The National Clinical Assessment Service (NCAS) has published a report Concerns about professional practice and associations with age, gender, place of qualification and ethnicity 2009/10, reinforcing concerns raised by recent incidents arising from out of hours services staffed by practitioners who have qualified overseas.

Statistics, taken from the past 5,600 odd referrals, demonstrate that doctors and dentists qualifying outside the UK are more likely to be referred to NCAS over performance concerns, or excluded or suspended from work than those graduating from UK medical schools.

NCAS is calling for the NHS to strengthen induction and support systems for international medical and dental graduates, to try to reduce levels of concern about professional practice.

Rates of concern are higher amongst practitioners who qualified outside the UK – whether in other parts of the EEA or outside Europe altogether. Although the report records that the highest rates of concern are seen amongst non-white doctors and dentists, NCAS attributes those differences to places of qualification and training at undergraduate level rather than to ethnicity; levels of concern amongst UK-qualified practitioners do not differ between white and non-white groups.

The report also shows a strong correlation between performance concerns and the age and gender of those being referred to NCAS. NCAS consistently finds greater levels of concerns in older age groups, underlining the need for ongoing appraisal and educational support, and fewer concerns amongst female practitioners of all ages.

The Director of NCAS, Professor Alastair Scotland, said “Most doctors from outside the UK do excellent work for the NHS and the service depends a great deal on them and the skills they bring. But these statistics show clearly that there is a greater likelihood of concerns being raised in some groups than others”. Identifying the source of the problem should enable the NHS to better direct its resources towards prevention rather than cure.