The NHS must raise the bar for foreign doctors

The pass mark that enables foreign-trained doctors to work in Britain should be raised immediately, while innovation is needed to avert a deepening crisis in primary care

A review carried out by University College London into the proficiency of foreign doctors in Britain has found that half of them lack the qualifications that are expected of domestically trained practitioners. Each year, about 1,300 physicians from overseas are licensed by the General Medical Council, provided that they pass a competency exam that assesses clinical and language skills. But this test is too easy, according to the UCL researchers, who say its pass rate should be raised from 63 per cent to 76 per cent to “ensure patient safety”.

This recommendation should be acted upon immediately: in 2012, three quarters of doctors struck off were trained abroad, corroborating the theory that standards are lacking. Yet if we do raise the bar, the result will inevitably be fewer doctors to fill the yawning gaps that have appeared in the NHS, despite the vast amounts spent. This is not a new phenomenon, of course; without the help of doctors from the Commonwealth countries over the past 50 years, the health service would have ground to a halt. Today, more than 88,000 foreign-trained doctors are registered to work in Britain, including 22,758 from Europe, accounting for almost a third of the total.

The question that needs to be asked is why we are having to rely so heavily upon foreign doctors. In part, this stems from the contract signed by Labour under which GPs no longer need to provide an out-of-hours service. This has necessitated employing locums from abroad to cover nocturnal and weekend visits. Another factor is the growing number of women GPs. This is a welcome development in many ways; but – as Prof J Meirion Thomas warned earlier this year – figures show that more GPs end up working part-time or retiring early, resulting in more positions to fill.

Above all, however, the GP shortage is a result of poor planning. Figures released earlier this week showed that this country has fewer hospital beds than any other major economy – and half the number in France. NHS officials claimed that this did not matter too much, because we propose to focus more as a country on community-based care. Yet we now discover that many of the doctors expected to provide it are not skilled enough to do so.

If we seriously intend to recalibrate the NHS to make it less hospital-centred, then we need to apply the highest standards to front-line services. One idea floated by the last government but not taken up (after objections from the BMA) was for a countrywide network of polyclinics, offering a range of services under one roof or within a small area. This sort of innovation needs to be developed if we are to avert a deepening crisis in primary care.