BAPIO, the 2003 PLAB (Professional & Linguistic Assessments Board),  review came to the right conclusion that the “standard of test should be that of doctors completing the end of FY1 yet failed to design and implement a test that will be common to UK FY1 doctors and IMGs. A common test is the only valid method that can provide equivalence. UK graduates never take PLAB or IELTS. Given this scenario, comparisons are essentially impossible and hence meaningless.

According to Dr Kailash Chand, Deputy Chair BMA Council, “It can’t feel great to be an international medical graduate in Britain right now. A lot of politics is being played to neutralise the UKIP( UK Independence Party) anti-immigration rhetoric.”

Dr Ramesh Mehta, the president of BAPIO, said: “We must drive standards up, but we need objective evidence and fair processes. We have asked the Academy of Medical Royal Colleges (AoMRC) to work with us and start such a review. We may be Indian origin but we are foremost NHS doctors and want the NHS to be the best; this blame game is not helpful.”

However, Dr Umesh Prabhu, national vice-chairman of BIDA, argued that over the years Asian doctors have contributed a lot to the NHS and without their tremendous contribution many patients would not received excellent care.

“It is the Asian doctors who have worked in inner cities, most deprived parts of the country with poor resource and support. It is the Asian doctors who have worked as consultant in less glamorous specialities like elderly care, psychiatry and other specialities where traditionally local graduates have shied away from working.

Most doctors work hard and provide excellent care and this is true for the vast majority of Asian doctors. One in five doctors working in NHS is from Asia,” he said.

The recent study which published as nearly half of foreign doctors would not have passed PLAB exam if the pass mark was raised has upset many hard working Asian doctors.

Dr Prabhu said, “It has demoralised many doctors who have given their life to the NHS. However, if there’s evidence to suggest that because of low pass mark for PLAB exam NHS allows some foreign doctors who provide sub-standard care then the British International Doctors Association (BIDA) will always support raising pass mark.

“It is a sad reality that Asian doctors face bullying, discrimination, victimisation on a regular basis and unfortunately NHS has never been good at dealing with these issues.”

Dr Satheesh Mathew, Vice-President of BAPIO reacted by saying that they found it extremely objectionable to call any doctor qualifying from UK as the ‘the worst UK graduate’. “The use of such phrases does not reassure the public in our increasingly litigious society.”

At present, 68,116 doctors in the NHS acquired their primary medical qualifications abroad and countries that fall under the European Union. Out of this, nearly 25,000 doctors who qualified in India later passed the necessary tests to enrol themselves in the NHS.

Dr Mohammad Iqbal, chairman of Association of Pakistani Physicians & Surgeons of the UK, said: “Studies do vary in their result and one study is by no means all or none law to be considered as the conclusive result.We welcome the findings of Prof McManus but would encourage the other researchers to come forward to provide the repeatable results and also the reasons, and until then, Prof McManus study is just one finding.”

Further, he maintained that nearly two thirds of the doctors at GMC hearings being overseas has no relationship with scoring in PLAB exam.

“This study has not shown that a doctor who scored lower is likely to face GMC hearing and a higher score will not face the same situation. Association of Pakistani Physicians and Surgeons of UK would like to show displeasure to the recommendation of increasing the pass rate score.

“We must understand that 249/669 doctors who were suspended or struck off in the last five years were trained in the UK as compared to 420/669 trained overseas. This proves that though overseas trained doctors were more likely to face the penalty but a significant number of the UK trained doctors also faced the penalty.

“In my opinion there are various personal reasons for a doctor to face such a harsh penalty, and we need to improve those personal qualities by training and development rather than to hit overseas doctors by increasing the pass rate.

“I would request our governing body, GMC to consider ‘development and training’ of all doctors regardless of where they have been trained, to ensure that their practice is safe and patients are happy with their service. It will be useful to implement mentoring process as soon as possible when there is a concern,” he added.

Meanwhile, Dr Chand maintained that the nation is forgetting the contribution of IMGs to the health of the nation. Almost 40% of the NHS’s doctors are foreign born; 26% of doctors registered with the GMC qualified outside the European Economic Area.

“For years, the UK has been seemingly content to staff its health service with doctors from countries that in many cases could ill afford to lose them.

Despite this the IMGs have hardly been welcomed with open arms. Once here, achieving professional advancement has been tough. Last year Esmail and Roberts calculated the standout statistic: ethnic minority candidates who trained abroad were 14.7 times more likely than white UK candidates to fail the clinical skills component of the Royal College of General Practitioners’ membership exam .

The findings of the two research articles published in the BMJ were similar:  They conclude that pass marks for PLAB would have to be set much higher than now if international graduates are to have an equal chance of passing college membership exams.”

Therefore PLAB graduates and UK graduates are equivalent at that stage. Three to five years down the line, the performance of IMGs is significantly worse than that of UK graduates. This could be due to lack of proper training, and teaching opportunities in the UK, for the foreign doctors, he argued.

 Niall Dickson, Chief Executive of the General Medical Council, however assured that the GMC is determined to do what the Council 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, whether it’s their ability to communicate clearly and effectively with patients or their clinical abilities. This review, along with our decision to increase the score we require in our assessment of English language skills, will help us ensure that high standards of practice are maintained. This is vital not only for patient safety but also for maintaining public confidence in the standards of care in the UK,” he said.

Claiming that the area is a “complex” one, Dickson stressed on the need to work together to address the issue not just at the individual level but also “because of its implications for the healthcare workforce and for the standard of care provided to patients by all doctors, regardless of where they qualified.”