Overseas doctors » Hospital Dr

Posts Tagged ‘Overseas doctors’

Minister commits to testing docs language skills

By Mike Broad - 5th October 2011 10:10 am

The government is finally moving to ensure that overseas doctors have the language skills required to work in the NHS.

Addressing the Conservative Party conference, health minister Andrew Lansley said he would change the law to ensure overseas doctors have “the language skills needed to practice here”.

Doctors’ representatives have been campaigning for years - particularly since German locum GP Dr Daniel Ubani killed a patient with a painkiller overdose on his first shift in England - for the GMC to test the language skills of overseas doctors.

There was uncertainty over whether the Medical Act 1983 had ‘gold plated’ the EC’s mutual recognition of professional qualifications directive, thus preventing the language testing of doctors entering the UK. It’s believed amending the Act would enable some degree of testing.

Lansley told delegates: “I am determined that doctors who come from overseas to work here must not only have the right qualifications, but also the language skills needed to practice here.

“This is not about discriminating; we’ve always appreciated how much overseas doctors and nurses give to our NHS. It is simply about our absolute commitment to put patients’ safety first. So I can tell conference today that we will change the law to ensure that any doctor from overseas who doesn’t have a proper level of English will not be able to treat patients in our NHS.”

Responding to the announcement, Dr Hamish Meldrum, chair of BMA council, said: “The BMA has, for many years, been calling on the government to change the Medical Act so that the General Medical Council has the power to properly regulate doctors from the European Economic Area that come to work in the UK. Doctors trained outside the UK make an important contribution to the NHS but it is essential that they are able to communicate effectively with their patients and colleagues.

“Today’s announcement seeks to ensure all doctors working in the NHS are fit to practise; we would hope that this will extend to doctors working in the UK but are not employed by the NHS. It will also introduce mandatory checking of English language skills for EEA doctors before they can be employed by the NHS in England. These changes are a positive way forward and should help close the loophole that has allowed doctors with inadequate English language skills to work in this country.”

Dean Royles, director of the NHS Employers organisation, said: “It will always be down to the employers to carry out pre-employment checks and we need to ensure that any new arrangements are pragmatic and workable.

“Most employers are assessing language and communication skills already through the assessment and interview process. Guidance and clarity from the government in this area is a welcome help to all employers who will continue to improve the checking process. While the focus is on doctors, employers also recognise that language skills must be adequate across all front-line workers, including nurses and specialists, and are working hard to ensure that this is the case.”

Read a recent blog on the issue.

Tags: Language test, Overseas doctors
Posted in Hospital Dr News | No Comments »

We owe overseas doctors more than an induction

By Mike Broad - 22nd September 2011 11:01 am

It’s taken a long time to come to a rather obvious answer.

Overseas doctors need more support when working for the NHS - and a good place to start would be with a useful, comprehensive and consistent induction process.

This is one of the conclusions of the GMC’s State of Medical Education and Practice report.

It says that more than a third of registered doctors completed their primary medical qualification outside the UK, and the medical profession is more ethnically diverse than the population it treats.

I don’t have a problem with this (as long as we’re not permanently robbing developing nations of their doctors). Overseas physicians have long made an enormous contribution to the success of the NHS.

But there’s no doubt that for some the transition to working for our health service is a challenging one. You only have to flick through the GMC’s diary of pending fitness to practise cases to realise how many overseas doctors fall foul of the regulator.

Many of the problems come down to communication issues. It’s over three years since Dr Daniel Ubani killed David Gray and yet we still cannot test the language skills of European doctors working in the NHS. And the stories keep happening.

Before we start talking about inductions, we must find the political balls - even if it leads to dispute with our European cousins - to facilitate the language testing of overseas doctors. (And while you’re at it Lansley what happened to the promise to renegotiate the opt out from the working time regulations).

Once we are confident that an overseas doctor is competent in English, and has been familiarised with our health system, we must ensure that they’re then given the same career development, support and training opportunities as everyone else i.e. they’re not just here to plug a service gap.

When there are concerns, we also have to ensure they’re treated fairly. Research suggests that GMC decisions about doctors who qualified outside the UK are more likely to have far reaching consequences for their careers.

So, a decent induction would be a start, but only a start.

Tags: Overseas doctors
Posted in Dr Blogs | No Comments »

MTI for overseas doctors facing closure

By Mike Broad - 20th June 2011 10:13 am

Proposed changes to immigration laws will have a significant impact on a training initiative that increases the quality of medical healthcare in the developing world and has significant benefits for the NHS.

This is the fear of both VSO and the Royal College of Physicians, which both warn that the two-year Medical Training Initiative (MTI) will be put at risk if the government adopts its proposal to cut the duration of Tier 5 visas for temporary workers to just one year.

VSO and the RCP are calling for an exemption for health workers coming to Britain as part of the MTI, which trains about 200 doctors a year from the developing world, to ensure they can take advantage of the full two years of training.

VSO UK head of external affairs, Kathy Peach said: “The MTI has minimal impact on long-term immigration numbers with all doctors carefully selected and processes put in place to ensure they return to their home countries after their training. A full two years of medical training is needed to ensure doctors receive all the skills they need to save more lives in developing countries.

“Under the proposed changes it will be easier for an unskilled Australian bar worker to stay in the UK for two years than a skilled Sudanese doctor who wants to come to Britain to receive medical training that saves lives, and make a contribution to providing high quality services to patients in the UK.

The changes will mean that MTI doctors and other workers will no longer be counted in incoming migrant figures.

Peach added: “In many developing countries, such as Sri Lanka, doctors cannot receive their post university training in their own country. They must go abroad for two years to complete their qualifications. Britain has played a vital role in training doctors from countries where the shortage of skilled health professionals is leading to tens of thousands of preventable deaths each year. We are concerned that our good work in helping address needless deaths in the developing world is under threat.

“Reducing the MTI to one year will lead to doctors seeking training in other countries which do not have the safeguards in place to ensure those doctors return to their home countries, where they are needed most, once they complete their training.”

There are currently 340 doctors working in 149 trusts across the UK through the MTI. Of these, 77 were sponsored by the RCP and an additional 205 physicians are due to start posts in the UK in the coming months.

Sir Richard Thompson, president of the Royal College of Physicians, added: “The MTI benefits the NHS. It makes financial sense by reducing locum costs. The MTI also helps hospitals fill rotas gaps, which has been exacerbated by the limiting effects of the European Working Time Directive and the New Deal on junior doctors’ hours of work”

Fifty-seven countries worldwide suffer from a severe shortage of health workers. Thirty-six of these are in Africa, which has just 3% of global health workers but bears 24% of the global burden of disease.

Commenting in Hospital Dr earlier this year, Nuradh, a Sri Lankan oncologist in the MTI scheme, said: “After training for 4-5 years in local hospitals, our postgraduate training programme requires a mandatory period of overseas training of around 24 months. This is meant to give us an exposure and experience in working in a different health care system.

“Many trainees of my country completed this period under the MTI and have returned to my country. As an overall figure almost 80-90% of our trainees return to the country. Reducing the Tier 5 visa duration would mean that we may have to look to other countries such as Australia to complete this component.”

Tags: MTI, Overseas doctors
Posted in Hospital Dr News | 1 Comment »

Testing language skills of European doctors

By Mike Broad - 4th May 2011 2:22 pm

Doctors’ leaders have upped the pressure on the government to resolve the issue of testing European doctors’ language skills prior to working in the UK.

As part of a submission to a European Commission consultation on the rules covering the free movement of medical professionals across borders, the BMA said confusion persists over the verification of language abilities.

It’s still widely believed that the Medical Act 1983 ‘gold plated’ the EC’s mutual recognition of professional qualifications directive and prevents the language testing of doctors entering the UK.

Amendment of the Act would enable some degree of testing, the BMA speculates, and calls on the government to address this issue ‘as a matter of urgency’ to protect patients.

It’s now three years since German locum GP - Dr Daniel Ubani - killed patient David Gray with a painkiller overdose after being flown over at short notice for his first and only shift in England.

The Department of Health recently suggested that the new NHS Commissioning Board might take responsibility for testing the language and clinical skills of foreign doctors from within the EU.

The EC is considering revisions to its directive on the mutual recognition of professional qualifications. Under the directive, European Economic Area medical qualifications are valid across Europe, and EEA doctors can seek work in any country in the area.

The BMA submission says: “It is essential that EEA doctors who exercise their right to free movement are able to demonstrate regularly to the host competent authority that they are fully qualified and fit to practise.”

The BMA also calls for better information sharing across borders; for European medical graduates to be prevented from applying for over-subscribed FY1 posts; and, for a Europe-wide system that can verify the CPD status of applicants.

The Royal College of Nursing also called for ‘greater confidential exchange of information between regulators on fitness to practice and disciplinary cases’ in its submission.

Overseas doctors more likely to be suspended

By Mike Broad - 17th February 2011 11:35 am

Doctors qualifying outside the UK are more likely to be referred to be excluded or suspended from work than UK medical graduates.

Statistics from the National Clinical Assessment Service reveal higher rates of concern among doctors who qualified elsewhere in the European Economic Area as well as outside Europe, with the highest rates seen amongst non-white doctors.

However, NCAS attributes these differences to place of qualification and training factors at undergraduate level rather than to ethnicity. Levels of concern amongst doctors qualifying in the UK do not differ between white and non-white groups.

Approximately 5,600 NCAS referrals were examined altogether, including 900 in the most recent year, 2009/10. The latest year’s figures show patterns very close to those reported in earlier years.

NCAS, which provides advice to trusts on improving the performance of individual doctors, is calling on the NHS to strengthen induction and support systems for international medical graduates so that levels of concern about professional practice can be reduced.

Professor Alastair Scotland, Director of NCAS, said: “We are not generalising. Most doctors from outside the UK do excellent work for the NHS and the service depends a great deal on them and the skills they bring. But these statistics show clearly that there is a greater likelihood of concerns being raised in some groups than others”.

The analyses also show a strong association between concerns about professional practice and the gender and age of doctors being referred.

Scotland added: “We consistently find higher levels of concern in older age groups, which might be telling us something about the educational needs of doctors at the later stages of their careers. We also find fewer concerns amongst women at all ages. The reasons for that are less clear and it is therefore important we see more research in that area.

“There has been a great deal of discussion in recent years about the influence of ethnicity and place of qualification on concerns about professional practice. NCAS’ statistics have shown consistently that place of primary qualification has a more powerful influence on referral to our services.”

Read the full report - Concerns about professional practice and associations with age, gender, place of qualification and ethnicity - 2009/10.

Tags: Overseas doctors, Suspended
Posted in Hospital Dr News | 3 Comments »

Three in four GPs from Europe haven’t been tested

Pulse - 14th October 2010 4:58 pm

Fewer than a quarter of EU doctors from outside the UK registered to work in this country as GPs have been tested for their language skills and clinical competence.

PCT records show hundreds of foreign doctors are included on primary-care performers lists without having been formerly checked, exposing a shocking lack of action in the wake of the Daniel Ubani case.

An investigation into more than 100 PCTs have raised alarm at the GMC, which wrote to all trusts in England seven months ago, urging them to carry out tougher checks on EU doctors.

The move followed the unlawful killing of 70-year-old patient David Gray, who was given an overdose of diamorphine by German locum Dr Ubani on his first GP out-of-hours shift in the UK.

UK must be enabled to test European doctors

The Guardian - 11th April 2010 12:20 pm

The next government must “as a matter of extreme urgency” demand changes to a 2005 EU directive governing the free movement of labour in an effort to prevent more deaths at the hands of incompetent foreign GPs, senior MPs claimed.

New ministers should also promise to change UK laws which “goldplated” European rules and prevented medical regulators giving language tests to European doctors, according to a critical report on out-of-hours services by the Commons health select committee.

The report criticised NHS bodies for failing to use other vetting powers, noting that no disciplinary action had been taken against an NHS body that did not check the English language skills of Daniel Ubani, a German doctor who unlawfully killed a patient on his first shift in Britain.

The challenge to begin changing the structure for vetting EU doctors before a long-planned Brussels review in 2012 could mean an early clash with EU partners for the new administration.

At present, EU doctors can join the GMC’s register without undergoing the language and competence tests faced by other doctors from abroad, as long as their own countries’ regulators vouch for their credentials.

The Department of Health in England has already ordered that the NHS implement properly its existing system for safeguarding patients following a damning coroner’s verdict on the case of 70-year-old David Gray, who was accidentally given a massive overdose of a painkilling drug by Ubani in 2008.

GMC wants new powers to test European docs

By Mike Broad - 19th March 2010 4:49 pm

The GMC has once again called for an urgent change in the law to enable them to test the language skills and competency of European doctors before they start work in the UK.

In presenting evidence to the health select committee, GMC chief executive Niall Dickson said the regulator needed more powers to be able to properly check the competence of European doctors.

Dickson said: “What we can do is check who they are; we can get from the competent European authority a certificate saying they are somebody of good standing, and thirdly we get the qualifications they produce.

“What we cannot do is look behind those things. We cannot say well that qualification doesn’t mean very much. If it is approved, and it is on the European list, then we simply have to accept them and in the case of Dr Ubani that was of course what happened.”

German doctor Dr David Ubani negligently killed a patient during an out-of-ours visit in Cambridgeshire in 2008. David Gray died after being administered 10 times the normal dose of diamorphine. The coroner, and a subsequent inquiry, raised serious concerns about the management of out-of-hours care.

Health minister Mike O’Brien, who also appeared in front of the committee, questioned whether empowering the GMC was the best way to tackle the problem.

He suggested that greater adherence to existing responsibilities, and better management of the ‘performers list’, by trusts and employers could be the solution.

O’Brien said: “I am making absolutely clear that PCTs should have been by law, since 2004, looking at language skills. They had no discretion on this; it was a legal obligation. They should be doing it now.”

He added: “The most important check, and where we have to tighten up a lot, is on the employer because the employer, either a co-operative or a private company, needs to ensure that the competence in terms of the skill and also the language skills are adequate to do GP services.”

Dr Ubani was employed as a locum GP covering an out-of-hours shift by private sector provider Take Care Now, which recruited him at short notice from Germany.

O’Brien felt that that working with PCTs and employers would be more expedient than changing the law. “If we go into a long drawn-out discussion about changing EU Directives, what the GMC want and giving them new powers…I think it will just take longer, but I want to sort this out by the end of this year,” he said.

Tags: Out-of-hours, Overseas doctors
Posted in Hospital Dr News | 2 Comments »

Our GPs must prevent out-of-hours “killings”

By Mike Broad - 4th February 2010 6:20 pm

Apologies over the unnecessary death of David Gray have filled the front pages and airwaves this week.

He was given a fatal overdose by Dr Daniel Ubani, a German doctor flown in to provide out-of-hours GP cover in Cambridgeshire, and a coroner ruled this week that his death amounted to gross negligence and manslaughter.

The coroner William Morris issued 11 recommendations to the Department of Health to improve out-of-hours GP services.

The main one, and most people’s biggest bone of contention, is the need for a review of how EU agreements work in the UK. Morris said the government must issue guidance to all NHS trusts over checking doctors’ English, their experience of the NHS and how they acquired their GP status.

However, as the GMC is at pains to point out, they’re not allowed to test doctors from the EU. The combination of EU law and domestic legislation (the Medical Act 1983) excludes the testing of a European applicant’s language proficiency or their competence.

This is a bit of a problem when you consider that Ubani was flown in at the eleventh hour, started work immediately with no induction and was utterly incompetent. (Makes you also wonder why we booted out loads of good doctors with excellent English from the sub-continent a couple of years ago).

Without wanting to come over all UKIP, our health secretary needs to grow a spine and put our relationship with Europe on a proper footing on this issue.

Morris also demanded “robust” clinical and management measures, including training and induction for non-UK doctors, and said only the company actually running the out-of-hours GP services should recruit doctors in future. It follows the Care Quality Commission making similar demands of trusts last year.

And this is where we get to the crux of it. Of course all overseas doctors coming into the UK should be tested and we should have a clear idea of the equivalence of their training. But, the real problem is how we’ve organised our out-of-hours GP services. Crap European doctors shouldn’t be required.

This week’s apology by NHS Cambridgeshire, which employed Take Care Now to provide the services in question, is revealing.

Dr Paul Zollinger-Read, chief executive of NHS Cambridgeshire, said: “We as an organisation still have much to learn from this case. Our monitoring of contracts has already improved significantly, but we must not become complacent.

“Systems around the registering of GPs by the GMC and on Performers’ Lists need to reviewed, and the recruitment, checking and vetting of GPs by our providers is vital if we are all to prevent this happening again.”

He’s got responsibility but seemingly limited power to control events. It doesn’t take much to go wrong, in a safety critical environment, where organisations are contracting and sub-contracting to the private sector, to lose sight of the process.

The reasons why Ubani was used remain. He was cheap and available (he even paid for his own flight and accommodation). It had nothing to do with quality. More checks will help but, in our new age of austerity, PCTs are still going to be looking for cheap deals.

I think it speaks volumes that Take Care Now is still in business, regardless of whether it has improved. It lost its Cambridgeshire contract, but still provides services for two other trusts: NHS Worcestershire and NHS Great Yarmouth and Waveney.

The GP contract has been an unmitigated disaster for out-of-hours care in the community. It’s time to bring local GP practices back into the equation and if that means the GP contract has to be re-negotiated, then so be it.

Tags: Out-of-hours, Overseas doctors
Posted in Dr Blogs | 2 Comments »

German doctor unlawfully killed overdose patient

The Guardian - 12:18 pm

A patient who was given a fatal overdose by an out-of-hours doctor was unlawfully killed and his death amounted to gross negligence and manslaughter, a coroner has ruled.

Dr Daniel Ubani was “incompetent and not of an acceptable standard”, the coroner said.

David Gray, 70, died after the German locum administered a fatal dose of a painkiller when he was working on his first shift for an out-of-hours GP service provider.

The comments were made by the Cambridgeshire and North-east coroner, William Morris, sitting in Wisbech, at the end of an inquest that has highlighted the concerns about the quality of out-of-hours care offered to patients.

Morris said “weaknesses remain in the system” and made 11 recommendations to the Department of Health for a review of the entire service.

In August, the GMC and the Royal College of GPs demanded a rewriting of EU rules that allow doctors from Europe to be registered in the UK without tests on their English or medical competence. Doctors from the rest of the world already face such checks.