One might naively think from reading this thread that indeed our NHS is " awash with foreign shysters " .


• Of the quarter million doctors registered with the GMC to work in the UK, about 2/3 qualified in the UK ; followed by India ( 1/10 ) ; then Pakistan, South Africa, and Nigeria. Around 1/1000 trained in the UK are struck off ; 1/250 of those trained in India, and 1/350 Pakistan.


• Most doctors do a good job, and it does morale no good to read constant criticism .


• Some might think more than 1/3000 doctors should be struck off – but how many is acceptable, given the cost and time of training ? ALL doctors are now " revalidated " – annual appraisal to ensure, as far as possible, they’re competent and fit to practice.


• Some would wish the NHS to have only UK medical graduates. There are enough applicants from our medical schools. But the UK is multicultural, and foreign graduates fill essential posts, including locums, often in undesirable areas, that our graduates don’t want ( and can’t be forced ) to take on. Some foreign graduates also have top medical and surgical jobs in the NHS and our universities. The UK can’t afford to do without the third of its doctors who are foreign ( 1/5 GPs ; 2/5 hospital doctors ) any time soon.


• In the Philippines if you can’t afford to live healthily and have treatment when needed, the consequences are serious. At least in the UK treatment is available to all, even if standards are not uniformly high ( and in places unacceptably low ).



• Should it be the GMC in the dock ? They set standards for undergraduate and postgraduate medical training and they should call doctors to account / protect patients from avoidable harm. We do recognise they have their faults, tending to delay difficult cases for too long.


• GMC requires " acceptable overseas qualifications " which meet standards as close to our own as possible ( http://www.gmc-uk.org/doctors/regist...lification.asp ). It has powers to check English language skills in international and ( now ) European medical graduates. Local appointment committees MUST scrutinise references in addition to checking qualifications and communication skills.


• The governing body of the GMC ( Council ) has 12 members, of which only half are doctors and half are " lay " ( non medical ) members.

Hearings for doctors whose fitness to practise are called into question are run by the Medical Practitioners Tribunal Service ( MPTS ). The standards are set by the GMC, but the MPTS makes independent decisions, and has the powers to impose sanctions. Not only are most of the hearings held in public, but the panels are made up of a mix of doctors and non-medical people. They are appointed through open competition. Vacancies are advertised on their site (http://www.mpts-uk.org/ ).



• I am not qualified to make judgements on all doctors whose practise falls seriously short of the standards expected of them. Some activities are self-evidently wrong ! But ALL doctors make mistakes. Others in the same specialty are best placed to judge whether the number of mistakes are compatible with their extent of training and responsibility. Should a surgeon be struck off because one patient died during an appendix operation ; or a pathologist likewise because a cancer was missed on biopsy ? Who would then attempt to do their work ?



• These judgements cannot be made by one person alone – hence the balance of doctors and non-medics on the MPTS and GMC. One way to effect improvements is to be on the right committees, including patient representative and clinical commissioning groups.


Thankfully I’m not in the dock, and try to answer members’ questions, as well as picking topics which may be of interest to members from Philippines and UK .