NHS recruiting doctors from WHO “red list” countries
Eleanor Burkey and Amplify Curator Omar Harris Vernon El-Halawani explore how the NHS is now recruiting more doctors from outside the UK and EEA than from within. They also discuss the emergence that some of these doctors are from the World Health Organisation’s “red list” countries.
It is a truth universally acknowledged that the health sector, like many other public services, is struggling with staff shortages. Multiple Governments have searched for solutions with international recruitment being a key one.
Since Brexit, the UK is now relying on more immigration from outside the EU. Consequently, 2021 was the first year the NHS hired more doctors (10,009) from outside the UK and European Economic Area (EEA) than within (9,968). Several of these medical professionals come from the World Health Organisation’s (WHO) “red list” of 47 countries – developing countries that severely lack medical personnel.
The UK Government claimed to have added the WHO’s list to its medical code of practice. However, a questionnaire given to 188 Resident Medical Officers by the British Medical Association (BMA) and Doctors’ Association, revealed that 92 per cent had been recruited from Africa, 81 per cent of whom came from Nigeria, a “red list” country. Medical recruiters say they do not hire from “red list” countries to ensure their health services continue to be well staffed. Nonetheless, many medical professionals from these countries end up working in British hospitals. Ultimately, this points to a difference between words and deeds.
92 per cent had been recruited from Africa, 81 per cent of whom came from Nigeria, a “red list” country
Taking the Professional and Linguistic Assessments Board test set by the General Medical Council (GMC) is the first step to getting a medical license in the UK. This is overseen by the British Council who are sponsored by the Foreign & Commonwealth Office. Though many doctors have been recruited from Nigeria, the GMC also offers the exam in several other “red list” countries such as Ghana and Pakistan. Both the GMC and British Council say they are not involved in active recruiting, rather they are providing a service for doctors wanting to come to the UK independently. This is permissible according to the guidelines.
The promise of higher salaries and better working conditions attracts many to the idea of coming to the UK. However, many find the truth to be quite different. Several doctors talk about being offered visa sponsorship and a job by a company called NES healthcare. Excited at the prospect, one individual, Augustine Enekwechi, signed a contract with NES without thoroughly checking the small print. The contract opted him out of the Working Time Directive, which legislates that the average working week must not exceed 48 hours. These working hours are typical of a doctor although they can work 72 hours if they request to do so. In stark contrast, Augustine, was on call 24 hours a day for up to a week at a time and was also not allowed to leave the hospital grounds. Another doctor, Femi Johnson, was expected to work 14–16-hour days and be on call overnight. When Femi took time off from being burnt-out, his employer deducted money from his salary. NES Healthcare said their “feedback about doctors experiences” was “extremely positive”. However, these examples have caused great concern among many about how international recruits in the private sector are treated.
The contract opted him out of the Working Time Directive, which legislates that the average working week must not exceed 48 hours.
Doctors in similar positions to Enekwechi and Johnson have contacted Dr Jenny Vaughan from the Doctors’ Association; a lobbying group which voices concerns on behalf of frontline doctors. Vaughan describes the emergence of a two-tier system: one for NHS recruits and one for international recruits working in the private sector.
This case poses ethical questions as to whether health providers should hire health professionals from “red list” countries where health services are already struggling with staff shortages. In doing so, it could make the situation for these stretched healthcare systems even more precarious. As long as international recruitment continues in this manner, ethical questions around the treatment of those coming to work in the UK will most likely remain.