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British medical regulator calls for urgent checks on differences in medical qualifications ‘which could put patients at risk’ UK medical regulators have demanded minimum standards for doctors’ training across all 27 EU member states, saying the present variety of systems could endanger patients and undermine public confidence in healthcare and in the single market in jobs. The General Medical Council has called for urgent checks of all national medical qualifications to prevent migrant foreign doctors working outside their own country in health systems they may not understand. Lack of information about the nature and content of training in other countries means regulators “cannot have full confidence in each other’s medical training and education”, it says in its response to a European commission review of a 2005 directive that governs automatic recognition of the different systems. Nearly one in 10 of the 239,300 doctors on the UK register qualified in EU countries, Switzerland, Lithuania and Norway. NHS statistics show doctors who qualified outside the UK are more likely to be excluded or suspended from their jobs than those who trained in this country. The GMC’s devastating attack is the most outspoken critique yet of the European system which requires states to recognise each other’s medical qualifications, meaning that regulators cannot test their competence or language skills, as they can with doctors from other parts of the world. Even employers have limited powers to assess whether candidates are suitable for a particular job. These flaws were revealed by the Guardian’s investigation into the case of Daniel Ubani, a German doctor who accidentally killed 70-year-old David Gray in 2008 during his first shift as a locum GP on the out-of-hours service in Cambridgeshire. Ubani, who can still practise in Germany although struck off for incompetence in Britain, works mainly as a cosmetic surgeon and specialist in anti-ageing medicine. The GMC was unable to check whether he had ever worked as a GP in Germany. His qualification alone gave him access to the register in the UK. But the GMC has other concerns. “What is a routine treatment or procedure for a general practitioner in the UK, for example, may not be within the normal scope of a doctor trained from another [European] country.” This echoes government concerns that, for instance, GPs in Italy do not traditionally treat children as they are normally seen by specialist paediatricians. “We also have a specific on-call system [in hospitals] which means our doctors have to know the generality of a speciality. “We understand that this is not necessarily common in the rest of Europe and gives rise to a patient safety risk where the expectations placed on a doctor working in one jurisdiction, but trained in another, are not met.” The GMC document says current EU legislation “does not allow competent authorities to assure themselves that the migrant doctors they register have kept their skills and competence up to date since the award of their professional qualifications”. This, it adds, “inevitably weakens the level of confidence that competent authorities can have in the competence of doctors entering the host state”. Although the virulence of the criticism will not surprise officials in Brussels where the government and GMC have been lobbying heavily for change in the wake of the Ubani scandal, the GMC document’s analysis that the current regime is unsafe provides plenty of ammunition for those who criticise the wider culture of the EU. Rory Gray, son of the patient killed by Ubani, said: “It is great news the GMC is being so forthright. It has said the present system is a public safety risk. Of course, it is.” Sons’ battle The searing criticism of EU rules by the GMC is another victory for Rory and Stuart Gray, two of the four sons of David Gray who died after a 10-fold overdose of a painkiller administered by Daniel Ubani. Their tireless research and campaigning to expose the flaws in the English health system and the European single market for jobs highlighted by the accident have already helped fashion big changes in the out of hours system of GP care and monitoring by the NHS. Andrew Lansley, the health secretary, as part of his proposed reforms to put GPs in control of most of the NHS budget, has also made clear that he expects more local doctors to be on call for overnight and weekend calls, so that foreign locums are unnecessary. Rory, a satellite engineer in Germany, and Stuart, a GP in the West Midlands, have been driven by a burning desire to lower the risks to other patients. Their vivid articulation of system failures revealed by their father’s death has stung NHS officials in Cambridgeshire, where their father died, ministers at the Department of Health and the GMC alike. A year ago, Rory and Stuart revealed how the cause had almost taken over their lives. GPs Doctors NHS Health European commission European Union Germany James Meikle guardian.co.uk