Patient care will be compromised by new measures preventing hard-pressed trusts from recruiting experienced doctors from overseas, the Royal College of Physicians has warned.

Following the immigration cap for skilled workers entering the UK, trusts had to use the Medical Training Initiative to employ overseas doctors. The MTI allows non-EU doctors to practise in the UK for a maximum of 24 months before returning home.

But now the MTI is under threat. Later this year the Home Office intends to cut net migration and reduce the maximum length of stay for doctors on the MTI to 12 months. Such a short stay would remove any training incentives for non-EU doctors and make it even more difficult for NHS trusts to recruit experienced overseas medical graduates.

The RCP said that, while it supports a fully home-grown healthcare system, there is currently a need for trusts to recruit from overseas and it is vital for patient care that hospitals can employ experienced non-EU doctors.

President of the RCP, Sir Richard Thompson, said: “Through the MTI, NHS trusts not only contribute to the training of doctors in developing countries, but also experienced medical graduates on the scheme help to ensure hospitals in England are adequately staffed.”

The MTI scheme has been criticised in the past for not enabling enough doctors to enter the country and for being bureaucratic.

Matthew Foster, head of international affairs at the RCP said: “Reducing the time limit of the tier 5 MTI will result in an inflexible system and international doctors and health leaders overseas will lose interest. They will go elsewhere and it will be the UK’s loss.

“The current arrangements ensure that the UK continues to maintain clinical links around the world, and support the World Health Organisation’s code of practice on international recruitment of health personnel.”

Professor Rezvi Sheriff, director of the Postgraduate Institute of Medicine, Colombo, Sri Lanka, said: “Training time in the UK is of great importance to Sri Lankan doctors and the continuing development of our health system. After so many changes to UK immigration regulations in recent years, restricting the Tier 5 medical training initiative to 12 months will force our doctors to shift their focus away from the UK.”

Tier 1 and Tier 2 visas were capped; the former allows highly skilled migrants to apply for permission to work or train in the UK without a job offer; the latter allows UK employers to recruit workers from outside the UK and European Economic Area to fill vacancies which have undergone the resident labour market test.

The MTI scheme falls under Tier 5, which allows overseas nationals to participate in government authorised exchanges. The scheme provided 250 two-year placements for doctors from developing countries in 2008 and was expanded by several hundred more by the previous government.

Read the WHO’s code of practice on international recruitment of health personnel.

Strict new immigration rules are creating problems with recruiting junior doctors from overseas and leaving hospitals short of staff.

Gynaecological services at Erne Hospital in Enniskillen, Northern Ireland, were suspended recently because only one of six new junior doctors recruited from the Asian subcontinent was able to start work on time. The doctors have been told it will take at least 9 to 12 weeks for their work permits to be issued.

“It is bureaucracy gone mad,” said Professor Mahen Varma, a cardiologist at the hospital.

In South Wales, the Abertawe Bro Morgannwg Trust has recruited nine middle grade doctors from India who are waiting the green light from UK immigration. The trust currently has 73 vacant doctor posts at all grades, according to figures collected by South Wales West Welsh Assembly Member Alun Cairns.

Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO), said they had heard of similar problems across the UK with the Working Time Directive making the situation even worse.

He said the problems related to bureaucracy created by the new Medical Training Initiative (MTI), launched in February, which allows international medical graduates (IMGs) to work in the UK for two years and then return home.

The immigration process involves paperwork from five organisations - the royal colleges, deaneries, the GMC, NHS Professionals and the Home Office. 

BAPIO has proposed that all the paperwork should be coordinated by the royal colleges. It has also asked for IMGS to be allowed to stay for longer than two years because it takes them six months to settle in and that they should be given more training under the scheme.

“The immigration process for IMGs is taking too long while hospitals have acute shortages of doctors. These people in their ivory towers should wake up and let these doctors come here and get on with some good work,” said Dr Mehta.

A Department of Health spokesman said: “We are not aware of any delays caused by immigration, however, we will respond to any issues raised with us.”

He said the royal colleges could never take over the role of UK Border Agency (UKBA) or issue the overseas visas. 

But he said the current length of leave for IMGs to stay in the UK and proposals to increase training benefits were currently under discussion.

“The DH continues to work closely with UKBA to ensure the MTI can bring maximum benefit to IMGs and the NHS,” he said.

It’s planned that MTI will provide 750 placements a year for IMGs.

Employers are being warned not to exploit overseas junior doctors taking up new training placements in the NHS through the new Medical Training Initiative (MTI).

The MTI, which provided 250 two-year placements for doctors from developing countries last year, is now being expanded in stages to provide up to 750 opportunities.

Dr Ramesh Mehta, president of the British Association for Physicians of Indian Origin (BAPIO) fears the scheme could be used as a mechanism for filling posts left vacant following the April 2006 immigration ruling that led to the exodus of thousands of international graduates.

“The Department of Health should come clean on the service needs that have made such an initiative necessary. BAPIO’s policy has always been to press for proper workforce estimations and allowing the required number of overseas doctors to enter the UK and then giving them the opportunity to make progress by treating them on merit,” he said.

Dr Mehta said employers must ensure that MTI doctors are given proper induction, mentoring and training and the same pay as UK trainees to ensure they are treated fairly.

“Also it is important that it is made clear to these doctors at the outset the details about their prospective jobs and that this training will not lead to further career opportunities in the UK and that their training may be aborted if they do not demonstrate necessary competencies,” he says.

Juniors are voicing similar concerns. Delegates to the BMA’s recent Junior Doctors Conference, who noted that the scheme has striking similarities to the Permit-free Training Visa, passed a motion calling on the government to ensure that training places are genuine and of high quality.

Health minister Ann Keen said the MTI will enable international medical graduates from countries where medical training was not widely available to secure “vital” training and work experience in this country.

BAPIO’s view on the issue