Exclusive: Trust orders external review into medical training ‘concerns’

University Hospitals Birmingham has ordered an independent review into a major international medical training programme, after concerns the scheme may be routinely underpaying overseas doctors.

The foundation trust confirmed to HSJ it was “now in the process of commissioning an independent review” into its three international medical training programmes.

A spokesman said the decision to order an external review had been sparked by an earlier internal review of its medical training, which itself followed “concerns raised by clinical and non-clinical colleagues”.

And a bulletin sent to UHB staff yesterday from chief medical officer Kiran Patel, seen by HSJ, said “pay parity” issues had come to light through the internal reviews. 

It follows previous reports that overseas doctors were being paid substantially less than domestic peers working at a comparable level (see below).

Details about who will carry out the external review, how long it will take, and the terms of reference are yet to be confirmed.

UHB said the initial reviews of its training programmes had been instigated in October 2023, amid major changes to its executive structure and top team, including the departure of its chief medical officer.

Under UHB’s international training programmes, some 220 doctors, also known as “international training fellows”, are taken on for two-year placements.

The trust said this was part of the national NHS Medical Training Initiative. This is an England-wide Academy of Medical Royal Colleges scheme, under which doctors from countries with a “fragile healthcare system”, such as Pakistan, Saudi Arabia and India, can come to train and gain experience in the NHS. They are expected to return to work in their home countries afterwards, bringing back benefits from their NHS experience.

Some fellows are sponsored, for example, by their home country, while others are employed directly by an NHS trust. 

A BMJ investigation into MTI schemes in 2023 said University Hospitals Birmingham – along with the Dudley Group FT and Walsall Healthcare Trust – had a specific agreement with the College of Physicians and Surgeons Pakistan, under which doctors on the scheme were paid less than doctors employed by the trust. 

The magazine reported evidence the trainees were being paid substantially less than trainees on domestic training programmes working at a similar level.

The BMJ quoted an unnamed UHB consultant as saying the trust was using the fellows as “cheap labour”. The publication also highlighted the lack of employment benefits for the fellows on the scheme, and a case of one trainee who became pregnant while on the scheme having her fellowship terminated.

UHB told HSJ that, after its earlier internal review of the programme, its model was amended so that “overseas partners” had a bigger role in managing trainees’ contracts and wellbeing, rather than this passing to UHB.

In 2023, the trusts sought to defend the scheme to the BMJ. Diane Wake, chief executive of the Dudley Group FT and now also Sandwell and West Birmingham Trust, said Dudley Group did not directly employ the staff, so was “not responsible for their remuneration”.

The news comes as consultants at UHB last month voted “no confidence” in the trust’s chief executive and chief medical officer. Trust chair Dame Yve Buckland responded by saying that Professor Patel was “actively tackling” concerns raised by previous reviews into UHB’s culture and had “uncovered a number of issues that may be uncomfortable for some but are necessary to address, at pace, to improve our culture, governance and, ultimately, patient safety and experience.”