With the well publicized case of Dr Daniel Ubani earlier this year has come the question as to how many other EU GPs practicing in the UK are ‘lost in translation’. Dr Ubani had “unlawfully killed” UK patient David Gray in 2008 after mistakenly giving him a large overdose of diamorphine.
Alongside this case came a public cry for language competency tests, which was supported by both the British Government and the General Medical Council (GMC). Yet a recent investigation by Pulse Magazine, a magazine for GPs, suggests that Primary Care Trusts (PCTs) are not only failing to administer these tests to all foreign doctors but also fail to keep a record of who has completed a test and who has not. In just a quarter of PCTs in England over 300 foreign doctors were found to be on ‘performer’s lists’ without ever having undergone language competence testing.
But why is such language testing so important? The reason is that medicines are not given standardized names that are used globally, between countries or languages a drug may be given a completely different name; so hypothetically a doctor could be proficient in one European country but, for this reason, incompetent and dangerous in another. Take Dr Ubani, who himself admitted to never having heard of diamorphine before administering the fatal dose to Mr Gray. Without a global categorizing system it is imperative that doctors can read, write and speak proficiently in whatever language that the country or countries they practice in requires.
The problem is that European law prevents the GMC from making such testing mandatory for all EU doctors registering in the UK. The GMC and the Government can but “remind” PCTs of the need for effective testing. There is no central body that can ensure that every doctor coming into the UK is linguistically proficient enough to practice here.
Instead the responsibility lies with the PCTs, of which there are 152 in England. Yet these sub-divisions are strained already, under pressure from both reduced economic funding and problems with the quality of out-of-hours GP services. Thus they are pushed further towards using foreign doctors at weekends or in the evenings, when previously UK GPs might have been used. These cut backs have been imposed by the government and yet it cannot legally intervene to ensure that the use of non-UK doctors is safe.
The case in question highlights the dangers of relying on PCTs, as they often fail to communicate their concerns to other trusts. Dr Ubani himself was denied NHS work in West Yorkshire before being employed by the NHS in Cornwall and later fatally in Cambridgeshire. Further afield the communication between different European health care systems is also troubling, as GPs can be struck off in one country but can immediately take up a position elsewhere.
Surely there needs to be a standardized language aptitude test to ensure that foreign doctors, who are an important part of the NHS, do not place any more patients “at risk”. Moreover, there needs to be a defined structure in place to conduct these tests, record how each doctor does and then store and communicate this data across the UK. A facility that just doesn’t seem possible within the geographical and financial limitations of PCTs.