NHS insider: We should train British doctors instead of importing doctors from abroad
A top surgeon lifts the lid on what's really going on inside the NHS
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The following guest piece is written by J Meirion Thomas, a retired cancer surgeon.
Some information, when it’s finally revealed, is so unexpectedly shocking that one is left wondering why it was ever concealed in a supposedly democratic country.
The answer is simple. When it comes to some issues in our society, the elite class that is in charge does not want us to know the truth.
Take the National Health Service (NHS), for example, where I spent decades working as a cancer surgeon.
For decades now, it’s been obvious to everybody with half a brain that Britain does not have enough medical school places to train the doctors we desperately need to meet the growing demands of our already collapsing health service.
The Blob, the elite class, have always understood this.
But instead of training larger numbers of our own doctors here in Britain, instead of encouraging and supporting more young British people to enter medical school and benefit from world class training, the people who govern our country did what they always do. They decided it was cheaper and easier to import people from abroad.
Here are just a few astonishing numbers you really need to know. Why? Because they reflect what a total shambles the system has become.
Last year, in 2024, the General Medical Council registered 9,285 doctors who had been trained here in the UK and … get this … 19,279 doctors who trained abroad.
Of the latter, 2,366 qualified in Europe while 16,913 are what’s called ‘International Medical Graduates (IMGs)’, recruited from low-income countries such as India, Pakistan, Egypt and Nigeria.
In fact, if you want to take an even longer-term view then over the last five years some two-thirds of all doctors who registered with the General Medical Council —66% of them—were trained abroad, outside of the UK.
It’s truly shocking, isn’t it?
Why, you might ask, are we relying so heavily on people trained overseas while refusing to train and support young Brits to become doctors?
Well, we know why —money.
As in many other areas of our national life, the ruling class has gone for the easy option, deciding it’s cheaper to import people from overseas.
But that’s not where the scandal ends —far from it.
Let me now also tell you something else that very few other people in the health service will be willing to say, even if many will agree with me in private.
Many of the foreign doctors we are now relying on and importing into the NHS have no experience of British culture or of the National Health Service, raising serious concerns about what is happening and will continue to happen in the years ahead.
There’s already convincing evidence, for example, published in the British Medical Journal, that the examination taken by International Medical Graduates to achieve registration with the General Medical Council is too lenient.
The research suggests that the pass mark for non-UK trained doctors needs to be increased significantly in order for successful candidates to reach equivalence of knowledge and skills with their British graduate counterparts.
This tallies with data published by the General Medical Council, which confirms that doctors trained overseas are three times more likely than their British counterparts to be referred back to the General Medical Council on fitness-to-practice grounds.
The GMC’s solution is to issue new guidance to employers to raise the threshold for referral, thus disguising this incompetence. This amounts to disgraceful practice by the GMC given that one of their central roles, apparently, is to protect patients.
It would be a massive disservice for me to malign all foreign doctors and to tarnish the reputation of those who are just as competent as their British counterparts.
Nevertheless, unlike the United States, Canada and Australia, the simple fact of the matter is that the UK does not have an entrance exam that can discriminate and eliminate those candidates who should not be allowed to practice here.
Meanwhile, every year, thousands of UK-trained doctors who are already registered with the GMC move abroad or leave the profession for pastures new —often moving sideways into finance and the City of London.
So, what I’m describing here is a recipe for disaster.
Nobody in positions of responsibility seem to care so long as there are enough people to fill slots on already-stretched hospital and GP rotas.
Nobody seems to care anymore about the erosion of skill and leadership in the NHS, including its failure to train and support more British students to become doctors.
Poaching doctors from low-income countries, furthermore, also raises serious ethical issues which do not seem to bother our politicians or the General Medical Council.
The UK, for example, is a signatory of the World Health Organisation’s Code of Practice on international recruitment of health workers.
This states that “member states should discourage active recruitment of health professionals from developing countries facing critical shortages of health workers”.
On this basis, the UK is in breach of this convention yet in pursuit of national or personal self-interest, no-one in authority seems to care.
Neither do foreign graduates themselves, who choose to abandon their own people, knowing perfectly well that healthcare in their native country is of an appallingly low standard and where their skills are desperately needed.
Let me ask, does that action chime with compassion and duty of care, which are important personal attributes needed to practice medicine?
Some International Medical Graduates are coming to the UK for postgraduate study, which is a worthy reason, especially if they plan to return home with greater skills.
But GMC data confirm that 70% of IMGs are between 30-49 years of age and are too old to start training in a major hospital speciality. This suggests, in other words, that professional advancement was not the primary reason why they chose to migrate to UK. A better lifestyle, economic security and other reasons are a bigger magnet.
What I’m describing here is not an accident, far from it.
It’s the direct consequence of hapless British politicians putting a cap on medical school places for British students for decades.
During this time, tens of thousands of able and enthusiastic British students with the required A-level grades and aptitude failed to gain entry to medical school.
This is a national disgrace and a bitter blow for all those British students and their parents, who wanted to help their own people and communities but were rejected at least in part because the elite class preferred to import cheaper foreigners.
And then these British students and their families have to watch as thousands of foreign graduates, often less well trained than their British counterparts, flood into the UK to take up the medical jobs those British young people yearn to do.
How is this fair or right?
It’s not as if the UK does not have enough students who want to become doctors. The opposite is true. Why then are there no voices raised in objection?
There can be no parliamentary constituencies in this country without students who have been refused entry to medical school. Why don’t those students, their parents and even schools petition their MPs for change, using this article as evidence?
The moral and ethical case for a major correction has clearly been established. What’s needed now is ongoing, cumulative pressure so this issue can generate the attention it deserves and the British people can get another much needed change of policy.
An excellent article thank you. Some points.
1. Reform need to shine the spotlight on this and start a wider conversation with the public. Make it part of their NHS policy.
2. Others have said it cost c£250k to train a doctor. Whatever the cost is, we should insist that they stay in the UK to work for the NHS for at least 5 years post-qualification or else part of this sum should be repaid.
3. There must be entry examinations for doctors from countries where their qualifications are not an equivalent standard to ours. We already do this with Chartered Accountants for example so there’s precedent.
4. We need to quadruple the number of medical students training to become doctors at the expense of the many waste of time degrees that Blair encouraged during his destruction of the country.
It’s articles like this that really help us see what’s going wrong and how to fix it.
What an excellent yet thoroughly depressing summary of the utter incompetence of our politicians to recognise and act on what is blindingly obvious regarding the challenges faced by the NHS. As my wife and I approach our 80s we are increasingly obliged to enter the clutches of this dreadful organisation and although we do encounter excellent people working hard and supplying good care we also see the other side of the coin which is depressingly more prevalent where incompetence, crippling bureaucracy, bad staff attitudes and sheer lack of professionalism are the norm.