NEWS FOCUS: Doctors, dentists and nurses are living in poverty in the UK.They are the refugees and asylum seekers who, a year ago, were promised a welcome by the hard-pressed NHS.But as Daloni Carlisle reports, little seems to have happened since then

It was a year ago that the then health minister, John Denham, launched the report of the working group on refugee doctors and dentists. As many as 2,000 medically qualified refugees could find roles in the NHS to ease staff shortages, he said.

Twelve months on, refugees and asylum seekers are once again in the news as home secretary David Blunkett reviews the system for processing asylum applications and considers extending work permits to more new arrivals.

So where are these refugee doctors now? Still very much trapped in the system, it appears.No figures are available on the number that have gained their UK registration.

Mr Denham told the House of Commons in March: 'We do not know at the moment how many refugee doctors are in the UK'. But a snapshot of the current state of affairs suggests that progress is slow to use the resource.And offers of help to professionals needing support are thin on the ground.

The Northern, South Trent and North Western postgraduate medical deaneries have been supporting refugee doctors for two years. Between them they have just one success story.

In London, Redbridge and Waltham Forest health authority set up a programme in 1997 that has won an NHS equality award. It had helped 10 doctors gain their English language qualifications and four pass their clinical exams.

Hardly a flood - and this slow progress has left refugee doctors frustrated and angry. Alan Rich, associate postgraduate dean at the Northern Deanery, says: 'To some extent, [the report] has given refugees more of a lever to ask why services are not being provided.

Unfortunately, it also engendered a belief that because there is a report, there is some money for these recommendations.

'Some of them have read it and tried to exercise what is seen as good practice. They have been met with the response that we would like to do it but we have no money. It has raised expectations among refugees unduly.'

In fact, money was allocated to the report's implementation. The Department of Health put aside£500,000, later extending the fund's scope to include nurses, midwives and allied health professionals.

A first step was to establish a database. Deng Yai, employment training adviser at the Refugee Council, says: 'We have set up a voluntary database with the British Medical Association and we hope to register all refugee doctors.We hope to know exactly how many refugee doctors are here, where they are, what skills they have and what support they need to practise in the UK.' So far, there are about 400 doctors registered.

The DoH has also funded an information pack, produced by the Jewish Council for Racial Equality, and a training centre run by a GP in north London.

But most of the money remains unallocated - much to the frustration of those involved. An advertisement inviting bids was placed in the nursing and medical press in October 2001 and a meeting to consider them was scheduled for early November - a full year after the report's publication.

While the organisations bidding for funds are wary of being too critical in public, the frustration is evident as HAs, trusts and deaneries wait to hear whether they have funding.

For example, the Northern Deanery's support project is in limbo while a bid for a full-time administrator is considered.

If doctors are frustrated then so, too, are the other health professionals. Nurses and midwives can only look on in envy at what has been achieved in medicine.While a working group on nurses, midwives and allied health professions has been set up, it has yet to meet.

Dee Borley, director of NHS Nurse Line and the Royal College of Nursing representative on this group, says: 'The overseas doctors sub-group, which did the report on refugee doctors and dentists, was well supported and well funded and launched with great pomp and circumstance. We came away thinking this has to be something for nursing too.'

Nevertheless, a number of successful nursing projects are up and running, and in terms of sheer numbers now working in the NHS, they are outstripping medicine.

For example in London, community organisation Praxis has set up a joint programme with three trusts (Barts and the London trust, Tower Hamlets primary care trust and Newham Healthcare trust) to work with City University and the North East London NHS workforce confederation.

Funding comes from the East London health action zone. Over 40 nurses have completed the course and 12 are in jobs.Most of the rest are on their way to getting NHS employment.

Kath Evans, lead on recruitment and retention for the workforce confederation, says: 'We want to offer [refugees] jobs and the support to get into jobs. We are incredibly keen to support these local initiatives.That is what we are about. Local jobs for local people.'

It is easy to be critical of slow progress. Sallie Nicholas, head of the BMA's international department, says she is not surprised as the number of organisations involved in getting this disparate group of doctors into practice is bewildering.'It is like a giant jigsaw, ' she says. 'I would say the pieces are beginning to fall into place.'

The Refugee Council is also encouraged by progress to date.

Mr Yai says: 'Hopefully the situation is going to improve. I think sufficient attention is being paid to this now.

'The resources are being made available and we are optimistic that this effort is going to make the difference. If more refugee doctors are supported they will contribute to achieving the NHS objectives.'

To those doctors struggling through the system, this will be precious little comfort. Davinder Sandhu, associate postgraduate dean for South Trent region, speaks on their behalf.

'There are lots of doctors in the UK who are living in poverty. It is difficult for them to get out of that situation.

They want to work, and if we can get them into jobs it would save our taxes and help them to help others. These are the aspects we need to highlight.' l