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Three in four EU doctors get no GP quality tests

By Gareth Iacobucci

Exclusive: Fewer than a quarter of EU doctors from outside the UK registered to work in this country as GPs have been tested for their language skills and clinical competence, Pulse can reveal.

PCT records show hundreds of foreign doctors are included on primary-care performers lists without having been formerly checked, exposing a shocking lack of action in the wake of the Daniel Ubani case.

Our findings from an investigation into more than 100 PCTs have raised alarm at the GMC, which wrote to all trusts in England seven months ago, urging them to carry out tougher checks on EU doctors.

The move followed the unlawful killing of 70-year-old patient David Gray, who was given an overdose of diamorphine by German locum Dr Ubani on his first GP out-of-hours shift in the UK.

Both the GMC and BMA have called for urgent reform of EU law that prevents the GMC from assessing the clinical competence and language skills of foreign doctors from the EU, as it does for those from outside Europe.

Pulse's investigation – based on data from 35 PCTs responding to Freedom of Information Act requests – found just 23% of EU doctors on performers lists had undergone language tests, and just 17% had undergone tests of their clinical competency.

But the true scale of the problem could be even greater – the remaining 74 of 108 responding trusts admitted they did not collate data on whether doctors had been checked. This suggests up to 1,500 untested doctors could be working as GPs across England.

Many trusts that provided data said some doctors had not been checked because the requirement had only been introduced this year or was only being applied to new applicants.

Remarkably, these included NHS Cambridgeshire, the trust in which Mr Gray was killed, which has 29 non-UK EU doctors on its performers list, but has only tested 10.

Dr Christine Macleod, Medical Director at NHS Cambridgeshire said the trust 'has completed language tests on European doctors applying to the performers list in Cambridgeshire since 2004'.

Ms Macleod added: 'Doctors that were already on the performers list from European countries would not previously have required a language test, but are monitored (as are all doctors) for any performance issues involving communication skills. However some of these foreign graduates, already on the performers list, had trained vocationally in the UK. The European legislation does not refer to retrospective testing of language, unless there is a performance issue.'

Elsewhere, NHS Derbyshire County said it had not tested the 11 EU doctors on its list, but relied on testimonies from employing providers. NHS Brent said ‘testing for clinical competence is not part of PCTs' remit'.

Niall Dickson, chief executive of the GMC, criticised trusts for ignoring its calls to test EU doctors: ‘Both the Government and the GMC have reminded PCTs of their responsibility to ensure doctors they employ, or contract with, are fit for purpose. This includes making sure they can communicate effectively.'

Dr Stuart Gray, a GP in Kidderminster, whose father was killed by Dr Ubani, said: ‘I'm horrified. Lessons haven't been learned, changes haven't been made. What more does it take? It's only a matter of time before there's another death.'

Professor Steve Field, RCGP chair and co-author of a recent Government-commissioned report into out-of-hours care, said: ‘We've given PCTs a wake-up call and it's disgraceful they still aren't taking the issue seriously. The performers list simply hasn't worked in providing safety for patients.'

A DH spokesperson said: ‘PCTs and employers have a legal duty to satisfy themselves that doctors on performers lists are fit to provide the services for which they are being employed. They can and should verify language knowledge.

‘However, if a PCT is satisfied, on the basis of documentation or an interview, there is no requirement to ask a doctor to sit a language test.'

Dr Stuart Gray, whose father was unlawfully killed by a German locum, is horrified by Pulse's findings Dr Stuart Gray, whose father was unlawfully killed by a German locum, is horrified by Pulse's findings Professor Steve Field Professor Steve Field

The performers list simply hasn't worked in providing safety for patients

EU doctors

• Currently, the GMC has to treat qualifications held by EU nationals in the same way as UK qualifications. The council cannot assess the knowledge and skills of incoming EU doctors who hold recognised qualifications.
• But following the Ubani case, the GMC wrote to PCTs reminding them of their responsibility to ensure the gaping hole in our registration system'is closed to unsafe doctors.
• The DH also issued interim guidance to PCTs in February, urging them to satisfy themselves that EU doctors were linguistically and clinically competent before admitting them to their performers lists.
• Both the GMC and BMA are continuing to push for changes to European law that would allow foreign doctors from the EU to be tested in the same way as those from outside the EU.

Interview: Professor Steve Field

Map of checks on EU doctors

To view an interactive map showing how PCTs across England are faring in testing EU doctors, please click here.