Professor Sir Magdi Yacoub is spearheading the latest drive to tempt overseas-trained doctors into the NHS. But many have doubts about whether the scheme will work. Daloni Carlisle reports

Published: 21/03/2002, Volume II2, No. 5797 Page 16

The opportunity to live and work in the UK on a salary starting at£52,640 with relocation expenses, accommodation and a pension worth 12 per cent of the pay packet thrown in. . .Who could turn it down?

This is the package on offer to senior overseas doctors to tempt them to join the NHS on two-year international fellowships. The Department of Health has appointed world-renowned heart surgeon Professor Sir Magdi Yacoub to sell it.

The international fellowship scheme for the NHS, launched last week, aims to attract 450 top specialists from abroad over the next three years. A pilot scheme starting in March will look for 50 fellows to work at consultant level in the NHS in cardiology, histopathology, medical imaging and psychiatry.

The aims of the scheme are wrapped up in worthy terms - to act as a showcase for British medicine and enhance the reputation of the NHS abroad, for example, or to foster international co-operation and shared learning. Fellows will take part in research and teaching.

But at the bottom line it is actually about helping the NHS meet modernisation and expansion targets. The government has promised an extra 7,500 consultants by 2004, and the British Medical Association estimates, it will fall short by at least 1,000 without recruitment from abroad.

Prime minister Tony Blair did not attempt to dress up the scheme as anything other than a short-term recruitment drive.

'Fellowship doctors will work alongside their British counterparts and help ensure the health service can expand and modernise as rapidly as possible, ' he said.

It has the backing of the medical royal colleges and the BMA's joint consultants committee - though with provisos. The Royal College of Psychiatrists called for a costed induction programme, while the BMA said the scheme should be accompanied by initiatives aimed at retaining consultants in the UK and offering more training opportunities.

But not everyone is pleased.

Shadow health secretary Dr Liam Fox said the NHS didn't need more consultants but more intensive-care beds and specialist nurses to staff them. 'It is typical of this government to launch yet another high-profile initiative rather than deal with the real problems facing the NHS, ' he said.

Liberal Democrat health spokesman Dr Evan Harris highlighted the plight of qualified doctors from overseas already working in the UK, who have been unable to access the training posts to qualify as consultants. Last December he sent his evidence to the Commission for Racial Equality, where the fellowship scheme also set alarm bells ringing.

'We need to know more about how it will work and ensure that long-standing inequality experienced by many doctors already working in Britain is not ignored or made worse, ' said a CRE spokeswoman.

It is a point well taken by Bolton GP Dr Krishna Korlipara, an elected General Medical Council member who sits on the overseas doctors registration committee.

'There is a huge bottleneck of doctors waiting to get onto the training ladder but they are shunted sideways and not allowed to get their accreditation from the royal colleges, ' he says.

He also feels uneasy about some of the overseas doctors attracted to the NHS through international recruitment drives. 'Many are being appointed as trust-grade doctors, ' he said. 'They are not consultants and never will be because they are not in training posts. I always understood that the people who came here on limited registration were coming for training. In fact, they are being used as extra pairs of hands.'

Not only is this a form of exploitation, he says, but potentially dangerous. 'With the lack of supervision and training, I personally feel there is a tragedy waiting to happen.'

There is also the question of whether overseas consultants will want to work in the NHS. The DoH says yes, pointing to the interest generated by its overseas recruitment drive last September.

Over 2,500 doctors expressed an interest and 600 applied.

This is where Sir Magdi will come into his own in his role as special envoy - at least in recruiting cardiac surgeons. He has said that he knows almost every heart surgeon in the world, and many want to come and work in the UK.

In line with existing policy on international recruitment, he will target only developed countries - Australia, Canada, the US, Denmark, Finland, Germany, Greece, Ireland, the Netherlands, New Zealand, Sweden and Switzerland. But even in these countries, there is concern.

New Zealand Medical Association chair Dr John Adams, for example, says his country faces its own shortage: 'We rely more and more on overseas-trained doctors, who now comprise 34.5 per cent of our medical workforce.We would prefer to retain more of our locally trained doctors, who have an understanding of New Zealand cultural issues.'

NHS International Fellowship Scheme www. doh. gov. uk/internationalrecruitment/intfellowships. htm Guidance on International Recruitment www. doh. gov. uk/internationalrecruitment/index. htm