Genre: Information/Explanation

Foreign doctors are more likely to receive serious rulings on fitness to practise Authors: Helen Jaques Publication date: 08 Apr 2011 Doctors who trained outside the United Kingdom are more likely to receive serious rulings at all levels of the General Medical Council's fitness to practise procedure than are UK trained doctors, concludes research published in the BMJ (2011;342:d1817, doi: 10.1136/bmj.d1817 ). The retrospective study commissioned by the GMC found that doctors who qualified in the European Union or further afield were more likely to be referred for investigation at the initial triage of their fitness to practise case, to be sent for adjudication after assessment at the investigation stage, and to be erased or suspended from the medical register if their case went to a hearing. The authors say that this disparity may be due to real differences between UK and international medical graduates in fitness to practise or because GMC processes may discriminate against certain groups of doctors. However, they emphasise that their research makes it "difficult to reach a conclusion that clearly supports either of these potential explanations, and both might be valid." "Patients all over the UK rely on doctors who qualified overseas," said Niall Dickson, chief executive of the GMC. "They make an invaluable contribution to healthcare in this country, and we need to know if there are factors that either lead to the poor performance of a small minority or if there is any unfairness in how they are treated." Pointing to a 2007 audit of GMC procedures that found that its decisions were sound, consistent, and appropriate, he added, "We do not believe there is any firm evidence that our procedures unfairly discriminate against doctors from overseas, and we are committed to ensuring that our processes are fair to everyone." The authors of the new study analysed 7526 GMC inquiries into 6954 doctors between April 2006 and 31 March 2008, 4702 of which concerned doctors who qualified in the UK, 624 concerned doctors who qualified elsewhere in the EU, and 2190 concerned doctors who qualified outside the EU (in 10 cases data were missing). At the initial triage stage, doctors who qualified outside the UK were around 60% more likely to be referred for investigation than those who trained in the UK. Those who trained elsewhere in the EU were then twice as likely as those trained in the UK to be referred for adjudication at the investigation stage, whereas those who trained outside the EU were 68% more likely to be referred. At the adjudication stage, erasure or suspension was more frequent for inquiries involving non-UK qualified doctors, with those who trained in the EU in particular being more than twice as likely to be struck off as UK graduates. Those who qualified outside the EU were about 50% more likely than UK graduates to be struck off. The researchers also found that the nature of the complaint against the doctor was a strong predictor of the outcome, which, they say, provides some reassurance that the process is working as intended. The differences found in the study may have arisen because patients are more likely to complain about doctors who qualified outside the UK, suggests editorialist Marcella Nunez-Smith ( BMJ 2011;342:d1641 doi: 10.1136/bmj.d1641 ), assistant professor of medicine at Yale University School of Medicine. This possible explanation is backed by the study's finding that disproportionately more of the complaints about non-UK qualified doctors came from the public than from other sources, such as the police and employers. The GMC plans to commission a new independent audit next year into the decisions made during its investigations to ensure that they are made in accordance with the council's guidance and continue to be consistent and fair.