Supplementary written evidence submitted by Meirion Thomas (RTR0142)

Recruiting an ever-increasing number of doctors from low-income countries to plug manpower gaps in the NHS is unethical. These doctors are needed in their own countries to maintain essential services. Based on WHO recommendations of doctor-to-patient ratios, India has a shortage of about 600,000 doctors and Pakistan 200,000 doctors. 

Guidance is enshrined in the WHO Code of Practice (1) which states that “member states should discourage active recruitment of health professionals from developing countries facing critical shortages of health workers”. A similar NHS code of practice listing 47 countries, was published by NHS Employers (2).

This guidance has been ignored. In 2018, 53 percent of new doctors registering with the GMC had been trained abroad. In 2019, this trend increased to 60 percent – we trained 7,343 doctors and imported 10,966. 

   Of these 10,966 doctors, 2,461 came from the European Economic Area (EEA), and were then able to register directly with the GMC. Few came from affluent Western European countries. The other 8,505 were International Medical Graduates (IMGs) from outside the EEA, who had passed the GMC’s Professional and Linguistic  Assessment Board examination (PLAB).

In 2021, the GMC registered 12,600 foreign graduates accounting for 63% of the total.  Between 2016 and 2021, the percentage of UK graduates has increased by 2.7%; of EEA graduates by 20% and of IMGs by 197%. This unpublished data was provided to me by the GMC and is truly astonishing.

Meanwhile, thousands of eligible students have failed to gain places in UK medical schools because the number training places is controlled by cost.

 There is convincing evidence that PLAB is too easy. The exam is pitched at the level of skill a British doctor would reach within a year of graduation, at about 25 years of age.  GMC data confirms that 70% of PLAB graduates are aged between 30 – 49 years of age. (3) Most of these would be too old to train in major hospital specialities.   

Two articles from UK departments of medical education in 2014 concluded that the pass mark of PLAB needed to be raised significantly to reduce the difference in performance observed between IMGs and UK graduates. (4,5). That has not happened.   

 Increasing the pass mark would inevitably reduce the pass rate which would have implications for workforce-planning in the NHS.

 The five new medical schools announced in 2018, will only produce an extra 1,500 graduates per year, the first in 2023. 

  In August 2019, the GMC industrialised its PLAB facility in Manchester by doubling the examining capacity to 11,000 candidates per year.  Furthermore, the GMC encourages recruitment from abroad, by arranging PLAB1 exams in 24 centers in 15 countries outside the UK. Places and times are available on their website.

This moral and ethical dilemma must be addressed. We must train more British doctors as a matter of urgency. Recruitment from abroad on this scale is not in the best interests of the NHS nor the donor countries.

  REFERENCES.

1. WHO global code of practice on international recruitment of health personnel. 2010.  https://www.who.int>hrh>resourses
2. Developing countries recruitment. NHS Employers. 2018. https://nhsemployers.org
3. GMC annual report. 2018; Page 16: Fig 5
4. McManus I. C. et al. PLAB and UK graduate’s performance on MRCP(UK) and MRCGP examinations. British Medical Journal 2014; 348: g2621
5. Tiffin P. A. et al. Annual review competence progression performance of doctors who passed PLAB compared to UK graduates. British Medical Journal 2014; 348: g2622

Hi Mr Thomas

I’m very sorry for the delay getting the requested data over to you.

As I mentioned in my previous email, when collating the updated figures for 2020 and 2021 we noticed a discrepancy in the UK figures. This was down to a reporting systems issue which we have addressed. In doing so, we identified some minor changes to the information that was provided previously so for consistency we have included a full update of figures from 2016 to 2021. Just to note there are also some small changes due to administrative processes.

March 2022