Health Check

'Foreign doctors are the lifeblood of the NHS. But who acknowledges their difficulties or helps them to adjust?'
  • @jeremylaurance

The names of the doctors before the General Medical Council (GMC) have a depressingly familiar ring. This week, those in the frame are Nalini Senchaudhuri (resumed hearing), Idowu Otote (charged with acting inappropriately towards female staff) and Unniparambath Prabhakaran (charged with carrying out unnecessary night visits).

Readers may be struck by their ethnic origin. This is, alas, typical. Figures published last week show that 58 per cent of doctors charged with serious professional misconduct qualified overseas, roughly twice their proportion in the medical workforce (and that does not include British doctors with ethnic names). Doctors trained abroad are over three times more likely to be found guilty of serious professional misconduct than their UK-trained colleagues.

Despite the fact that this imbalance has been well-known to medical organisations and to the media for the best part of a decade, I do not recall seeing it written about or hearing it discussed (except in one instance I will come to). We have adopted the ostrich position, unwilling to confront the problem because of the sensitive issues it raises.

But it cannot be ignored. Foreign doctors are the lifeblood of the NHS. They already comprise 30 per cent of doctors and the Government is engaged in a global recruitment campaign to increase their numbers. We would be crazy to bite the hand that feeds us by unfairly targeting them for disciplinary correction.

On the other hand, public mistrust of doctors is one of the gravest issues confronting the medical profession today. If foreign doctors are undermining that trust by disproportionately breaching their professional ethics then extra measures are clearly needed to protect patients.

Last week, officials twice suggested to me privately that "cultural differences" might lie behind the greater frequency of misconduct cases involving foreign doctors. This is something with which staff from overseas have to struggle. To cite one example, a Manchester hospital found that nurses recruited from India were unused to the way that patients answered back and experienced difficulty adjusting to their loss of control.

It must, indeed, require superhuman levels of self-restraint to deal politely with demanding British patients complaining of bad backs and runny noses when you have recently been treating Aids, malnutrition and the ravages of poverty in the developing world. But who acknowledges this difficulty or helps foreign staff to adjust?

There is one exception to the wall of silence that surrounds this matter. The GMC has, to its credit, commissioned three inquiries over the last six years by Professor Isobel Allen of the Policy Studies Institute – the only occasions when the issue has attracted media comment. Unfortunately, what she found was inconsistency in the judgements made at every level of the disciplinary process, which leaves the council open to charges of racism.

The strongest evidence of bias is that even among doctors with convictions in the courts, those with UK qualifications were less likely to be referred for a full disciplinary hearing than those with overseas qualifications.

The GMC is pinning its hopes on a programme of reforms, including the appointment of professional case examiners to assess complaints, which will be introduced next year. But if, as seems likely, this does not iron out the differences, then a wider examination of the issues that lie behind them will be necessary. It is already long overdue.