Refugee doctors face £1,000 fee

Hospitals are preventing hundreds of badly needed health care professionals from working in the NHS by demanding up to £1,000 from qualified refugee doctors - just to watch staff at work.

Hospitals are preventing hundreds of badly needed health care professionals from working in the NHS by demanding up to £1,000 from qualified refugee doctors - just to watch staff at work.

The charge covers a period of "clinical attachment", which refugee doctors need to complete to obtain jobs in the NHS. But many of them cannot afford to pay, especially those on social benefit or with low-paid, unskilled, casual jobs.

Britain is currently short of nearly 10,000 doctors, and the British Medical Association, which is campaigning against the charges, said: "These doctors could make a significant contribution to the NHS."

It has also been claimed that refugee doctors are refused social benefits for spending "too much time" studying for language and medical exams.

Dr Edie Friedman, founder of the Jewish Council for Racial Inequality, said: "The whole system is a scandal. It needs sorting out. Some hospitals charge for clinical attachments and some do not."

Job centres maintain that if refugee doctors have time to study, they have to work, even if that means delivering pizzas. And if they are lucky enough to be offered a free attachment to a NHS hospital, it can still be a struggle to make ends meet.

One highly-qualified doctor was denied benefits while studying 16 hours a day. Dr Nayeem Azim, who belonged to the social elite in Afghanistan, was working at a leading teaching hospital in Kabul in 1993 when he was forced to flee the country.

Dr Azim, 33, didn't speak English when he arrived, but now speaks it fluently, thanks in part to a pioneering course at Barnet College, north London, that prepares refugee doctors for English and medical exams.

"Coming to Britain was like going to another planet," said Dr Azim, "but I was just grateful that my life had been saved. I spent 16 hours a day for eight months studying for the medical exam which had four components with one-and-a-half hours for 300 questions. I managed it in 20 minutes."

But his conscientious approach didn't help at the local job centre - he was judged "ineligible" for social benefit because he was spending too much time studying. He recalled: "I'd thought they'd encourage me to study. It was very humiliating to be turned down. I survived financially because I had my family with me. Without their support I'd never have been able to work here as a doctor."

Dr Azim was given a free clinical attachment to Chase Farm Hospital, in Enfield, Middlesex, and is now a GP in north London. He teaches part-time at Barnet College and has set up a postgraduate training centre for refugee doctors.

Many of the estimated 1,000 refugee doctors in the UK applying for clinical attachments face stiff competition from other overseas doctors seeking experience in internationally-recognised centres of medical excellence. Unlike refugees, these doctors can return home to practise.

A report by the Working Group on Refugee Doctors and Dentists, published by the Department of Health, says: "There is considerable competition for attachments, and strong anecdotal evidence to suggest that medically qualified refugees are disadvantaged. Other aspects, such as costs and accommodation, can also act as barriers." The report recommends that the NHS executive should "encourage" health trusts and GPs to provide clinical attachments free of charge to refugee doctors, but says that, at present, "operational arrangements are determined locally".

The report explains: "Practices therefore differ. In some areas, deans/directors of postgraduate education retain some responsibility; in others individual trusts take entire responsibility."

The BMA says: "We should encourage refugee doctors to work in Britain to go some way towards making up the shortfall in medical manpower. We have only 1.7 doctors per 1,000 of population, the lowest in Organisation of Economic Cooperation and Development (OECD) countries. In Germany, the figure is 3.4."

Of the 25 refugee doctors completing the Barnet course each year, only 20 to 25 per cent obtain medical employment in the UK.

Tony Fitzgerald, the course coordinator at Barnet College, said: "Many of them cannot get limited registration until they have a job, but they can't get a job until they have limited registration. It's a Catch-22 situation. And yet [these doctors] represent a fantastic resource for the NHS."