Wednesday, 4 July 2007

Who are you?

Gordon Brown has today announced, in the context of recent security alerts, a review of the vetting procedure for NHS staff from overseas.

I will therefore tell you a cautionary tale.

However I will preface my story by saying that for the past 50 years the NHS has be sustained by doctors trained overseas. These doctors have in many cases filled posts in unfashionable parts of the country, or in less popular specialties; they have been disproportionately represented for example in inner-city general practice, in psychiatry an in geriatric medicine. Many of my colleagues in Bedford trained overseas; they are excellent committed doctors and many are personal friends, and they are as horrified as everyone else by recent events.

Until a few years ago, most overseas doctors came to the UK from a very small number of countries, and within those countries they came from a very small number of medical schools.
At Bedford, one department had a regular flow of juniors from one medical school in India; we knew exactly what training they had had there, and they were without exception just the sort of doctors, and just the sort of people, that we needed.

In the past five years or so, the geographical spread of medical graduates has expanded remarkably; anyone who has had to look through CVs presented by intending candidates for junior medical posts will need an atlas to identify where they are coming from, and it has been almost impossible to evaluate what their medical experience equated to.

When this trend first became apparent to me I telephoned the General Medical Council, the body which by statute regulates whether foreign medical graduates can get on to the Medical Register, and thereby practice medicine in the UK, to ask for clarification.

"Suppose", I asked, presenting an entirely hypothetical scenario "someone came to them from, say Outer Mongolia, and presented himself as a graduate of the Ulan Bator Medical College - if there is such a place- and provided certificates showing that he had passed his exams with a first class degree, that he had won the gold medal for neurology, and first prize in orthopoedics, how would they actually know that the certificates were genuine rather than something that he had created on his home computer?"

"Did they" I asked, naively" keep a selection of genuine certificates to compare?"

The answer I was given, was that they did not.

The regulatory authorities for nursing in the UK have in the past unmasked a number of individuals who have claimed overseas nursing qualifications which have turned out to be entirely bogus. Yet remarkably, the GMC, the guardians of medical standards in the UK, appear to have to have a system of regulation that is as watertight as a sieve.

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