Sir, Another nail has been placed in the coffin of surgical excellence by this most illiberal of governments.

On March 7, the Department of Health announced that all doctors wishing to work in the UK from outside the European Union will be required to have a work permit. This ruling comes into force today.

The move means that any NHS trust wishing to employ doctors from outside the EU will have to prove that a “homegrown” doctor cannot fill the vacant post, ending the current permit-free training arrangements for international doctors.

The term home-grown is taken directly from the website and is a quote from Lord Warner, the Health Minister, who went on to state that “in future, international medical graduates who wish to work or train in the NHS will need a work permit. To obtain a work permit the employer must show that a genuine vacancy exists which cannot be filled with a resident worker”.

Many will welcome this legislation, as it will reduce unemployment, particularly among graduates from British medical schools. Most will be aware of the debacle caused by recent changes introduced by Modernising Medical Careers (MMC), which have resulted in many foundation year 2 doctors being unemployed. Similar laws already exist and are accepted in Australia, the United States and many other countries where permanent employment for non-nationals is dependent on there being no local applicant.

It is important, however, to consider the wider ramifications of this change in policy. The Yorkshire Deanery recently received 160 applications for a training post in general surgery. The standard of applications was, as ever, high and shortlisting took many hours. Even so, country of birth, university, race, religion and colour were of no consequence in the process, just merit.

Yet, with the new legislation in mind, the appointments committee were advised that shortlisting would have to be repeated such that every British graduate who could potentially be trained as a surgeon (ie, fulfils the job specification) should be shortlisted before any overseas doctors could be considered.

In such a case any graduate from a British or European medical school, who has completed basic surgical training and achieved the MRCS examination, is theoretically a candidate for higher surgical training.

These individuals must be given priority over overseas applicants irrespective that some overseas applicants will have far superior experience, qualifications and CVs.

Under these new rules the chances of overseas graduates getting onto a shortlist in any competitive medical speciality will be slim. This new legislation effectively means that the meritocracy is dead.

DENIS C. WILKINS
President
Association of Surgeons of Great Britain and Ireland
London WC2

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