Ben Leach and Laura Donnelly, Telegraph (London), December 29, 2012
The full extent of the danger presented by foreign doctors working in the health service can be revealed.
New figures from the General Medical Council (GMC) show that the vast majority of doctors who have been struck off were trained abroad.
The revelations will add to concerns that NHS patients are not adequately protected from health professionals from countries where training is less rigorous than in the UK, and from those who are unfamiliar with basic medical practices in this country.
The figures, disclosed for the first time and obtained by The Sunday Telegraph using freedom of information laws, show:
• Three quarters of doctors struck off the medical register this year were trained abroad.
• Doctors trained overseas are five times more likely to be struck off than those trained in the UK.
• The country with the biggest single number of doctors who have been removed or suspended from the medical register, is India, followed by Nigeria and Egypt.
In total, 669 doctors have been either struck off or suspended by the GMC over the last five years.
Of those, only 249 were British (37 per cent) while 420 (63 per cent) were trained abroad — whereas one-third of doctors on the register were trained abroad, and two-thirds in Britain.
In recent years, a series of cases have raised concerns about the competence and language skills of overseas doctors.
In 2008, the pensioner David Gray was killed by a German-trained doctor, Daniel Ubani, who gave him ten times the recommended dose of pain relief while working as a locum.
Dr Ubani, who was born in Nigeria, was working his first shift in this country and later said he had never heard of the medication diamorphine, which is not commonly used by GPs in Germany, before he administered it.
A series of other cases at the GMC have included Vladan Visnjevac, struck off after a baby girl he was delivering died of a fractured skull and brain injuries when he used forceps wrongly, and Navin Shankar, who failed to diagnose a young woman’s cancer over six years before her death.
Julia Manning, chief executive of centre-right think tank 2020 Health said: “These figures are really worrying and shocking. I think we need to take a really hard look at the assessment of all doctors coming into this country.”
Mrs Manning said she was concerned that the European Working Time Directive, which restricts doctors’ hours, had left hospitals relying too heavily on locum staff, including those who were not familiar with British medical practices or the routines of the NHS.
“If I was a hospital chief executive looking at these figures I would be going to work tomorrow to check just how rigorously have we assessed our own doctors,” she said.
Under the current system, British hospitals and medical agencies which hire doctors are not allowed to test the language skills of those from EU countries to seek if staff will be able to communicate safely.
Until now, Britain has interpreted EU law as meaning that doctors who qualify in any of the 27 countries must be free to work elsewhere, without restriction.
The coalition has promised to change the law, so that doctors will have to prove they can speak English before they get work here, but the changes are bogged down in discussions in Brussels.
Many of the problems with locum medics arose after Labour’s 2006 GP contract meant that family doctors were able to give up responsibility for out-of-hours care, with private agencies taking over.
In recent years, locums have been increasingly used to plug gaps in care, because of shortages of doctors thanks to Britain’s strict adherence to the European Working Time Directive, which limits their hours.
Since a 48-hour maximum week came in two years ago, the number of doctors who trained elsewhere in Europe but are registered to work in the UK has risen by 13 per cent.
Those who come here from beyond Europe are subject to a language test, and a multiple choice exam, which can be taken repeatedly until it passed, before a practical assessment is made.
The new figures from the GMC give the first detailed picture of the problem facing medical regulators.
Last night, there were calls for extra safeguards and training to ensure that any doctor working in this country is familiar with the drugs and procedures used in this country.
The newly disclosed figures also suggest that the picture is worsening.
Of the 39 doctors struck off by the General Medical Council this year, 29 were trained outside the UK — 75 per cent of the total — whereas in 2009, 41 of a total of 67 doctors struck off came from overseas, 61 per cent of the total.
The figures show that India has the highest number of doctors who have been suspended or struck off the register with 123. Nigeria and Egypt also fare badly, each with 33 doctors subject to the measures since 2008. Eastern European countries account for 27 such cases.
When the numbers of doctors disciplined is compared with the total number working here from each country, the highest proportion of those who have been struck off or suspended come from Cameroon.
Since 2008, there has been average of 18 Cameroonian doctors working here at any one time.
Of those, one has been suspended, and one struck off. Mexico, Cuba, France and Uganda were the countries with the next highest proportion of doctors subject to the disciplinary measures.
The country with the best record is Hong Kong. Despite having an average of 773 doctors working in the UK since 2008, none have been struck off or disciplined by the GMC.
Similarly, New Zealand has had an average of 600 doctors working in Britain, but none have had those measures taken against them. Next best were Iran, Slovakia and the United States.
There are around 253,000 doctors on the medical register. Around 92,000 were trained abroad, an increase of around 2,000 over the past year.
Of those, more than 25,000 were trained in Europe and around 67,000 were trained in other countries.
Doctors from outside Europe have to take a test before they can work in the UK, but the GMC can refuse entry to those from medical schools which do not meet its official standards or those agreed internationally.
There have been long-standing concerns about the difficulties of monitoring the standards of training in distant overseas countries.
In 2010, graduates from seven medical schools from Nigeria were banned from seeking work in the UK, because of alarm over falling standards of training.
Corruption in medicine remains common in India, most often in the form of bribes to gain access to treatment.
In 2010, the president of the Medical Council of India was accused of accepting bribes to certify medical colleges which did not meet basic standards.
The investigation was closed earlier this year, after insufficient evidence was found to support the claims.
Last month, the same council barred 27 doctors from their register for their part in setting up fraudulent medical courses.
Some doctors claimed they were running two medical colleges simultaneously, while other courses claimed to have far more consultants to train students than they actually did.
Niall Dickson, chief executive of the GMC, said the health service would not have survived without the contribution from overseas doctors, and that it was important not to demonise tens of thousands of professionals who had brought their skills to this country.
He said: “We absolutely acknowledge that when it comes to the serious end of the scale, those from overseas are more likely to appear, and we have set about a series of reforms to address this.”
The regulator is reviewing the tests set for doctors from outside the EU, having raised the language standard requirements, and is about to pilot a new induction programme so all doctors who are new to UK practice undergo extra training about how medicine operates in this country and the ethical and professional standards they are expected to meet.
From this month, all UK doctors will also have annual checks of their competence, under a new licensing system called revalidation.
Dr Umesh Prahbu, national vice-chairman of the British International Doctors Association, said he believed the reasons why overseas doctors are far more likely to be struck off were complex and varied.
He said: “The NHS is known for having problems with discrimination and racism and I think this is part of it.”
Dr Prahbu said that patients were no more likely to lodge complaints about doctors trained overseas than they were about those from the UK, yet when it came to referrals from NHS trusts, foreign doctors were far more likely to be referred to the GMC.
Analysis of the 2008 to 2012 figures shows that among cases of those struck off, 17 per cent of those involving UK-trained doctors began with a complaint from a patient, compared with 11 per cent in the case of those from abroad.
Dr Prahbu, medical director of Wrightington, Wigan and Leigh NHS foundation trust, said other problems stemmed from cultural differences and communication problems, more than from differences in clinical training.
Dr Prahbu, who trained in India, said the technical training was very similar to that in the UK, but it was more difficult to learn about the “softer” skills and ensure that patients felt treated with courtesy.
A Department of Health spokesman said the checks being introduced would “ensure that the small number of dangerous, often overseas trained, locum doctors who do not understand the British medical system are stopped from treating patients.”