Do you have trouble understanding your doctor’s English? No?
Well, apparently some people do. According to Nigel Farage, GPs who “don’t speak very good English” are “something that people out there are talking about”. The Ukip leader told Sky News that non-English-speaking health workers shouldn’t be employed, and said it’s “scandalous that we are not training enough nurses and doctors in our own country”. We fact-checked this. Here’s what we learned.
Are there really doctors in the UK who don’t speak very good English?
To put it bluntly, no, says Dr Chandra Kanneganti, chair of the British International Doctors Association (BIDA). All doctors who qualified outside Europe and apply for registration to work here have to satisfy the General Medical Council (GMC) – the independent regulator of the UK’s 267,000 doctors – that their English is up to scratch.
This means passing the “academic version” of the globally recognised International English Language Testing System (IELTS) test in speaking, listening, reading and writing. Accents can sometimes be hard to understand, says the deputy chair of the British Medical Association, Kailash Chand, but he argues that’s a problem within the UK, too. “Sometimes you can’t understand what a Scottish person is saying, sometimes you have problems understanding a heavy Liverpudlian accent. [Language] is a non-issue. Farage doesn’t have a leg to stand on.”
European-trained doctors don’t have to take the IELTS test, but last summer the law was changed to give the GMC the power to check their language skills if a serious concern is raised about their ability to communicate effectively with patients and colleagues. The GMC also increased the overall score needed in the IELTS test from 7 to 7.5 points out of 9.
What level of English do you need to get that 7.5 score?
“It’s not a simple exam,” says Kanneganti. “You have to have a good command of English.” Elements include a vocab test and listening to a conversation in English, then answering questions about it. “The most important thing people need to realise is that doctors trained in the Indian subcontinent follow the British system of education in medical school,” he says. “And, more importantly, the medium of education is English – particularly British English.”
How many foreign doctors are there, and where do they come from?
In December, some 97,910 doctors registered with the GMC received their primary medical qualification outside UK organisations – 37% of the total. Among the foreign doctors, 29,010 had qualified in European countries. The top five overseas suppliers of doctors to the UK are India (25,005 doctors), Pakistan (9,770), South Africa (5,282), Nigeria (4,169) and Ireland (4,046). Around 1,300 foreign doctors a year pass the IELTS exam and the Professional and Linguistic Assessment Board, or PLAB, which is required for them to practise in the UK.
Do they perform less well than British-trained doctors?
Debatable. Last year, experts from University College London and Cambridge highlighted what they called a “performance gap” between overseas-trained doctors and those who had attended British medical schools, and suggested that the pass mark for the PLAB exam should be raised from 63% to 76%.
The researchers found that those who’d trained overseas did much less well in entrance exams for professional bodies like the royal colleges of physicians and GPs, and that their subsequent career progression was not as good. The British Association of Physicians of Indian Origin (BAPIO) said it was disturbed by the “grossly misleading assumptions proffered as conclusions” and said fair comparisons could only be made using a common test.
In September, the GMC said the PLAB test should be made more robust, with a broader assessment of ethical values and a cap on how often candidates are permitted to retake it. In 2012, GMC figures showed that over the past five years, 63% of the 669 doctors who were struck off or suspended had been trained overseas, despite making up a much smaller percentage of the total number of doctors.
Do those figures relate to a language barrier?
Absolutely not, according to Chand, because the checks are in place to ensure doctors have good English. The study, he says, doesn’t take into account factors like the stress of immigration and interruption to doctors’ careers. “It’s a very complex issue,” he says. “It’s not to do with English. It’s to do with so many other things: attitudes, culture, immigrants coming to another country, their mental health.
By and large, their clinical competence is of a very high quality.” Kanneganti says of the GMC figures: “People complain about overseas doctors not because they make more mistakes than others, but because there are inherent doubts in the minds of the general public about their competencies, and a tendency to assume that their training may be inferior to that of British-trained doctors.” It’s not racism at play, he thinks, but subconscious bias. “It is also a fact that a greater proportion of overseas doctors work in more emergency, acute services where there are higher chances of things to go wrong,” he adds.
Why are there so many foreign doctors in the NHS?
Actually, this is by no means a new phenomenon. Doctors, nurses and other health workers have been recruited from overseas since the 1930s, and with the birth of the NHS in 1948 they were needed in even greater numbers, explains Stephanie Snow, a senior research associate in NHS history at the University of Manchester.
Attracting foreign-trained staff was the only way of keeping up with the increased provision and advances in medical technology; between 1949 and 1958 alone, the medical workforce in England increased by 30%, and by 50% in Scotland. By 1960, between 30% and 40% of all NHS junior doctors were from India, Pakistan, Bangladesh and Sri Lanka, and the following year Lord Cohen of Birkenhead told the House of Lords that, without them, the health service would have collapsed.
Today, the ever-growing elderly population, combined with even more rapidly expanding technologies, continues to create additional need. Given that it takes five years to train a doctor in the UK, cutting overseas doctors from the equation is simply not an option. “The history of foreign-trained doctors and UK health services suggests that it would be most effective for policy to focus on providing better support for these doctors in terms of acculturation and mentoring, given that the UK has been dependent on their skills for decades,” says Snow.
Is it so bad that we don’t rely on homegrown doctors?
To Farage’s mind, it’s a scandal; to others, the contribution of those who’ve come from overseas and prop up our system – often working in less popular specialisms such as general practice, psychiatry and geriatrics – deserves a little more respect. “In Stoke-on-Trent, where I’m from, 58% of GPs qualified outside the EU,” says Kanneganti. They are popular with patients too: in 2005, a study found that British patients’ favourite doctors were young, female and Asian.
It costs £150,000 to £200,000 to train a GP in Britain, and even then there’s no guarantee they won’t emigrate to a country like Canada or Australia, Kanneganti points out. Overseas doctors arrive ready-trained, and keen to stay. “Farage should stop talking politics and realise the immense contribution of immigrant doctors,” he says.