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.
Responsibility 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.