Only in the UK do all doctors have different strands of training - it happens no where else.The Foreign doctors in USA after their registration have no cap t o their ambitions and are doing exceedingly well. Over here training is actively denied overseas doctors and that in part may explain this phenomenon - not to talk of covert racism that starks certain kind of jobs to overseas doctors.

OLU WILSON, LONDON, England

"The question has to be asked - why do they want to practice medicine in the UK in the first place, rather than their own country?"

May I pose a different question: 'Why do UK banks, financial institutions and other companies want to trade abroad, instead of their own country?” OR “Why do Man United and Chelsea field 'foreign' players?!”

For emerging economies like India (or Poland for that matter), the biggest inflow of foreign exchange comes from export of services. In domains like Information Technology, the jobs could be done remotely, but not always the case in healthcare.

Despite many of us would like to believe, we live in a globalised economy and flux of talent is simply a part of it!
It is up to the NHS to ensure they are employing the best doctors, irrespective of where they got their degree from. Unfortunately, the competency test (PLAB) is not taken by EU doctors, while an Indian national who had all his education in English has to do so!

Dr. J George, York,

There is an element of racism which is hidden under guise of incompetence or other conduct like skills in communication.
What I would like to know how many overseas people complained as compared to non overseas people.This will allow to compare both ways.

M.Khan, Manchester,

The culture of pain relief varies in different countries, as shown on a TV documentary. When a UK team of doctors and nurses helped out in Bosnia, they had to diplomatically convince the local doctors that a child whose foot had been half blown off needed anaesthetic in order to change adhering dressings.
Initially, the child was half out of his mind with terror as doctors approached him for this daily torture.
The team said they were not convinced that anaesthetic would continue to be used once they had left.
Foreign doctors competence training should include use of pain relief for painful procedures.

Mitzi Blennerhassett, York, North Yorkshire

vSam of Manchester has a valid point, but how was this man with a history of drug abuse allowed to continue to practse? Those working with and around him were of little help, but principally those responsible for the whole National Health Service need to answer questions about the employment and continued assessment of health professionals on a much more frequent basis - irrespective of background.

Perhaps the control should be taken away from bodies such as the General Medical Council, The BMA and The General Nursing Council and in hospitals, is it not time that a proper ward hierachy was re-introduced to provide some discipline among the ward staff, clean the wards up and avoid patients entering hospital without the fear of contracing MRSA or worse.

It is all a matter of discipline and control

Rodney Barker, Gainsborough, England U.K

As an Australian, originally born in England, I had to ensure that I could speak English before I started work in Austrlaia.

That was 40 years ago with limited technology to check ones qualification.

My point is, in this modern day of high technology - are not all newly qualified doctors kept on some sort of computer register in their own country and does not the GMC/NHS, etc., have a very simple access to those records. By the way I include my adopted country in this observation.

Lets get back to basics.

Gerald Savage, Sippy Downs, Queensland, Australia

I am a Canadian citizen who arrived here in 1971 fluent in English (my first language) and French. I had passed all my high school exams, with an average mark of 78%. I had then taken a year of university study and passed all those exams as well. Due to a family move, I arrived in England with all my certificates intending to apply for nursing training. Imagine my surprise when I discovered that none of my educational qualifications were recognized, and that I had to sit a fairly intensive intelligence test and supply references. Poor English language skills would have made the test difficult to understand and pass. I still work as a nurse, and find on almost a daily basis that I am having difficulty communicating with some colleagues who have limited English. This is not prejudice, but a purely practical issue concerning patient treatment. I would like to know how people with restricted English are able to apply successfully and work here.

C. Smith, Southampton,

Your caption entitled "Foreign doctors face competence inquiry" is misleading in that it implies that all erasures are to do with competence.

It must be appreciated that apart from competence, cases of conduct also come under scrutiny. Therefore one cannot conclude that doubling of the figures necessarily mean that twice as many are incompetent

It also lacks clarity in that while the caption refers to "Foreign Doctors " you quote Mr Paul Philip as saying that “The number of fitness-to-practise cases we deal with is going up year on year. Doctors with a primary medical qualification from overseas or within the EU are disproportionately represented, and more are being referred to us than we should be seeing without a good explanation"

The term foreign doctors usually refers to both EU and International Medical Graduates. Your report does not give a breakdown. There may be different explanations for 'impaired competence' in the two groups

Vice Chairman - PLA Board, GMC

Dr Sati Ariyanayagam, Brentwood, Essex

I am very surprised by Dr Crippens statements do not know what he means by "foreigners by their very nature etc". Is he trying to say there is some form of genetic incompetence? I am glad Shipman; Most of the Bristol doctors, The Epilepsy specialist in Leicester etc were not foreigners. There is evidence to suggest that
1) You are more likely to be reported if you are not just a foreigner but a black or ethnic minority doctor
2) You are more likely to go beyond the assessment stage to full hearing if you are a BEM
3) The GMC says now the suspension rate is the same for local and foreign doctors
I think it is xenophobic to include all” foreign doctors " under the same umbrella because in their midst there may be noble laureates as well as fresh graduates
Jayaprakash A Gosalakkal

Jayaprakash A Gosalakkal, Leicester, UK

I am an indian doctor who worked in the NHS. I did feel discriminated by some British colleagues and Seniors purely based on my ethnic origin. It was so evident to my other good colleagues and they couldn't understand why I was being treated so harshly. And this had nothing to do with lack of competence for the very same people would be asking me to do extra shifts. Infact my patients liked me a lot. And that kept me going!

All doctors make mistakes for they are only human. And with experience, you make less mistakes. Overseas trained doctors are employed (after competence testing by the GMC) along with british doctors in junior supervised positions. So, they are meant to be constantly guided by the senior doctors. But most often due to staff shortage, this doesn't happen as it should thus leading to mistakes.

Sara, Sydney,

I have followed the problems the NHS has had since it implemented 'universal health care' and compared it with which is better, -- our (US) system which has many uninsured, but more stringent requirements for practioners, or less quality and longer waits (UK) but health care [?] for all. This is surely a problem to resolve.
But this (finally recent) invesigation into many (almost all foreign trained) "physicians" who cannot even speak the English language! This is so basic -- so incomprehensible -- can he/she even spell the word 'stethoscope'? I wonder what their notes after a visit look like; can any other physician/lawyer/specialist/overseer even read them?
You underpay these poorly trained physicians who are forced to have hundreds and hundreds of patients to satisfy their cost and income.
So basic, as in the US, a graduate from a questionable med sch must do at least one year's internship.
Your "take anyone" system is an embarrasment -- and dangerous.

I W Gittleman, MD, FACP , Long Beach, CA, USA

At a recent consultation with a senior gynaecological registrar, I was rather startled when, having told him I'd had a hysterectomy 25 years ago, he asked me how regular my periods are now! Referrring to another specialist's letter, he then told me I have angina, which was news to me. Questioning this, it emerged he thought the 'A' in 'TIA' (transient ischaemic attack) meant angina. When I explained what the initials stood for, he asked me what the words meant. I left the consultation lacking any confidence in his expertise.

CJ, Stoke-on-Trent, UK

This is not surprising really, given language and cultural difficulties. Some doctors may have a "reason" for leaving their home country and hope if won't be discovered in the UK.

We need to look long and close at language and cultural differences - language may be overcome, but what of cultural differences.

How do I know that the doctor treating me may class me as a second class citizen and treat me accordingly?

This needs to be placed high on the agenda for discussion

Anna, camberley,

There really should be more vetting of doctors!! Our lives are in their hands, and many is the time that I have been unable to get the doctor to understand fully what I am saying, because of a lack of good English. This is nearly always a doctor from South Asia, and not from the EU. At the risk of being labelled racist, UNDERSTANDING of English and the culture and concepts that go with it, are surely a fundamental requirement of a doctor??

Peter Groves, Surbiton, Surrey, England

""Under current rules, doctors from Europe can register and treat patients in Britain but are not tested for clinical competence and do not have to prove they can speak English.""

Mindboggling buffoonery of truly awesome proportions!!

Simply staggering!!

What an inept institution our government has turned into.

John, London,

This review is long overdue. The UK accepts medical qualifications, which are not acceptable by several countries. e.g. Singapore does not accept those from India. Also, as a recent Glasgow terroist case revealed, a doctor who was accepted for work in the UK, was rejected in Australia on qulaifcation validity grounds.

Also the level of corruption in several countries is high. In India/Pakistan and Bangla Desh, 'baksheesh' is regularly required to gain admission to medical school, and a final payment needs for the award of the qualification. Corruption levels are also high in several African countries e.g. Zimbabwe.

Failing to question the quality and validity of medical qualifications from certain overseas countries, is undoubtedly compromising the care, and risking the lives, of UK patients. No doubt if the NHS did attempt to take action on this issue it would be accused of 'institutional racism'.

Objectivity and not polical correctness is essential in the NHS!

Nevin Pillai, Winchester, UK

I am sorry but I disagree with you. The GMC are presently investigating a complaint that I had to submit against a "foreign doctor" who abused his position, an experience which has left me traumatised.
The doctor involved is a senior medical practitioner and playing this race card I find somewhat appalling given that I am myself an ethnic minority. I have come to believe as a result of my experience that the sole reason why Asian doctors in particular chose to practise in this country is to make lots of money. Patient care is a secondary consideration.

Only today another ethic minority doctor was charged with child abuse. Are you suggesting that this doctor has been unfairly targeted?
The problemis that most doctors are regarded as demi-gods and thenthey themselves beging to beleive that they are beyond reproach and can get away with anything.
There do need to be tighter rules for ethnic minoroty doctors.. whether they like it or not...

Sophia, Yorkshire, England

Dear sw of Cambridge,

Ironically it's "fluency" not "fluancy" !!

Thanks for the chuckle.
regards

DI of London

David Ince, London, London

There are many doctors who can hardly speak the Language, forget about the competency, and they can somehow I donot know can get through the system in this Holy profession and get paid very well.
most of there are from Europe.

Maria, Bristol,

The NHS appears to depend on foreign doctors and staff to an extraordinary, and damaging, degree, unparalleled elsewhere in the western world. There are basic communication problems with my current GP - he speaks English, to a certain degree, but has trouble understanding it. His locum last summer was worse still - unable even to recognise the name of common antibiotics, or find them in an alphabtetically arranged index. Eventually, I found the relevant name for him myself, and the embarrassed receptionist dealt with the prescription. It is patently untrue to claim that the checks carried out by the NHS are "stringent", when basic skills and the ability to communicate are fundamentally lacking.

Stuart, London,

Overseas trained doctors represent all the world except UK. They recognized as fit to practice in UK by GMC. After many years, GMC found, that when there were less than enough places for UK trained doctors (should ALL of them work in UK, and do they want?), foreign doctors were less fit to practice. Questions:
1) How long time it takes to count sipmple numbers and percents?
2) Why before everything was allright with GMC?
3) Is it a coincedence, that many overseas doctors in one short year of MMC program will need work permits, more security checks and more proof of their professional abilities?

Are UK trained doctors best in the world? Or discrimination against foreigners is not counted as such? Why all these half-backed accusations not only widely published in UK press, but also used as a background for more accusations? Does it create normal relationship inside of NHS, and, widely, between UK and other countries?
WHO IS RESPONCIBLE FOR IT?

DR Enough, AL-London,

I have no doubt that the greatest part of this scare is caused by racism. To speak English with a foreign accent in the UK is to be considered incompetent.

A fair competence inquiry would look at objective measures, like rates of complications.

And why does the UK have 40% of its doctors from overseas?

Niel Malan, Bronkhorstspruit, South Africa

What a sensational headline! I expect better from the Times.
The situation is very different, and even your story says so!

The majority of International doctors (calling them 'Foreign' is not only distasteful, but incorrect as well, many are British subjects now) are from the Indian subcontinent and have to pass the PLAB exam for clinical competence (set by the GMC), get a high score in IELTS (English, set by Univ of Cambridge), produce a certificate of good standing from a medical regulator and have references. Many will work unpaid for a few months in a NHS setting, under very strict supervision before they are offered a job. Despite all these vetting they are still more likely to be referred to the GMC for the SAME transgressions than their locally trained colleagues, and moreover likely to get stricter restrictions on their practice from the GMC and trusts.

This review is in part instituted on the repeated requests of bodies representing International doctors and not the DoH!

Dr J Grover, Wroughton, Wiltshire

There are really important issues here, which I raised officially with the GMC over the last 2 years. The role of the GMC is to protect patients and "put patients first" - it is meant to be an ethical organisation.

Yet now that we are part of the EEA with equal employment opportunities, the GMC has gone along with its interpretation of European law and will give GMC registration to Doctors who qualified in the EEA, without even checking that they can speak English! That is left to the employer. Yet as The Times points out doctors trained in English in Australia, India, Pakistan and Sri Lanka etc, have to do an exam in English!

The GMC should act ethically and challenge the legal system to act against it. The public would clearly back a systemt that ensured that doctors working in the UK can speak the main language of the UK! Professionals are people who when forced to make a choice between an ethical and a legal action, tend to choose the ethical action.

Dr Gordon Caldwell, Worthing, West Sussex

I agree with Phil from Preston. EU doctors must be submitted to some form of pre-employment assessment for English Language and clinical skills competencies.

Doctors from out side the EU do the PLAB test after possessing a high score in IELTS (International English Language assessment test).

Therefore, there is a theory of racism against overseas doctors who actually spend time and effort to pass the GMC exams and get a job in the UK while EU doctors get full registration straight away without any form of assessment.

Overseas graduates have always been part of the NHS and i hope that some one will look into the number of consultants in this country who come from outside the EU originally and what role they play in providing the service and even training UK graduates.

I believe, the system needs to be farer to every one. UK, EU and overseas doctors and discrimination in our field should only be based on the level of English Language and clinical skills efficiency.

Al, Newcastle,

Before I retired I warked ,as an administrator, in a large teaching hospital.
To my certain knowledge an Indian Registrar working in the maternity unit was removed after some dreadful blunder alnost cost a life. He had never qualified but had bought his certificates in India.

A chief Nursing Officer made some really stupid decisions and was found onlt to have a mental nursing certificate from Southern Ireland, and that was never established.
In both cases a view of their "Certificates" was all that was asked. That complete lack of verification is STILL going on whatever ministers may glibly say.

Gearge Robertson, Kircaldy, fife

Foreign doctors have contributed tremendously to the NHS. Like any walk of life, most foreign doctors are hard working and competent doctors who provide good quality care but like any walk of life there are some bad apples and this is true for doctors from India, Pakistan, and USA, UK or any part of the world. That is simply a human nature.

Let us remind ourselves that all recent high profile cases of ‘bad doctors’ in the UK like Shipman, Rodney Ledward, Richard Neale, Bristol Cardiac Babies, Kerr, Haslam and Ayiling are all locally qualified UK doctors who caused untold misery to their patients. None of these doctors are overseas qualified!

Of course, any doctor who provides poor quality care or puts patients at risk should be addressed and dealt firmly. Just because GMC has dealt more foreign doctors, it doesn’t mean that foreign doctors are bad. As the BMA has said “Institutional Racism does play a significant role”.

Dr. Prabhu, Rochdale , UK

The BMA has finally woke up to what the public has been telling them. Foreign doctors who cannot speak English cannot diagnose illness from interviewing a patient, no matter their qualifications. With no or little qualifications and no or little experience of practicing medicine what chance have we or them.

Competence should be the first test prior to appointment not political correctness. You tell a foreign doctor he has not got the job, guess what, you are accused of racism. Sad-Sad-Sad

Bill, Sheffield, UK

This is worrying indeed. Often patients already prefer to be cared for by a 'British' medical team, if only because they struggle to understand staff whose first language is not English. Statistics such as these, which intimate a lower standard of care offered from international staff, will widen that rift and result in a further loss of confidence in NHS care. Also, disciplinary action very often follows civil suit, costing the NHS millions of pounds. Perhaps these stringent preemployment checks need to be more stringent still.

Robert Dickason, London,

I do not think NHS is institutionally racist.

Dr P Mulay, Wadebridge Cornwall,

Why on earth is the BMA introducing the red herring of "institutional racism" here?

Patients' lives or mental well-being may be at risk from malpractice or poor training. Introducing this "Politically Correct" football will only serve to muddy the waters and prevent any investigation from properly dealing with the issues and discovering the truth.

The damage is already done of course. The BMA has now provided a defence line to any medical shark who cares to use it. And use it they will - to string out the inevitable public inquiries and ratchet up the cost to the taxpayer.

How stupid can you get? The MBA should be made to pick up the tab before it is abolished.

Bill McCann, Suzhou, China

One of the foreign doctors accused of the recent bomb attacks in London and Glasgow had attempted to get a job in the US. He thankfully was unable to pass the US competency test - this is several hours of examination and I would guess a lot more rigind than a quick Home Office glance at say fake Nigerian paper "qualifications". The fact that this would-be doctor/ terrorist then shows up in the UK and gets a job in the National Health System tells us all we need to know about medical "standards" in the UK.

Grant, New York, USA

The question has to be asked - why do they want to practice medicine in the UK in the first place, rather than their own country?
The UK hospital system is highly dysfunctional. Is it likely that a competent overseas doctor would want to work/train here unless there were problems at home either with the system or the person?
With respect to institutional racism, we have been listening to this old chestnut for at least 20 years. It must be obvious to the GMC and the BMA that the Dr-patient relationship is changed when they do not share cultures and first language.

L Wilson, London,

Canadian Doctors face additional medical exams before they can practice in the USA.

Yet the UK lets thousands in as long as so called foreign papers and certificates looks up to the mark. And the fluency in English standard doesn't seem to pass muster with most of the patients.

Let copy the USA on this as well as doing the same as them in Iraq.

jj, Cambs, UK

And this comes as a surprise? Anyone can turn up in the UK and claim to be a doctor and be employed by the NHS. Their competence is not checked, which should be top of the list in any interview. We are getting a third-world health service because we have more third-world staff, may of whom have had poor or no training.

David Smith, Stourbridge, UK

I am amazed that any doctors get to GMC hearings in the first place - having recently tried to follow through on a complaint about a consultant - we have been stonewalled by the hospital, side tracked by the Health Commission - and we started from one of this consultants colleagues asking us to complain, because it 'wasn't the first time' - End result,: an admisssion by the hosital of wrong doing, but no action taken against the consultant and still no full info on what exactly happened. The sooner there is external regulations and control of medics, rather than the DOH variable standards the better. This should include competence checks on a regular basis- proper one's - not buddy appreciation sessions. Maybe we could include interpersonal skills as well as technical competence!! I dont care where my doctor was trained - just that he can do the job well and communicate that to me!

sheelagh , chester, cheshire

We knew this was going to happen but the government wouldn't listen...........

Phil, Preston,

I work with the doctors out of hours service and the language problem is significant and yet we are viewed as racisit if we or the patients cannot understand them
I have Polish doctors saying to me
can you speak to this old lady she is rambling on and I cannot understand her.That is what old lady's do ! you have to listen carefully to establish the problem.
I had another Spanish doctor who's daughter rang with typical symptoms of a stroke. the doc diagnosed a urine infection and said to come back in 24 hours if she was not any better.
By that time she had lost her speech and swallowing and was admitted to hospital.
the daughters initial referral said'Face drooping and dribbling !
We have trained loads of our own doctors who can speak the language who may not be able to get onto training courses while we ae paying afortune per hour to people whose lack of communication skills make them incompetent
I t is not racist to say that someone paid £50 hour should be able to do the job.

martin bickley, london,

""Stringent preemployment checks". Define stringent.

Kathleen, Hemel Hempstead, UK

The British Medical Association said that the pattern might be accounted for by a culture of institutional racism within the NHS.

This is doubletalk for, "We got them on the cheap, but if we blame racist tendencies we can get away with incompetence"

Foreigners by their very nature, are of a different culture to the UK indigenous population, where there is no mutual understanding, or empathy there will be friction, and abuses of power and trust.

Dr Crippen, London,

I find it incredible that Britain seems to accept documentation originating in many countries that now have a reputation for fraud and general high crime rates. For example, a person arriving from South Africa (or Zimbabwe) by virtue of their being members of the commonwealth and former colonies, their SA driving licences are able to be swapped for a British one with no testing at all. This despite the fact that it is now a simple matter to buy a driving licence in especially South Africa for a few pounds.

One official at the government licensing authority last year was arrested and found to have "sold" more than 19.000 licences to "drivers" many of whom would not even pass the medicals.

It should be mandatory for all foreign medical students to sit an examination in Europe before they are allowed to practice here, and it is really the duty of the Medical Councils to insist on this for the sake of the taxpayers and patients they are sworn (Hyp. oath) to attend.

B J Deller, Marbella, Spain

I seem to recall that several years ago the GMC carried out a study on complaints made against foreign trained doctors. For the same type of complaint they were 3 or 4 times amore likely to be penalised or more severely penalised compared to their UK trained counterparts.

brian musah, hertford,

Are there any more secrets being held by the GMC concerning our invaluable medical profession and do those secrets need to be translated too.

Rodney Barker, Gainsborough, England U.K

Are there any more secrets being held by the GMC concerning doctors and do these need translating into English?

Rodney Barker, Gainsborough, England U.K

Whilst ensuring doctors are competent for the job, lets not alienate foreign doctors since they are currently carrying the NHS at the moment, without them we would be in a total mess.

After all, the biggest serial killer in the NHS was a british trained GP- Harold Shipman.

Sam, Manchester,

indeed it seems strange that people from australia, america would have to take exams for english fluancy while people from EU doesn't. shouldn't it be fairer and safer to impose a standard test for competence and english fluancy for everyone who wish to practice in UK? as education and practices of medicine are all different everywhere.

sw, cambridge, UK