How Are Doctors Coming to Britain From Poor Countries Exposed to Exploitation?

Despite their countries' severe shortages of medical personnel, foreign doctors are being encouraged to leave their homelands and work in UK hospitals under poor conditions, as has been reported in a BBC investigation.

Doctors from poorer countries recruited to work in the UK said that they are being exploited and overworked to the point that they fear they are putting patients' health at risk.

The investigation revealed a sad reality of young foreign medics, especially from Nigeria.

The majority of the medics from developing countries were hired through a private company called NES Healthcare. The latter specializes in employing doctors from overseas, many from Nigeria, "and using them as Resident Medical Officers, or RMOs - live-in doctors found mainly in the private sector," according to the investigation.

The British Medical Association (BMA) said their situation is really "shocking" and called to bring the sector in line with NHS working practices.

 

Extremely Exploited

Doctors from some of the world's poorest countries who were recruited to work in UK hospitals say they are being exploited during their working hours and believe they are so overburdened that they fear putting patients' health at risk.

Many of the foreign medics were interviewed, including a young Nigerian man who worked at the private Nuffield Health Leeds Hospital in 2021.

Augustine Enekwechi said that he had no time to breathe as he had to be available 24 hours a day for a week at a time. He said he was even unable to leave the hospital grounds, describing his work there as "a prison."

Augustine said he was extremely tired that, at some point, he could not properly function or clearly think.

"I knew that working tired puts the patients at risk and puts myself also at risk, as well for litigation," he says. "I felt powerless…helpless, you know, constant stress and thinking something could go wrong."

But Augustine was not the only doctor who was exploited by British Hospitals. The BBC said it received Newsnight exclusive access to the findings of a questionnaire put to 188 Resident Medical Officers from the BMA and the front-line lobbying group the Doctors' Association.

It found that 92% had been recruited from Africa, and 81% were from Nigeria. The majority of medics, if not all, complained about "excessive working hours and unfair salary deductions."

 

How Do They Come?

The World Health Organization (WHO) has for years warned against the "active recruitment" of doctors and nurses from poor and developing countries that already suffer from severe shortages of medical personnel. WHO put 47 of these countries, most of them in Africa, on a list banned from recruiting.

The UK government has then incorporated that list into its own code of practice and called it the "red list," which means that Nigeria is a no-go destination for British medical recruiters.

The question is, how did the doctors come to be working in the UK in the first place?

The BBC reporters went to Nigeria and told another troubling version of this story.

"In an exam hall in Lagos, the country's biggest city, we found hundreds of doctors queuing to take what is called a Professional and Linguistic Assessments Board test - or PLAB 1. The paper is set by the General Medical Council in London and is the first step required by the British medical authorities to secure a license to work in the UK," they said.

When young Nigerian doctors were asked about why they would leave to the UK, they said they were "attracted by the potential of higher salaries and better working conditions."

In fact, the long queue was being overseen by members of the British Council. The exams are offered in several other red-list countries like Ghana, Sudan, Pakistan, and Bangladesh by the General Medical Council (GMC).

 

Falsification of Facts

GMC and British Council denied, both, that they are involved in "active recruitment," saying they are simply helping provide a service for doctors who want to come to the UK independently, which is allowed under the guidelines.

Concerning Augustine's case, the young doctor was studying for the second part of those PLAB exams in the UK "when he was approached by NES Healthcare and later offered visa sponsorship and a potential job," according to what he said to the BBC.

Despite being clearly an "active recruitment," NES still refuses to admit that, saying "it is not a recruitment agency and, as such, only engages with doctors from overseas once they've already committed to practicing in the UK."

However, the Department of Health and Social Care said, "the UK code of practice did apply to NES - so the company was in breach of it."

All the interviewed African doctors recruited in this way by NES said they all had the same stories.

Dr. Jenny Vaughan from the Doctors' Association helped many of NES doctors as she received several complaints from Resident Medical Officers.

"No doctor in the NHS does more than four nights consecutively because we know that it's frankly not safe," says Dr. Vaughan.

"This is a slave-type work with…excess hours, the like of which we thought had been gone 30 years ago," she added.

"It is not acceptable for patients for patient-safety reasons. It is not acceptable for doctors.

"We took our findings to the BMA - and its deputy chair, Emma Runswick. She told us the situation was a 'disgrace to UK medicine.'

"Our international colleagues have come a long way to the UK, and have found conditions so exploitative it beggars belief."