Experiences of non-UK-qualified doctors working within the UK regulatory framework: a qualitative study

Abstract

Objective To explore the experience of non-UK-qualified doctors in working within the regulatory framework of the General Medical Council (GMC) document Good Medical Practice. Design Individual interviews and focus groups. Setting United Kingdom. Participants Non-UK-qualified doctors who had registered with the GMC between 1 April 2006 and 31 March 2008, doctors attending training/induction programmes for non-UK-qualified doctors, and key informants involved in training and support for non-UK-qualified doctors. Main outcome measures Themes identified from analysis of interview and focus group transcripts. Results Information and support for non-UK qualified doctors who apply to register to work in the UK has little reference to the ethical and professional standards required of doctors working in the UK. Recognition of the ethical, legal and cultural context of UK healthcare occurs once doctors are working in practice. Non-UK qualified doctors reported clear differences in the ethical and legal framework for practising medicine between the UK and their country of qualification, particularly in the model of the doctor–patient relationship. The degree of support for non-UK-qualified doctors in dealing with ethical concerns is related to the type of post they work in. European doctors describe similar difficulties with working in an unfamiliar regulatory framework to their non-European colleagues. Conclusions Non-UK-qualified doctors experience a number of difficulties related to practising within a different ethical and professional regulatory framework. Provision of information and educational resources before registration, together with in-practice support would help to develop a more effective understanding of GMP and its implications for practice in the UK.

Ways in which healthcare organisations can support overseas-qualified doctors in the UK

“…There can also be cultural issues including feelings of social isolation and cultural disorientation. [15][16][17][18][19] Interaction adjustment may emerge in subtle ways, such as unfamiliarity with nonverbal communication, 8,20,21 which may also present themselves in work-specific settings. Lack of professional and personal networks can make integration and adaptation into the NHS difficult.…”

“…16 Overseas doctors may have little experience of patients asking questions about treatment options or questioning the doctor's authority. 8,20 There are efforts to help doctors make the transition to new countries. Some deaneries (Deaneries are the bodies responsible for postgraduate medical education at regional level in the UK) already offer specific induction courses targeted at overseas doctors, but the GMC are piloting an induction programme for all doctors new to working in the NHS.…”

“…Healthcare systems and regulatory frameworks in different countries may have different values and expectations, causing difficulties when practising. 8 Regulators in other countries may focus more on the interests and welfare of doctors than on patients and quality of care. 9 There is a substantial literature looking at the adjustment of migrant workers to a new country -in a number of business domains.…”

Cultural dimensions in the transition of overseas medical graduates to the UK workplace

“…Currently, a greater proportion of UK-registered doctors have qualified abroad than had 10 years ago, although the proportion has reduced from a peak of just under 40% in 2005 to 37% in 2011 (GMC 2011(GMC , 2012. Slowther et al (2009Slowther et al ( , 2012 identified that doctors who qualified outside the UK can face difficulties when they start to practise in this country, such as unfamiliarity with UK legal and ethical standards. The UK General Medical Council (GMC) has recognised that overseas-qualified doctors need better support and need to be properly inducted into UK practice (GMC 2011).…”

“…The patient-centred approach emphasised in the UK can be at odds with the focus of regulators in many countries (Rand 2009), with doctors' own cultural values and experience (Manderson & Allotey 2003;Hall et al 2004;Jaffrey & Faroqui 2005;Hamilton 2009;Slowther et al 2009;Chen et al 2011;Dahm 2011;Slowther et al 2012) and with patients' expectations of consultations or the physician-patient power dynamic (Dorgan et al 2009;Hamilton 2009). Communicating emotional support for patients can be a challenge for doctors who have graduated overseas (Fiscella et al 1997;Hawken 2005).…”