NHS trusts in the West Midlands have been accused of using foreign doctors as 'cheap labour' following an investigation by the British Medical Journal (BMJ). The probe focused on the Medical Training Initiative (MTI) scheme, which allows overseas doctors to work in English hospitals for two years to gain experience.
The BMJ found that an agreement between the College of Physicians and Surgeons Pakistan (CPSP) and University Hospitals Birmingham NHS Foundation Trust (UHB), Dudley Group NHS Foundation Trust, and Walsall Healthcare NHS Trust led to trainees being paid less than trust-employed workers. Senior fellows from Pakistan working at UHB as grade three specialty trainee (ST3) registrars or above received a tax-free stipend of between £2,700 and £3,600 per month from CPSP, equivalent to £32,400 to £43,200 annually. In contrast, ST3 doctors employed directly by UHB earned a basic gross salary of £51,017 in 2022-23 and £55,328 in 2023-24, excluding overtime.
UHB declined to confirm exact equivalent salary details and argued that comparing the two pay scales was not representative. However, one anonymous consultant claimed the trust was using fellows as 'cheap labour'. Another senior medic praised the scheme's training opportunities but highlighted a lack of equal pay and rights.
An Academy of Medical Royal Colleges (AoMRC) spokesperson described the issues as 'concerning' and stated that doctors should be paid the 'correct rate for their work', but noted that this was a matter between the doctor and the employing NHS organisation. CPSP, in response to the BMJ investigation, plans to review and overhaul some guidelines, but maintained that the scheme has improved healthcare in Pakistan.
A UHB spokesperson said the programme 'undoubtedly benefits the NHS system, but in return it benefits the overseas healthcare structure'. Diane Wake, chief executive of Dudley Group NHS Foundation Trust, said the trust does not directly employ MTI fellows and is therefore 'not responsible for their remuneration'. Walsall Healthcare NHS Trust confirmed it has recruited three MTI fellows under the CPSP scheme, due to start in November, but currently has none in post.
An NHS spokesperson stated that salaries are agreed 'between the individual trust and their international partner' and that fellows play an important role in treating patients while learning 'advanced clinical skills'.
