Overseas Medical Professionals: The Case for Testing for Communicable Diseases

1 January, 2005

1. There is, at present, no requirement for doctors or nurses from overseas to undergo medical tests in order to join their professional register in the United Kingdom. Yet there has been a very rapid increase in the numbers arriving to work here, including many from countries with high prevalence rates of serious diseases. Compulsory screening should now be introduced for HIV/AIDS, tuberculosis and Hepatitis B before medical staff are recruited from overseas.

Overseas Medical Professionals
2. The Governments policy of rapidly increasing the numbers of front-line medical staff working in the NHS has led to large-scale recruitment from overseas.

3. In 2002/03, over 40 per cent of the 31,775 nurses joining the register were from abroad [1] whilst in 2003, nearly three quarters of the 15,549 doctors who joined the register qualified outside the UK [2].

4. The tables below show the top ten source countries for doctors and nurses respectively, from outside the EU [3], joining the register, in the most recent year available (2003 for doctors; 2002/03 for nurses). Prevalence rates for HIV [4], tuberculosis [5] and Hepatitis B [6] are shown for these countries, as well as for the UK, by way of comparison.

Country Number HIV TB Hep B
UK 4,731 0.2 13 low
South Africa 3,201 1.5 534 high
India 2,983 0.9 287 intermediate
Australia 2,104 0.1 6 low
Pakistan 633 0.1 359 intermediate
New Zealand 577 0.1 11 low
Hong Kong 524 0.1 N/A high
Jamaica 313 1.2 10 intermediate
Singapore 275 0.2 43 intermediate
Nigeria 176 5.4 623 high
Sri Lanka 134 0.1 72 intermediate

Sources: General Medical Council website http://www.gmcpressoffice.org.uk
UNAIDS 2004 Report on Global AIDS Epidemic WHO Global Tuberculosis Database WHO Communicable Disease Surveillance & Response (CSR)

Nurses and Midwives
Country Number HIV TB Hep B
UK 18,216 0.2 13 low
Philippines 5,593 0.1 517 high
India 1,830 0.9 287 intermediate
South Africa 1,368 21.5 534 high
Australia 920 0.1 6 low
Nigeria 509 5.4 623 high
Zimbabwe 485 24.6 703 high
New Zealand 282 0.1 11 low
Ghana 251 3.1 381 high
West Indies 208 N/A N/A intermediate
Pakistan 172 0.1 359 intermediate

Sources: Nursing and Midwifery Council
UNAIDS 2004 Report on Global AIDS Epidemic
WHO Global Tuberculosis Database
WHO Communicable Disease Surveillance & Response (CSR)

5. The tables show that, in the years examined, 3,200 doctors and 1,300 nurses arrived from South Africa, where the HIV rate is 1 in 5. South Africa also has a high incidence of TB and Hepatitis B yet none of these recruits were tested for any of these communicable diseases. The same applies to nearly 500 nurses from Zimbabwe.

6. In addition, nearly 4,000 doctors and 8,000 nurses were recruited from countries with high rates of TB.

7. 700 doctors and about 6,000 nurses came from areas of high incidence of Hepatitis B.

8. There is a reliable and accurate test for HIV. Hepatitis B can also be tested. Indeed, it is a condition of admission to a British medical school. Testing for TB can produce false positives but for the numbers involved further tests could be conducted to resolve any doubt.

9. The rapid increase in the recruitment of overseas medical staff has ignored the risk of importing additional infection into Britain. The very high incidence of serious communicable diseases in many of the countries of recruitment is such as to require the urgent introduction of screening for medical staff recruited overseas.


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