August 25, 2009

Another NHS Story U.S. Media Will Likely Ignore: Widespread Use of Foreign GP ‘Commuters’


I don’t anticipate that those in the UK who are rushing to the defense of their precious National Health Service (NHS) will be bringing up the item that follows any time soon, nor do I expect the U.S. statist heath care cheerleaders to take note of it.

The UK Daily Mail tells us that NHS is importing general practitioners who commute from foreign countries. Wait until you see the reason why, and the effect it has had on patient care.

Here are key paragraphs from the report by Rebecca Cambers:

The huge extent to which the NHS needs foreign doctors to treat patients out of hours is revealed today.

A third of primary care trusts are flying in GPs from as far away as Lithuania, Poland, Germany, Hungary, Italy and Switzerland because of a shortage of doctors in Britain willing to work in the evenings and at weekends.

The stand-ins earn up to £100 an hour, and one trust paid Polish and German doctors a total of £267,000 in a year (about $441,000 — Ed.), a Daily Mail investigation has found.

It raises fresh concerns that British patients are being treated by exhausted doctors without a perfect command of English.

…. The figures come months after an investigation was launched into the conduct of a German doctor after two patients died on his first shift in Britain.

…. (A) Nigerian-born doctor (based in Germany) injected 70-year-old kidney patient David Gray with ten
times the maximum recommended dose of morphine, and an 86-year-old woman died of a heart attack after Ubani failed to send her to hospital.

The NHS is having to rely on doctors from overseas because a lucrative new contract for British GPs has resulted in more than 90 per cent opting out of responsibility for their patients in the evenings and at weekends.

Despite doing less, their pay has soared by 50 per cent to an average of almost £108,000 (about $178,000).

Responsibility for out-of-hours cover has now passed to primary care trusts.

A different Daily Mail piece from August 20 tells us the following:

…. the controversial contract …. saw the pay of practice-owning GPs increase by 50 per cent over four years, to an average of almost £108,000, even though they are now working seven hours a week less.

Meanwhile the rise for salaried GPs, who work longer hours, has been just 10 per cent to £54,000 on average.

That second Daily Mail piece reports that the salaried GPs want to form a “breakaway union.” So in case you didn’t know that even doctors who own their own practices are unionized under the NHS, now you do.

Back on point: What in essence happened is that NHS cut a deal with its unionized in-country GPs that was so favorable to the GPS that they stopped doing what they had been doing. Rather than attempt to go back to the docs and try to solve the problem, NHS bureaucrats took the easy way out, spending lots of taxpayer money for expensive, imported temps. In some cases, not surprisingly, they haven’t vetted their commuters very well.

Say what you will about our the imperfections of the current health care system in the U.S. — and yes, there are many — it’s almost inconceivable that it could have produced a widespread bureaucratic screw-up in the provision of primary care such as this. But with a statist health care regime in place, even if run by the allegedly best, brightest, and most noble (which, sadly, would be far from the case under ObamaCare, based on the presence of the likes of Ezekiel Emanuel) botches like the one described here are likely to become a standard feature, as is the case with NHS – which, as seen here, has a long, long history of wide-ranging problems.

Cross-posted at



  1. I know you yanks don’t like vetting your media much, and will happily listen to any opinion piece as long as it agrees with your own point of view (thus the popularity of Fox News) but the Daily Mail is widely regarded in the UK as being full of populist, anti-immigration nonsense, and as far as I can see you have picked out a good example of it here. I’m not saying the NHS is perfect, or even that your point is wrong, but you could have at least picked a more balanced source or even gone direct to the government statistics

    Comment by CT — August 25, 2009 @ 9:11 am

  2. #1, spare me your condescension, which says far more about you than it does about those you impugn.

    What facts in the report are incorrect? If you can’t cite any, you have no legitimate right to complain about the source.

    Comment by TBlumer — August 25, 2009 @ 10:30 am

  3. If by my condescension you mean my sweeping statement about Yanks, I don’t really see how it is any different to yours about Brits in your opening sentence. In any case that was not where the brunt of my point (or my impugnment*) lay, my intention was to indicate that the facts, such as:



    “Lithuania, Poland, Germany, Hungary, Italy and Switzerland”

    “£267,000 in a year (about $441,000 — Ed.)”

    “90 per cent opting out of responsibility for their patients in the evenings and at weekends”

    “pay has soared by 50 per cent to an average of almost £108,000 (about $178,000)”

    were likely to be correct but I found it hard to see how the Mail’s statements, such as:

    “The huge extent to which the NHS needs foreign doctors” (how are they distinguishing between needing these doctors and attracting them)

    “A third of primary care trusts are flying in GPs … *because* of a shortage of doctors in Britain willing to work in the evenings and at weekends” (I fail to see where they established a causal link)

    “It raises fresh concerns that British patients are being treated by exhausted doctors without a perfect command of English” (again this is established in the ‘facts’ where?)

    “The NHS is having to rely on doctors from overseas *because* a lucrative new contract for British GPs has resulted in more than 90 per cent opting out of responsibility for their patients in the evenings and at weekends” (that word ‘because’ again)

    are irresponsibly garnered from the available facts.

    It seems to me that all of your analysis following the quotes is based on the Mail’s opinion and not the facts that they state (forgive me if I have interpreted that incorrectly though)

    I’m not particularly pro the NHS and in fact my preferred system would be something far closer to that of Singapore, but the “widespread bureaucratic screw-up” that you talk about did not prevent the UK from having a healthcare system that is both cheaper per capita than the US (by a long, long, way) and available to all with almost no caveats.

    Comment by CT — August 25, 2009 @ 11:32 am

  4. * I’m not sure if there is such a noun as ‘impugnment’ but you get my point

    Comment by CT — August 25, 2009 @ 11:33 am

  5. If you don’t understand the difference in “sweep” between ….

    I know you yanks don’t like vetting your media much (absent any qualifiers, it impugns ALL yanks)

    … and …

    those in the UK who are rushing to the defense of their precious National Health Service (NHS) (clearly refers ONLY to an undefined percentage of Brits doing the defending)

    …. I can’t help you.

    It would appear that you want a doctoral dissertation and not a news report.

    As to “cause,” if the Daily Mail is right in its claim that 90% of native GPs have opted out of evenings and weekends, and evening/weekend hours are customary, then they have indeed established cause.

    Comment by TBlumer — August 25, 2009 @ 12:09 pm

  6. Oh mate, are you serious? Just ’cause your statement was *less* sweeping, doesn’t mean it didn’t sweep. Yours swept me up, mine swept you up.

    Doctoral dissertations I can live without, balanced representation of the news is something that is sorely missing in both your country and mine.

    Correlation and causation? I take it that you are also a strong believer that “sleeping with one’s shoes on is strongly correlated with waking up with a headache”.

    Comment by CT — August 25, 2009 @ 1:28 pm

  7. Well, I’m not sure there is a real issue here. Sure, GPs contracts were re-organised to allow them to contract out of evening and night work. So someone has to do this cover, and we have a bunch of private organisations (note that, these are private organisations – actually most GPs work for their own business or a private business) who supply locums to cover practices.
    Is this a big deal? Not so much in the scheme of things. Sure, we spend a lot on our NHS. In that scheme, the cost of locums is small and necessary to cover out of hours needs.
    I’m sure you have a similar setup in the US, though obviously flying in locums from europe would be a bit difficult. But here it’s like flying in someone from a city an hour or two away. Not that unusual I would guess.

    Comment by Ivan Pope — August 25, 2009 @ 3:36 pm

  8. To: CT
    You say that, “the UK…(has) a healthcare system that is both cheaper per capita than the US (by a long, long, way) and available to all with almost no caveats”.

    I say that the first thing any medical system MUST do is provide excellent care, which includes doctors who speak the patient’s language, and who don’t kill patients through medical ignorance. Bragging about how cheap and readily available your deadly system is can hardly be considered a plus, dead patients are hardly going to be comforted by the money they saved.

    Comment by Boots — August 25, 2009 @ 5:27 pm

  9. #6, I’m serious, and you’re clearly not. I was “sweeping up” those in the UK defending NHS (i.e., some UK residents), you were “sweeping up” all yanks.

    Come back when you demonstrate an understanding of the difference between “some” and “all.” Until then, you are by definition not serious.

    The burden is also on you to prove that there is no linkage between the docs’ contract, lower working hours, and importation of temps. Have at it, and give me your blog address when you’ve worked it up.

    Comment by TBlumer — August 25, 2009 @ 10:49 pm

  10. Boots:
    I think it depends whether you think you can judge a system’s excellence based on the simplistic anecdotes cited above or real evidence. Sure doctors will make mistakes, maybe some will even be foreign, at what point is one a symptom of the other though?
    According to the OECD’s data US healthcare cost over 7000USD per capita while the UK system was under 3k USD. It may well be that that is justified, but the UK life expectancy is still higher than the US’. There are probably better stats to compare systems on, that a cleverer person than me can point you too, and they might even indicate the US is healthier. But twice as good? And how many people in the US have access to no healthcare? The number is 0 in the UK.

    I feel we have gone beyond semantic here but: surely the problem with sweeping statements is not the number of people they embrace but whether they wrongly embrace anybody. My statement wrongly embraced many Americans who are sceptical of their media, its agenda and its influence just as your statement wrongly embraced many British ‘NHS defenders’ who would happily point out the flaws in its system (I guess at this stage you’re not willing to believe I am one of them so I will offer the Daily Mail’s journalists as evidence of such people).

    I don’t really believe the burden is on me to prove anything, if I published something which I expected lots of people to read then I would feel a burden (as you and the Daily Mail perhaps should). But in any case I never contended that the three things you list were untrue or indeed had had no effect on each other. My issue was whether any of these things had actually resulted in worse service, a higher mortality rate or lessened patient care in any way. The malpractice examples from the article could have come from any country in the world including the US. There is not one statistic cited indicating anything has got worse (one could infer costs have gone up but even that would probably be spurious, part of the reason for incentivising GPs was to get them to reduce costs in other areas). Maybe it is possible now, or will be in the future, to prove that the scheme was wrong (via proper cost-benefit analysis, not anecdotal evidence), but I stand by my judgement that your article a) has not shown that, b) is deliberately sensationalist to suit your own agenda and c) shows a lack of understanding of economics and statistics of which I would expect more from a business blog.

    I’ll let you know if/when I get a blog up and running, I think if I did have one you’d see that we ideologically agree on more than you think

    Comment by CT — August 26, 2009 @ 5:53 am

  11. The number of uninsured in the US that gets bandied about frequently is between 40-45 million. Back when the SCHIP program was being debated (and ultimately signed into law) the number was around 35-37 million, I’m not sure how coverage was extended to more people yet greater numbers are now uninsured. Must be New Math. But I digress.

    If you take out persons who are in the US illegally (exactly why should US taxpayers fully fund healthcare for people who sneaked into the country?) and younger, healthy people who make sufficient income to purchase insurance but choose to spend the money on other priorities, the actual number of uninsured in the US is around 9 to 10 million. In a country of over 300 million, this is a relatively small number and can be dealt with on its own terms, WITHOUT destroying the healthcare currently enjoyed by the other 300 million.

    Also, the US has greater ethnic diversity than Europe or the UK, and often that population gives birth to smaller, lower birth weight babies. Those babies suffer greater mortality, which is what skews the longevity stats. It’s not that old people are dying off before they get old, older adults in the US are much better off than older adults in the UK (we have better outcomes for cancer for example because here old people actually get treatment)

    All of you in the UK who currently enjoy the fruits of the US’s research & development of new drugs, new procedures and new technology had better hope we keep our current system. Socialized medicine doesn’t make any investments in the future, it’s all about enforcing equal misery in the here and now on its captive populations. Other than cloning Dolly the Sheep, a dubious distinction at best, what new lifesaving treatments have come out of the UK?

    Comment by Boots — August 26, 2009 @ 11:23 pm

  12. Boots:
    I can tell you’re passionate about this issue so I’m not going to push it too much more (if only because I’m not that passionate about it myself, I don’t believe our nationalised system is a model for the world, I simply think it is possible to have an equitable model, that the US doesn’t currently have one and that the original poster made invalid claims about the NHS based on a shocking article from a terrible source).

    Your mathematics is beautiful, if your 9-10 million number is correct and you somehow manage to argue that 3% is an insignificant number when it comes to public policy, that is still 9-10 million people! More than the population of any city in the US, more than if you added LA, Chicago and Houston’s populations together. I don’t know if you’re too old to use facebook but I’m not and I have around 300 friends on there, in your world, all things being equal 10 of my friends would have no health insurance and face all of the problems that this entails (life threatening and not).

    I am always sceptical when someone argues for the status quo simply because it protects there own interests at the cost of others, surely you can see why someone might be. By all means be anti your president’s proposal, but what is the alternative you are bringing to the table?

    I think you are misquoting the infant mortality thing which in essence should be phrased “The US collects its statistics differently such that underweight babies, that would be considered still born in Europe, count towards infant mortality rates and thus skew the US higher.” However that argument is wrong as all WHO countries now collect information using the same standard (“a live birth is any born human being who demonstrates independent signs of life, including breathing, voluntary muscle movement, or heartbeat”). As for ‘greater ethnic diversity’, I have spent a fair bit of time in US cities (which I would assume are more diverse), and purely anecdotally find that very hard to believe!

    I’m sitting here in London in front of my Bloomberg terminal looking at the five largest pharma companies in the world by market cap. Three out of the five are European. Two out of the top ten are British. I have no idea which company came out with the most recent life saving innovation, but I know for sure it doesn’t only happen in the US.

    The fact that US citizens pay more towards this innovation is a different proposition, and appears to be something you are arguing to continue doing. If you didn’t I don’t believe innovation would stop just the cost would be shared globally and would still mostly pour into the coffers of pharmaceutical companies. This is not something I have an issue with or think you should. Where you might get a bit annoyed is the fact that a goodly proportion of your 7000USD goes into insurance companies’ profits (I have heard numbers as high as 2000USD), I’d much rather that went towards innovation as I’m sure you do too.

    I grew up in a working class family here in the UK and benefited from the NHS throughout my childhood, teenage years, university (college?) and now a few years on have a good enough job that I can afford to supplement the free state care with a private plan. Do I resent paying toward the system from which I benefited previously (and which my parents still do)? Not one bit. If you do/would then fine, but think about your reasoning and try wearing the other guy’s shoes (and apparently there are 10 million pairs of them)

    Comment by CT — August 27, 2009 @ 9:40 am

  13. CT,
    You sound like a reasonable sort, and I’m not trying to be difficult here, I’m just trying to make the point that the 9-10 million persons who are lacking health INSURANCE can be accommodated without destroying the health CARE for 300 million. In my opinion, those 9-10 million persons have become a political football and are being used in the worst sense of the word by politicians who want to exercise undue control over everybody’s lives.

    The bill as currently written (1,000+ pages) in the US House of Reps (HR 3200) would digitize and make available all citizens private health care records; would give the federal government access to everyone’s checking account to automatically debit as the feds see fit; and would cut $500 billion from the Medicare budget over 10 years, while the enrollment in Medicare goes up 30%. Medicare is the US program that provides universal coverage to America’s elderly and disabled, and those numbers indicate to America’s elderly that their current benefits will be cut drastically. How can you increase enrollment, cut funding, and NOT ration the services provided?

    Back to our 9-10 million for a sec, they are not lacking care, they lack insurance, all comers must be treated when they present themselves at a hospital. The solution is to provide the same tax benefits to individuals purchasing insurance as are currently provided to employers who provide insurance to employees. There are some very simple, two or three page solutions to this problem and it could be resolved this afternoon if the statists really wanted to improve the lives of those folks. They don’t, they are victimizing those folks to pick the pockets and increase control over the rest of us.

    Notice that the politicians have specifically excluded THEMSELVES from having to use this socialized system of rationed care. It would be a system of rationed misery for most of us at the same time our tax dollars would pay for a gold-plated system for our elites. We currently have a wonderful system, and want to see those last 9-10 million get on board.

    Last point, the ethnic minority population of the US is about 30%. According to the national stats website I found ( the ethnic minority population of the UK is 7.9 percent. The US is a huge country both in its population and geography, comprised of people from all over the world, who have very different lifestyles. We are a rowdy bunch over here, but the one thing we agree on is that we don’t want more bureaucratic control over our lives, more control means less freedom. And freedom is why people come/came here in the first place.

    Comment by Boots — August 27, 2009 @ 1:23 pm

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