Doctors from Nigeria and other poor countries are being recruited by a British healthcare company and expected to work in private hospitals in the United Kingdom under conditions not allowed in the National Health Service, a BBC investigtion has revealed.
These doctors have cried out that they are being exploited and overworked that they fear that they might put patients’ health at risk.
The British Medical Association (BMA) has described the situation as “shocking” and says the sector needs to be brought in line with NHS working practices.
According to data obtained from the General Medical Council of the UK, the total number of Nigeria-trained doctors who migrated to the UK as of August 30, 2022 stood at 10,096, The PUNCH reports.
Checks showed that the General Medical Council in the UK licensed at least 353 Nigerian-trained doctors between June 10, 2021, and September 20, 2021.
The BBC spoke to several foreign medics – including a young Nigerian doctor, Augustine Enekwechi, who worked at a private hospital, Nuffield Health Leeds Hospital in 2021.
He was hired out to the Nuffield Health Leeds Hospital from a private company – NES Healthcare – that specialises in recruiting doctors from overseas, to work as Resident Medical Officers, mainly in the private sector.
Augustine said his hours were extreme – on-call 24 hours a day for a week at a time, and that he was unable to leave the hospital grounds. He says working there felt like being in “a prison”.
According to him, there were times he worried he couldn’t properly function as the tiredness was so intense.
“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.”
He said he was so excited to be offered a job that he barely looked at the NES contract which took him off a legislation that protects UK workers from excessive working hours – the Working Time Directive – and left him vulnerable to a range of punishing salary deductions.
However, Nuffield Health has denied those working hours, saying its doctors are offered regular breaks, time off between shifts, and the ability to swap shifts if needed. The company adds that “the health and well-being of patients and hospital team members” is its priority.
There are many other medical practitioners facing similar problems as Augustine. The British Medical Association and the Doctors’ Association have given the BBC’s File on 4 and Newsnight exclusive access to the findings of a questionnaire put to 188 Resident Medical Officers. Most of the doctors were employed by NES but some were with other employers.
It found that 92% had been recruited from Africa with 81% from Nigeria. The majority complained about excessive working hours and unfair salary deductions.
The doctors the BBC spoke to during a Professional and Linguistic Assessments Board test (PLAB 1) in Lagos, Nigeria, said they were attracted by the potential of higher salaries and better working conditions in the UK.
PLAB 1 is set by the General Medical Council (GMC) in London and is the first step required by the British medical authorities to secure a licence to work in the United Kingdom.
The GMC also offers the exams in several other countries including Ghana, Sudan, Pakistan, and Bangladesh.
BBC also spoke to several African doctors. They all had similar stories about what the terms and conditions of their contracts meant in reality, once they had been hired out to private UK hospitals.
“It’s not humanly possible to do that every day for seven days,” says Dr Femi Johnson
Dr Femi Johnson was sent to a different hospital to Augustine, but says he was also expected to work 14 to 16-hour days and then be on call overnight. “I was burnt out,” he says. “I was tired, I needed sleep. It’s not humanly possible to do that every day for seven days.”
But when he needed a break because he was too exhausted to continue, NES was entitled to deduct money from his salary. The company says that is to cover the cost of finding a replacement doctor, but Femi says it leaves NES doctors in a terrible dilemma.
“In situations like that, I always make that internal discussion with my inner self – ‘Femi are you doing right by yourself, and are you doing right by the patient?” he tells us. “Unfortunately, I haven’t always been able to answer that question.”
“This is a slave-type work,” says Dr Jenny Vaughan from the Doctors’ Association.
Some NES doctors have received help from Dr Jenny Vaughan from the Doctors’ Association. She receives many complaints from Resident Medical Officers and says the UK healthcare system has developed into two tiers – one for NHS doctors, the other for international recruits working in the private sector.
NHS doctors can only be scheduled to work up to 48 hours, and if they request, up to 72 hours a week.
“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.
“It is not acceptable for patients for patient-safety reasons. It is not acceptable for doctors. ”
Emma Runswick of the BMA describes the situation as “so exploitative it beggars belief”.
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.”
NES Healthcare told BBC that its “feedback about doctors’ experiences” with the company was “extremely positive”. It says it provides doctors “with a safe and supportive route to pursue their career choice in the National Health Service, and in the UK healthcare system more generally, and that their work is of “great benefit to the British public.”