Thriving, not just surviving: Supporting non-UK trained doctors


Niall Dickson, Chief Executive of the GMC, talks about the vital role International Medical Graduates play in UK healthcare.

It is often said that the NHS and indeed healthcare as a whole could not have survived and thrived in the UK  without the dedication and skills of professionals who came here from other countries. And we need to go on saying that loud and clear, and more importantly we need to make sure we adequately support doctors and other health professionals who come here to practise. We have not done this well in the past.

One in three doctors licenced to practise in the UK has been trained outside the UK. We have tended to regard medicine as a series of skills and competences – and of course clinical knowledge and expertise should always be centre stage – but the impact of training, culture and experience should never be underestimated.

Doctors are like flowers: you cannot uproot them from one environment, stick them in a very different one and expect them to thrive. They must be nurtured and supported. The fundamental values of medicine may be universal, but  the way they are expressed will be different according to the social, cultural and organisational contexts in which care is delivered.

image of doctors in discussionResponsibility for getting this right (and doing it better) rests with many of us in the system. As a national regulator we have responsibility for highlighting the issue and for working with others in trying both to improve our own systems and procedures and influence better practice at local level.

We have taken a number of steps, but there is more to do. Last year, we began piloting our Welcome to UK Practice programme aimed at those joining our register from the first time. It is a modest intervention, but it explains how the UK health system operates, the GMC’s role in a doctor’s career and the standards and ethics we expect of all doctors. So far doctors from more than 40 countries have attended and the feedback has been incredibly positive. We are now considering how best to roll this out more widely so it becomes firmly embedded in the system.

We have also simplified how doctors wishing to get onto our specialist and GP registers can show they have the equivalent evidence and skills to those who have undergone approved training in the UK – this will particularly benefit doctors coming here from abroad. There are further reforms we want to make in this area but they largely depend on the law being changed.

We need to listen to doctors whose voices have not always been heard. The GMC has a BME Doctors Forum where we can engage with various groups – this is an important sounding board, helping us to understand how the decisions we make and the standards we set affect and impact on doctors in practice.

At the heart of all of this is fairness. We are working hard to ensure that our processes and procedures are fair, open and transparent, regardless of where a doctor was trained.

This is why we commissioned an independent review of PLAB, the test that overseas-trained doctors take in order to practise in the UK, to ensure it remains robust and fit for purpose. And we have campaigned for fairer language testing so that those from Europe need to demonstrate the same skills as we require of doctors from the rest of the world. That campaign has finally borne fruit, with new rules to enable us to assess the English language skills of doctors from Europe coming into operation in June. We have also commissioned independent research about doctors’ perceptions of the fairness of our work, and we will be publishing that soon.

Above all, we are committed to patient safety and high standards of medical practice. We believe the best, safest and most effective care is given by dedicated and well-supported health professionals. That is why we are doing all we can – independently and with partners – to ensure that doctors, regardless of background, are able to thrive in the UK healthcare environment.

7 responses to “Thriving, not just surviving: Supporting non-UK trained doctors

  1. I am very happy that GMC is improving working conditions and educational opportunities for the international medical graduates. It was not available to me or other overseas qualified doctors 37 years ago. There was no formalised education programme or training. The culture was alien to us and there was no training in that aspect either. We learnt those aspects as we went along and from other colleagues who suffered as a consequence of lack of awareness. I am pleased that the GMC has recognised our contributions to maintenance of the health of the nation and is taking steps to help us do our job better.

  2. Improvements to healthcare in the UK happen only by addressing the discrimination against the Non-UK trained doctors.
    What we expect from the GMC is to acknowledge this fact. Till date, the NHS, Deaneries and the GMC have denied this. But any one from this group will give many examples of discrimination suffered by people they know.
    This discrimination not just affects the Non-UK trained, but also the disabled doctors and the UK-trained but minority doctors.
    The first place to start is the leaderships of the organisations, most of which lack diversity. One gets a sense of disillusionment when the whole managerial board is filled with Public schooled, middle class, middle aged white men.
    It is difficult to address these issues unless the GMC starts active campaign to root out the discriminatory practices in the NHS.
    First step is,probably to collect data from all the doctors about their experiences, along the lines of the trainee surveys.
    We would like the GMC to take active lead, rather than being utilised by the senior management in persecuting the non-UK doctors.

  3. First of all I want to thank Mr Niall Dickson Senior leader of NHS acknowledging tremendous contribution made by non-UK trained doctors. Without the tremendous contribution of these doctors NHS would not have been what it is today. Each year 365 million patients are seen by 1.2 Million staff working in the NHS and most of them get good quality and safe care. Both UK and NHS owes lot of gratitude to all staff including non-UK trained doctors for all their hard work and providing excellent care to so many patients.

    However, it is equally important to remember that each year 20,000 patients die and nearly 55,000 patients suffer more than six months or permanently harmed due to medical errors. Most errors are not simply about bad doctors or doctors who don’t care. It is due to systems and process in which doctors work which makes them make these errors. Shortage of doctors in many specialities, difficulty in recruiting, lack of beds, lack of adequate resource, use of locum doctors who do not know the hospital systems, policies and procedures, lack of support for doctors, poor induction, poor support, bullying, harassment, victimisation, racism, sexism and so on are sad reality of our NHS which many staff face and sadly non-UK trained doctors face day-in and day-out.

    Most decision makers, GMC fitness to panel members, GMC experts, Medical Directors, HR Directors and CEOs are usually ‘White men’ and their subconscious/unconscious bias plays huge role in the way they make decisions. GMC has never looked at the impact of this on decision making process, patient safety and staff well-being.

    GMC investigates many good doctors and also takes long time to complete the investigation which also makes many good doctors lives a misery and many of these doctors are harmed, damaged and demoralised.

    At the end of the day none of us want to compromise patient safety and quality, Every patient deserves the best care. This must be the guiding principles of professional regulation. Equally any regulation must be fair and proportionate. So it is important to recruit good doctors and to support them but it is equally important for the GMC and other regulators to make their own system fair and fit for the purpose.

  4. Pingback: Understanding the profession – why we’re collecting new diversity data | General Medical Council·

  5. Pingback: The PLAB test is changing: your queries answered | General Medical Council·

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