We have become too reliant on foreign doctors

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In 2018, and for the first time, we imported more doctors than we trained. In 2019, this figure rose to 60%. This year, it is set to climb still higher.

Meanwhile tens of thousands of students with the required A-level grades and aptitude have failed to gain entry to our medical schools because places are strictly limited by cost.

The UK cannot continue to import an ever-increasing number of doctors from low-income nations to plug manpower gaps in the NHS.

Poaching foreign doctors is both immoral and unethical, as they are desperately needed in their own countries to provide essential services. It is also against a WHO code of practice which states that that “member countries should discourage active recruitment of health professionals from developing countries facing a critical shortage of health workers”. For context, it is estimated that India has a shortage of 600,000 doctors and Pakistan a shortage of 200,000 doctors.

What’s more, though it goes without saying that some foreign trained doctors are among the best, it is rarely asked if this recruitment pattern is in the best interests of the NHS.

The majority of doctors who qualify abroad must pass the General Medical Council’s Professional and Linguistic Assessment Board exam (PLAB) in order to register with the GMC. But this exam is far from perfect. It tests only communication and history-taking skills. There is no proper, structured clinical exam, and no interaction with an examiner. In short, it is little more than a box ticking exercise. Research from two UK academic departments of medical education published in the British Medical Journal in 2014 concluded that the pass mark in PLAB needed to be raised by 30% to reach equivalence with British graduates. Yet the pass rate did not change, and recruitment of doctors from abroad has more than doubled since 2016. Regrettably, this means it is likely that doctors with sub par knowledge and skills are slipping through the gaps.

Another concern, confirmed by GMC data in 2019, is that 70% of PLAB graduates are between 30 and 49 years of age and 3% are over 50 years. Not only will they spend less time working for the NHS than British graduates, but most are too old to begin training in hospital specialities which take at least six post-graduate years.

The UK needs to double the number of medical school places as a matter of urgency. We have made a start: in 2018, Jeremy Hunt, then Secretary of State for Health announced five new medical schools which will graduate a total of 1,500 doctors annually from 2023/24. And last year, the number of medical school places was expanded to 9,000 (although this was mostly due to grade inflation and some candidates were asked to defer their place due to insufficient teaching slots).

The Covid pandemic has thrown the UK’s lack of doctors into sharp relief. But that does not give us the right to poach doctors from low-income countries. We have a moral obligation to limit and stop this practice and turn our minds instead to nurturing home-grown talent.

J Meirion Thomas is a consultant surgeon 

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