PLAB TEST - AN UPHILL STRUGGLE

 

Dr Nasim H Naqvi FRCA                                              Dr Liaqat A Malik LLM, PhD

MANCHESTER

2003

INTRODUCTION AND HISTORICAL BACKGROUND

 

The Professional Linguistic Assessment Board (PLAB) test is an examination designed to assess medical graduates from outside the European Union (EU), who wish to enter employment in the British National Health Service (NHS). The test endeavours to select those who can achieve the same standard as a fresh medical graduate of a British medical school. A candidate who is successful in PLAB would be eligible to apply for a junior appointment and get limited registration from the General Medical Council (GMC), only then it is possible to work in a supervised hospital job. The doctors from many countries outside the EU generally remain misinformed about the many new changes and true nature of the big hurdle of PLAB. It is important to understand that simply succeeding in PLAB is no guarantee of a job in NHS hospital. In the following pages an attempt is made to provide relevant information, which should help the doctors to comprehend the realities, so that they may be in a better position to make informed decision. The first part is wholly devoted to a historical perspective, which is essential in understanding the veritable nature of unimaginable difficulties the migrant doctors have faced over last half a century and a future migrant doctor would be wiser with this rather important background knowledge and historical information.

Social scientists have not yet studied the impact of brain drain from mainly South Asian and to a lesser extent other third world countries to the richer nations. Accurate statistics may never be available, but we may have some idea of the numbers involved by taking into consideration a long period of migration of the medically qualified professionals. The doctors from ex-colonies have filled shortages of the NHS, from early fifties. At various periods during last fifty years, these doctors occupied more than 40% of junior posts in Britain. Many hospitals referred to be as 'peripheral hospitals', where 100 % junior staffs were from overseas. There were hospitals where for over quarter of a century betweenl955 tol980, no white doctor ever applied for junior post.

The unilateral brain drain of such proportion has obviously worked to the advantage of a richer society, making the health care of donor poor nations bankrupt in manpower. The economic impact of this unique scenario in exploitation may be assessed by the following rough calculations. The average cost of a medical graduate is around £200,000 before he/she qualifies as a doctor. During last 50 years well over 100, 000 migrant doctors have served in the British NHS. This plainly gives a net saving to the Treasury of over £20 billion or £500 million a year during last half a century. The number of medical graduates going to North America and other richer pastures are significantly more and not included in this equation.

The people are the most valuable resource of a country. A nation, which is not capable of utilising the skills of her own highly, trained and educated members, can never progress. The responsibility for this drainage of skilled professionals and resulting bankruptcy in technical skills flatly lies on the shoulders of the successive corrupt governments. Time is witness that their ignorance was proportional to their arrogance and they have proved with their dismal performance and after half a century of mismanagement no lessons have been learnt. The appalling treatment of some of those doctors and other professionals, who tried to return to their country, was more than insulting and offensively degrading. A number of genuinely patriotic doctors, who tried to come home during 1970, can tell many sad stories. The discrimination they faced in their own country was worse than they had to endure as alien in foreign lands. Only lately few could afford to have returned solely in the private sector, where their expertise are out of reach of the man, woman or child on the street.

Many factors had played in bringing about the appalling apathy or any desire of many well trained doctors from abroad to return home. They were not encouraged when they discovered that even minimal facility or essential equipment in hospitals was not available. It seems those who have been in control of the health-care system did not want better qualified and experienced people, who might expose their shortcomings. The state of affairs has led to a chaotic situation, which has resulted in near non­-existence health service out side private sector and total helplessness for those who are unlucky to be ill. In this age of progress, the health system has failed to introduce simple requirement of maintaining medical records of the population; the practitioners are under no pressure to take part in medical audit in any form and all the yard sticks to monitor the public health are moving in negative direction. A case of medical negligence is still a rarity in the legal courts in Pakistan, which is taken for granted as if medical negligence does not exist. The culture of mediocrity is common while excellence is infrequently seen. Such a situation is not conducive to job satisfaction. The doctors practising medicine in Pakistan have made little academic contributions in the peer reviewed medical publications.

 

The unfortunate reality is that medical migration to the west will continue, the entry requirements or conditions may be made stiffen many will take the road however long or tortuous it might be, many are willing to toil to overcome the steep uphill struggle. The basic human instinct to strive for a better life or to improve the existing desperate situation is too strong and deep-rooted. It is the intention to discuss and describe here the current changes, rules and regulations, and also the increasing hardships and decreasing opportunities any migrant doctor will face. Such frank discussion might help the young medical graduates, planning to take PLAB, and then seek employment or opportunities of higher training, to have a clear understanding of what lies ahead at the end of the flight from home. If your flight ends at the London Heathrow, as you leave the airport and approach the traffic tunnel, you will see a sign in very large letters, it says, "WELCOME TO LONDON". This goodwill gesture is not meant for the doctors wishing to come to work in NHS, or enter the higher training programme. It should have the additional interjection, '"NOT IF YOU ARE A DOCTOR".

 

As mentioned earlier the postgraduate training in the UK has under-gone major changes and some more are in the pipeline. These changes in the health-care have introduced many constraints on all doctors. Those from outside the EU, who are planning to take this route, must make themselves aware of what they will face before and after entering the employment in the NHS. During last few years many new trends have crept into the system, which must be recognised. For example the patients have started acting more like consumers, demanding better value for their taxes. Many organisations bombard them with information regarding their consumer rights more than their health requirements. The information how to make a complaint against a doctor, if the service is below their expectations is easily and freely available. The number of complaints at GMC has increased in such large proportions that the GMC cannot deal the increasing number of complaints and have to employ additional staff. The courts are awarding record amount of compensation against doctors' mistakes. There are many organisations, which give free help and guidance in this process. Doctors are no more in a respectable and protected profession. The complaints against doctors who come from abroad are significantly more, both in the courts and disciplinary hearings; they also deemed to get settled against them. The influential newspapers always publish headlines if an overseas doctor is alleged to have made a mistake. Some unfortunate doctors have-been subjected to murder inquiries, when there is allegation of negligence following death of a patient. Both in hospitals and general practice strict medical audits are carried out, anyone found not performing to standards set by the peers, will be subjected to retraining. A doctor found to be below par would find it very difficult to move into the next job. In the near future the GMC will introduce an ongoing assessment, in the form of regular testing, covering the whole spectrum of medical practice. This means all doctors will be regularly assessed at set intervals to see if their competence and knowledge has kept pace with the current medical progress. There is growing pressure from the public and politicians to shake the doctors from their traditional protected position. These restrictions are for the greater safety and larger benefits of the patients. The rationality to change is also reflected in the stiffer regulations for all doctors from outside, whose primary medical qualifications are not from the EU.

No doubt the medical politicians and the health-care decision-makers in the UK are also worried about the short term and future shortage of doctors. In the past the NHS has blatantly ignored the need to provide a standard service to the whole population. For decades nearly 50% of all medical facilities including medical manpower, well-equipped hospitals and beds were allocated within and around London area, while remote areas were openly neglected. Now; it is politically impossible to allow similar situation to occur. Moreover, in the past overseas-qualified doctors were exploited and forced to provide service in these unpopular areas only and their proper training was never on the agenda. The situation has dramatically changed, if these doctors are to be used to support the NHS, then they must be trained to same level as the home produced doctors. This aspect cannot be neglected or left to the individuals themselves, as has been the practice in past. The legal implications of non-uniform training are enormous. An overseas-qualified doctor, employed in the NHS, not received training to a satisfactory level, should not be held responsible for providing below standard service. The corporate responsibility must lie on the system, which employed such a doctor but failed him to train adequately. In other words a clinician or consultant, who assessed such a candidate, the chief executive who, accepted the appointment and the GMC who validated the registration; all must be held responsible.

During the last few decades a large number of overseas qualified doctors have faced allegations of below standard performance, such accusations have been levelled against many doctors both in the GMC and other disciplinary committees. In many cases even the legal advisors employed by the protection organisations have advised these doctors to accept the guilt to save time and cost of going ahead to the trial. No one has ever bothered to weigh and compare the performance and training of such doctors with British trained doctors and the true reasons of their poor performance. The old bad days have fortunately gone, institutional racism is strongly opposed by the responsible public figures and doors of the law are wide open to fight for compensation.

 

Considering the historical problems and the circumstances outlined above, the doctors from the third world countries contemplating to travel and find job opportunities in the UK, must consider all the implications, think about the difficulties, weigh all the odds before making up their mind to migrate as a doctor. The road is long, tortuous, very bumpy and all the way uphill.

 

During the last election campaign (June 2001) the shortage of doctors and nurses has been highlighted by all the three main political parties. All seem to quote a figure of 10,000 new doctors, required now, not in 6 years times. The important question no one has answered, from where 10,000 or even a mere 2000 new doctors will come from? It takes six years to train a doctor; a period longer than the government elected in June 2001 will remain in office. In other words this government will not see a single extra new doctor qualified from a medical school. So where the extra doctors will come from? The answer is from third world countries. During the last fifty years about twenty governments have changed, all have been successful in not balancing the correct number of doctors needed to make the NHS work smoothly. The politicians of the two governing parties have repeatedly failed to learn the lesson. In desperation the party in power has always found the easy way of encouraging medical immigration from poor countries, as a quick fix. The ironic truth is that this trend was set during the mid-fifties by a conservative rightist health minister, Mr E. Powell. He was also responsible of making aggressive speech against immigration, known as 'river of blood' speech.

 

From the very early days the migrant doctors were treated as slave labour, discriminated, and abused. Many published studies during last several years have demonstrated the extent of exploitation and discrimination against these doctors in the NHS. The classical example has been in print recently. An Asian doctor submitted two similar applications for the same job, one with his own name and other under a British name. He was not surprised to receive offers in British name, but none n his own name. He had a shock of his life when he was threatened by police to be prosecuted for the crime of misrepresentation. If the basic human rights of today were to apply retrospectively, many respectable people should be facing charges of racial discrimination and human rights abuses. There was stimulating evidence in a recent editorial in the British Medical Journal (23 June 2001) where it is recorded, 'in the national representative survey by the Policy Studies Institute 20-25% of the white participants admitted to prejudice against Asian, Caribbean, or Muslim ethnic minorities." This finding does not surprise those who have experienced such prejudices. The situation has been apparent for a long time and needed no scientific study to prove wide spread discrimination many thousands doctors have endured. In the NHS, doctors from ethnic origin have been concentrated in unpopular specialities or in areas where home-grown graduates would not dream of working. The membership of colleges and protection societies is still a closed shop, not representative of nearly 30% of ethnic doctors in service. There is published evidence that admission to medical schools by computer scoring was deliberately tempered to discriminate against foreign sounding names. The GMC has been publicly criticised on its record during last fifty years, which clearly shows greater number of complaints and harsher punishment awarded against black doctors. The diagnosis of institutional racism within the medical profession has been made, confirmed by second opinion; it is still waiting for treatment. A book recently published (2002), Racism in medicine: an agenda for change, reflect the true extent of endemic racial discrimination within the whole edifice of so called respectable and humane profession. The number of overseas doctors working as staff grade or as 'locum' for years after years is shameful evidence of open exploitation. Many have been filling-in these jobs, that a fully trained consultant should be doing, but these doctors are forced to carry out such duties at lower salary and amid uncertainty of career.

 

During the fifties discrimination was a legacy of colonialism or imperialism, but in the first years of the third millennium it is a reflection of open exploitation. Unfortunately with all the evidence, there is still pretence among those in a position of power and decision making that the over stretched NHS can offer training to doctors from third world countries. Their hidden agenda is that beggars cannot be choosers and many of these so-called post-graduate trainees will end up filling the service jobs, where they are badly needed.

 

There is another ironic side of the problem; their own organisations have miserably failed them by not taking the cause of these doctors in an honest manner. Though the British Medical Association (BMA) must be admired for infrequently fighting and taking up the union related matters of its members, including those who happen to be from overseas. It is highly advisable that those who pass PLAB and enter the employment must become members of BMA. This is the only organisation that will help you in many different ways. The membership fee is worth every penny and it is tax deductible, the British Medical Journal (BMJ) delivered every week is a mine of up-to-date medical information and a great bonus.

However, in this atmosphere of racial prejudices and untold difficulties, medical migration is still a buoyant industry. The queues are longer than ever, supply is inexhaustible and demand is increasingly selective. It is now generally known that motivated medical graduates from the third world countries, who have obtained better grades and prefer quality training than any job, are opting to go to America. The less motivated, poor performers, interested in any job rather than proper training in a chosen speciality are ending up in the UK. Although no one has produced any evidence in support of such a presumption.

 

A large majority of doctors, who head for the UK, make their move without any hard or thoughtful considerations, great many do not plan with any purpose. This aimless chance taking may be due to utter absence of opportunities in their home country. In reality these doctors are by all definition economic migrants, running away from their country to pursue a career or any career anywhere else. In present state of affairs it is highly advisable for them not to make hasty decision and before jumping on an aeroplane to take the PLAB test and then work in NHS, think carefully, talk to someone who knows better and find a sympathetic senior who may offer sound advice. Your present age and length of th.3 period from primary qualification are two important factors to be taken into account before any other consideration. After certain age junior jobs and on call commitments become difficult, the employing authorities feel justified not offering such posts to an older candidate. Similarly modern postgraduate studies are harder and stress of examination is too much if many years have lapsed between the basic qualification and efforts towards further unending examinations. The whole exercise is quite expensive as well; examination fees, travelling and living for a period in the most expensive cites in the world, will require fairly large initial investment.

 

In the second part, the PLAB test will be discussed in details, information and guidance will be offered to help those that are planning or contemplating to attempt this examination and then seek work in the British NHS. There is no doubt the NHS hospitals need many doctors now and also in the foreseeable future and those who can overcome the hurdle and are successful in obtaining PLAB will be able to find work in the NHS. At the same time the PLAB is not an immediate guarantee of a job, but some patience will eventually lead you to the long heavenly corridors of a NHS hospital.

A brief mention must be made with regard to exemption from PLAB, which is most common question asked by all those who are planning to come and work as doctors in the UK. There can be three possible ways when a doctor qualified from a non-EU medical school, may be exempted from PLAB.

 

1.      A doctor who has marvelled in his fields of performance and has made a unique contribution and made his name as a World expert. If his services are required in the UK by a university or a department, they will organise his placement and exemption.

 

2.      Any doctor who can obtain the sponsorship via British Council for higher training would be exempted from PLAB. This is also a rare situation, only few have achieved such sponsorship. These doctors are usually financed by an academic organisation in their home countries and must return to their original work after a specific training or qualifications in a British academic department.

 

 

3.   The common route is to obtain placement on Overseas Doctors Training Scheme (ODTS). This scheme is run by some of the Royal Colleges. There are about twenty Royal Colleges; all are not interested in training the overseas doctors. In the near past it was relatively easy to use this route. You needed a local senior doctor who can recommend you on merit to a consultant in UK, who is able to offer a trainee job and then recommend to his college for sponsorship. At present the colleges operate their own schemes and sponsor only few who can fulfil the eligibility criteria. The candidates must write to the relevant college, pay the required fee and wait for their turn on the training waiting list. Many doctors are already on the waiting list of this scheme. Those who come under this scheme are allowed a limited registration for a period of about four years after completion, they should return to their country. The addresses of some of the Royal Colleges are listed below; the information may be obtained from the college of your chosen speciality. Those doctors who take the option of ODTS are not allowed to take PLAB and if any doctor who has ever failed in PLAB will not be eligible for sponsorship under ODTS.

 

PLAB TEST

 

In this second part it is intended to give detailed, latest and relevant information to those doctors who are planning to appear in the PLAB test. First of all two important developments must be discussed, which have been introduced as policy by political decision-makers in the UK.

 

Towards the end of 2001 the Department of Health has adopted what may be described as ethical policy towards recruitment of overseas doctors. It is set in a document, Code of Practice for International Recruitment. The guidelines outlined here mainly deal with not to attract doctors from poor or third world countries to fill the manpower deficiencies in NHS. It also applies to nurses and other health care workers. The policy is not based on ethical principles, the reality is different. Many third world countries or so called developing countries, which include Pakistan, have not been able to maintain the standard of their education, the quality of their medical graduates is exponentially decreasing, while opposite is happening in the West. Another development is that the GMC has restricted the route of exemption from PLAB test.

 

Before we discuss the PLAB test, it is desirable to know who may be eligible to sit the test?

The candidate must have primary medical qualification from a medical institution, included in the World Health Organisation (WHO) directory of medical schools. This document is widely available in the libraries of medical colleges and other institutions. The GMC, after receiving an application first time, may also inform the applicant if his/her primary qualifications are recognisable.

 

It is also recommended that after primary qualifications, the prospective candidate should also complete a 12 months clinical working experience from a hospital recognised for registration purposes. It is possible to sit in PLAB without such experience, but then you can only be allowed to work at house officer or pre-registration level. Such jobs are not easy to get since these are allocated well in advance to the newly qualified U.K. graduates.

The other essential requirement is minimum scores in the IELTS test or International Language Testing System. A further restriction is that you must be able to appear and pass the Part I of PLAB test within 2 years of passing the IELTS, in case of lapse the IELTS must be repeated. The British Council offices in many countries conduct this test and information regarding the test and cost must be obtained from the British Council office. There is no restriction .of number of attempts one can try this examination.

The academic module of IELTS is set to test the skills of a candidate, which are essential to carry out academic activities within the higher educational atmosphere. It comprises of four modules of listening, writing, reading and speaking. It is not a traditional pass or fail examination. It awards the candidate scores from 1 to 9, depending on the degree of level of skills exhibited in each module. The lowest level 1 is equal to minimal language skills and level 9 is obviously evidence of possessing highest skills in language. The minimum scores required or expected in IELTS, (academic module) for the purpose of appearing in part I of the PLAB examination are as following.

 

Overall                                 7

Speaking                              7

Listening                              6

Academic Reading                6

Academic Writing                 6

 

It is difficult to list some typical or sample questions, which may be asked in the IELTS examination, except for a general discussion to give an insight regarding the format, might be useful. As mentioned earlier the examination is set for two levels, the Academic Module is for doctors, entry to a university or other higher education for degree or diploma. The General Training Module of IELTS is for those who apply for secondary education and other vocational training and also those who wish to migrate.

 

1. Listening Module. The first part is the listening test, which consists of four sections with forty questions each. It lasts for thirty minutes, after this you have a ten minutes transfer time to reach the next station or place. In this module you might be given a recorde3d conversation or a telephone between two people etc. The recorded material is usually played twice only. Then on the answer paper you would be asked to write answers, which are related to that specific conversation. It might be a form to fill or an incomplete sentence to be completed. There might be picture from where you need to identify details and complete the answers. The varieties and variations of the questions are limitless and far beyond the limit of this paper.

 

2.  Reading Module. The reading part is separate for academic applicants. It has three sections with forty questions and lasts for one hour. You may be given a text of up to 1500-2500 words to read. After reading the given text a number of related situations are to be completed. These might be in the form of pictures or straight questions to answer or many other forms of every-day-.life situations, which must be understood to make correct responses.

 

3.  Writing Module. Next the writing module for academic writing has two tasks to be finished in one hour. In the first part you are expected to write about 150 words. The task might be a report or information from a picture or it might be a graph to fill the information in or write some information from it. Again the varieties of quires are limitless. This part is shorter than the next and you must not devote more than 20-25 minutes on this. In the second part a topic is given and you are expected to write roughly 250 words on it. Out of total one hour you must allow 35-40 minutes to finish this. It must be written neatly and clearly and correctly in grammar and spelling. If you are able to add English proverbs or give a literary touch by quoting from literature, you have the opportunity to enhance your grade.

It is important to make correct responses that careful attention is paid to what is required after listening and the reading instructions. Do not allow yourself to be confused because the format is unfamiliar or there are pictures and graphs, from where information is to be extracted to complete the required answer.

 

4. Speaking Module. The speaking part lasts for about 12 to 14 minutes only. First, few simple questions are asked and you must speak and answer as correctly as possible. Your speech should be in clear voice and your response expressed with some confidence. Next you are expected to talk for 1-2 minutes on a topic given to you. Topics are selected with great care and are usually not difficult. Here the aim is not to test your knowledge but your speaking ability. Even if you know nothing about the subject you can start talking confidently saying that it is a topic you have never heard and your personal knowledge in this area is almost nil, will give you good marks. A non-hesitant, clear and confident normal talking is what is expected.

 

In order to prepare for IELTS it would be useful to adopt conversing in English during your daily life. Reading English newspapers or other material will also greatly help. It is also a good start to listen to BBC World service and watch English language television such as CNN or BBC 24. There are few books available; some of these are listed at the end. One published by Cambridge University is no doubt extremely useful.

 

Now we consider what is involved in PLAB Part I. It is possible to appear in this test in the UK and some other countries. In the UK there are three centres, London. Birmingham and Manchester. Outside the UK it is also held in Cairo in Egypt, four cities in India, Lagos in Nigeria and Colombo in Sri Lanka. In Pakistan it is held in Karachi and Islamabad. In the UK there is one examination every two months and three times a year at other places.

 

At present the fee for Part I is fixed at £145, it may increase during or after 2003, the fee is reviewed and fixed according to ongoing costs. The correct current fee and the dates of examination must be obtained at the time of application and paid according to the instructions. The candidates are also reminded to make specific inquiries regarding any ad hoc changes due to the present political upheaval in the World.

 

Now if you are eligible to appear in Part I of the PLAB and determined to go ahead, you must write to the addresses given at the end, depending where you want to take your exam and request the application form and relevant information.

 

It is absolutely essential that the candidates must correctly write their name and address, when completing the first application. The name must be exactly same in all respects of spelling and format as it appears in the diploma documents. It is also important that same name appears on the document, which you may be asked to produce for prove of date of birth, such as birth certificate, school leaving certificate or a passport. The name on the IELTS certificate must also be same in spelling as on your first application and your primary diploma. Any change in name or spelling will create suspicions, delay and unnecessary enquiries. In case of valid reason of change of name, such as marriage, the original marriage certificate must be available.

 

It is strongly advisable to make an application to appear in the test at least 6 weeks before the date of examination. The candidates in Pakistan must make contact with relevant British Council office confirming the date of examination and obtaining information regarding future dates of the test. Once you have made your first application, a package will be sent to you with comprehensive details, which you must study carefully. The application form contained in this package must be sent with in the time period. The certificate for ILETS must be enclosed with the first application, no other documents, such as the diploma of primary medical qualification is required at this stage. There is a charge if you decide not to appear in the examination. For overseas candidates it is £20.00 (in 2002) if you cancel before the closing date, but the total fee is not refundable if you decide and inform about your intention not to take the test after the closing date. If the authorities due to unforeseen situation cancel the test, full fee would be refunded to the candidates.

 

The candidates, who are eligible to appear in part I, will receive a letter, it is essential to bring this letter and proof of identity, such as passport. All such documents must bear your photograph. In case of change in name after marriage, the original marriage certificate must be produced. Any form of cheating for identification or during the examination is dealt with severely in accordance with the rules laid down by GMC.

 

The part I examination itself consists of 200 questions; its duration is maximum of three hours. A candidate reaching late by 30 minutes may be allowed into the examination hall and no candidate must leave during first half-hour of the examination. All required material for examination is provided; the candidates need not bring any thing. The candidates may be allowed a small bottle of water; no other drinks are allowed or available in the hall. Before the start of examination the senior invigilator will give essential instructions, which might take as much as 30 minutes. The candidates are not allowed to take away any paper or copy of the documents given to them for the purpose of examination, all papers must be returned. It is of paramount importance to listen and carefully follow the instructions given at the beginning by the invigilator.

 

It must also be emphasised that the PLAB Jest is subjected for ongoing improvements, which are carried out in line with the analytical studies. The candidates may not notice many changes, but any procedural modifications are always included in the information package sent to the candidates. Fairness and justice is never compromised and it is always the intention to give correct information openly well in advance.

The examination is set to a standard, which is expected, from a British graduate during his/her first Senior House Officer's appointment. The emphasis is on safe clinical practice, knowledge of relevant investigations and management of patients within a hospital enviournment. The questions are also framed to assess evidence-based investigations leading to diagnosis and logical management. The candidates are expected to have a solid understanding of legal, ethical and practice of medicine in a multicultural society, respecting the believes of patients from a variety of cultural background.

The exam booklet handed over to each candidate contains 200 questions in a format known as Extended Matching Questions. Each question is given a heading, which is called Theme. Under each theme numbers of options are listed in alphabetical order and may be as many as twenty, although on average they are 10 to 15. Then you are given few lines of instructions; these must be read carefully. The instructions are followed by descriptions, arranged in serial numbers. On average five of these are related to one theme. The candidates must select the most appropriate option and fill the relevant oval circle, which are printed on the computer readable answer paper. These circles are filled by the lead pencil provided during the examination and no other pen or writing material must be used. This paper has 1 to 200 choices; each numbered choice has A to T or twenty possible options. You must select and mark one of these. The options may be selected once, more than once or not at all, which is always mentioned in the instructions. The format of the questions is listed in the sample, which is included in the packet sent to all the candidates, it is essential to read and fully understand the format from this document.

 

The preparation for the PLAB examination is of same standard as final MBBS or a medical graduate level. It is highly recommended that you take PLAB as soon as possible after your graduation. If it is left longer more difficult and painful it feels. Those who are lucky to travel and plan to take part I PLAB in the UK will get huge benefit if they are able to organise permission as a visitor or observer for the teaching programme in a NHS hospital. Such a visit is not difficult at all if you can obtain personal sponsorship of a consultant in a hospital. Even if you do not have a personal contact, it is worth to request an appointment with the tutor of nearby Medical Education Centre and seek permission as an observer. Most medical teachers are extremely kind and sympathetic. It is further advised to try to observe the British trained House Officer or Senior House Officers, during their working hours and the way they approach and communicate, take the history, investigate and manage their patients. Preparing for PLAB in isolation, only reading from books without the knowledge of practical implications, is depressing and hard going may result in disappointment even after hard work.

It is difficult to recommend books or other reading material, which might help during the preparation of PLAB. There are few books recently published, which claim to be written specifically to help pass the PLAB. Most are collection of multiple choice questions with minor changes here and there to give them a different look form one another. It is advisable to follow the universally accepted textbooks. At the same time it is also useful to study and practice the Extended Matching Questions. Few books recently published are listed below. All medical books may be obtained through BMJ bookshop online.

 

A recent copy of the British National Formulary is also extremely important to look at the names and doses of common medicines. This volume is sent to every practising doctor in UK free and any doctor if approached may be able to give away previous copy.

 

There are a few courses advertised for PLAB, most are in London, these are solely private affair and not organised by any recognised educational or professional organisation. They are fairly expensive and are outside any quality control mechanism.

It is also advisable to learn the diseases, syndromes and other clinical titles, which generally appear in medical text books and are associated with someone's name. Few examples of these eponyms are, Alzheimer's disease, Gullian-Bare syndrome, Reiter's syndrome etc. Their clinical presentation, investigations, diagnostic features and treatment are often included in the PLAB examination.

 

The date of the result will be announced at the end of each examination. In the UK the results will be posted on that date and in most cases delivered at the candidate address next day. For those who have taken examination out- side the UK, the results may be collected from the office of British Council on the previously announced date. Those not collected will be posted. No other method like phone or fax can be used for obtaining the results.

If you fail the part I, there is no appeal mechanism, the decision cannot be challenged. You will receive further application form and allowed an opportunity to appear again. If you are lucky to pass the part I, another package is sent to you, which contains instructions regarding part II PLAB examination. This means you start preparing for the next hurdle.

Part II PLAB can only be taken in the UK; it is not held anywhere else. So after passing the part I, you must start organising not only the academic preparation for the examination, but also make travel arrangements to appear in part II in the UK. This also requires obtaining visa from the British Consulate. The second part of the PLAB is a practical clinical examination and it is also designed to assess the communication ability in spoken English language.

The present fee for part II is £ 430, the correct fee for the exam would be mentioned in the information packet along with other important documents. Those who have passed part I of the PLAB must clear part II PLAB within 2 years and maximum four attempts are allowed. If a candidate is not able to pass within the prescribed period he has to appear in PLAB part I and the IELTS test again. This restriction seems to be harsh but it is the rule. The part II is held ten times a year in different major cities in the UK. These centres are listed in the instruction package and the candidates may make their choice of any centre.

On the day of examination you must arrive before the time, after usual checking you will enter the hall. The examination is set on Objective Structural Clinical Examination; the aim is to assess you in five different skills.

 

1)   Taking history and reaching some logical provisional diagnosis.

2)   Performing physical examination and making relevant notes.

3)   Communication in a clinical enviournment.

4)   Performing a practical medical task.

5)  Managing an emergency or urgent situation.

 

Every candidate is asked to perform 14 different tasks at 14 stations. All 14 tasks are obligatory. At the entrance you will be given the number of the station from where your examination will begin. The instructions regarding the task will be found outside each station, these must be read carefully and followed strictly. These instructions are short, concise and relevant to what is required of you. For example you might be asked to take a short history of a patient, who has slipped and injured his wrist. A bell will ring to indicate that you can enter the station and start performing the task set in the instructions. There would be an examiner inside, you may not talk or ask any thing, unless it is in the instructions. Another bell will ring after four minutes thirty seconds, reminding you that only 30 seconds are left. A final or third bell will ring after five minutes when you must finish and leave the station. Now you should go to your next station, read the instruction for one minute and enter the station at the bell. This process will be continued till you have completed all the 14 stations. There are two rest periods and the whole process takes about hour and half. During the examination at some stations you may encounter a model or a patient, who is usually an actor trained to pose specific symptom or sign or disease. Some other form of clinical material or medical instrument may be presented to test your skills. It is important you concentrate at each task at the stations and must not allow a set back in a previous encounter to adversely affect the next situation.

 

Again to record here a selection of sample questions in the style of OSCE is quite an impossible task. Only a quick insight may be offered, for real questions it is advised to read one of the books listed at the end of the paper.

 

A radiograph or an X-ray picture is always available to most of the candidates to interpret or give a diagnosis or depict the positive finding. In most cases the features are quite obvious and no attempt is made to trap the doctor under going examination.

 

Similarly an ECG interpretation is also a common feature, it is important for the doctors coming from less developed countries to make themselves familiar with the 12 lead ECG and how the various leads are placed on the paper. It is generally expected that the candidate would be able to recognise at least three features from the ECG. It is strongly advised that doctors must learn the first and basic rule of finding the heart rate from the trace. In a normal trace with standard rate the paper moves, if you count number of large squares and with this figure divide 300, the result will give a reasonably accurate pulse rate. Such very basic knowledge will give you a good moral boosting start in the very beginning of the examination.

 

Many doctors would be asked to take blood pressure of a patient present at the station. There might be a manikin, in such a situation you must not talk to the plastic dummy, you explain to the examiner the procedure you are asked to perform. If for example you are asked to take the blood pressure, it is important that you introduce yourself to the patient and then explain what you are going to do. You must select a proper size of the blood pressure cuff, which must be applied to the arm so that the pulsating artery lies under the middle of the rubber bladder and not the middle of the whole cover of the cuff. It is also important to point out that you will take the reading from both the arms. Important steps of the whole procedure must be explained step by step and must be carried out in the allotted time, which is about five minutes or less.

If for example you are asked to draw blood from a patient, you must introduce yourself, explain the procedure to patient, and ask if he or she permits such a procedure. Then make sure you wash your hand, put gloves on and see that all the equipment needed for the procedure is available. It is also important to explain if a procedure or examination is being carried out on a female by a male doctor that a chaperon or another suitably qualified person is present. Such basic requirements are difficult to learn from the books, it is better to find a place as an observer in a hospital is.

 

At this stage it seems important to mention that doctors hoping to find training jobs in NHS hospitals must also appreciate that it is essential for them to learn basic expertise in using computers. At present there is no test to assess such skills but it must be emphasised that basic computer skills are now extremely important for all doctors and if they are computer illiterate they will soon be made aware how big handicap it is towards progress. All pathological reports patient's notes, literature search for studies and examinations are computerised. In short computer literacy for those that qualified from under developed country and did not have access to a computer cannot be emphasised more.

The marking is fairly complicated; the examiners at each station will observe your performance on different objectives, which are related to the five skills listed above. The examiner allocates grades A, B, C, D, or E, for each objective. In order to pass, a candidate must obtain overall grade of C or above in minimum of ten out of 14 stations and will not be successful if he/she gets grade E more than once.

 

It is said that the pass rate in final PLAB is fixed for each examination. This means it is dependent on the level of standard of the candidates in each examination and the participants are in a way competing with each other. But the pass rate in PLAB has varied from under 30% some years ago to over 50% at present. The success rate among doctors from Pakistan is lower when compared with some other countries. This is yet another indicator of decreasing standard of medical education in Pakistan. This trend would be appreciated more accurately if those doctor who fail the ILETS and never get chance to fail PLAB is counted in the equation. The policy of any developing country to go on opening new medical schools and ignoring the need of high quality teaching and research staff for those started some years ago, is an irresponsible policy based on ignorance. There is a perception that pass rate in PLAB is also dependent on number of doctors needed to support the NHS requirements, and the current pass rate has reached 60% because the demand at present has touched the peak of all times. But some other will argue that the improved results are due to the introduction of new methods of inquiry in the examination and selection, which has changed the situation to present higher pass rate in PLAB. In order to find the truth an in-depth un-biased inquiry must be carried out. At the moment no organisation is interested in financing such a research.

The results are sent to your address shortly after the examination. If you fail, further information and application form is posted to you. Those who pass are allowed to apply for suitable jobs. This is the start of yet another struggle. Many disappointments and frustrations are still in the waiting. But one thing is sure that sooner or later the NHS will come to offer you an opportunity for a career. Probably first appointment may be frustratingly difficult, once you are able to reach the first step on the ladder and you show the ability of hard work the opportunities are unlimited. The present drastic shortages of doctors in NHS offer to many doctors an opportunity to carve a great carer.

Success in final PLAB is not a guarantee of a job, but beginning of further struggles. It is highly advisable that you must not waste time while waiting the response after submitting applications for hospital jobs. More resourceful people will go around to neighbouring hospitals, meeting the tutors or any other contacts and try to obtain permission as an observer. Such positions can be arranged by directly meeting a consultant or making a request to any other doctor. Once you are in UK you have to register with a General Practitioner, you may request him/her to help you find a position in the local hospital. All doctors are generally sympathetic to a fellow doctor in need. This is also the time to organise your curriculum vitae and prepare for the interview. It is highly advisable that one CV must not be sent with every application. The CV and application has to be specific for the job you intend to apply. You must read the advertisement carefully and prepare the CV to suit the requirements of the job description. You must pay special attention to the instructions from the advertiser and fill the forms neatly. The CV is your opportunity to give all the positive information about yourself that will help the panel of selectors to choose you for the job you have applied. Make sure there are no spelling mistakes, the CV is neatly written in an organised fashion. These days every doctor is expected to be able to use a computer and printer for such primary requirements. You can hire the services of professional  CV  writers  if you  can afford  such  an  expense, which will  prove worthwhile. The contact telephone numbers of CV writers may be found in the career section of BMJ, which is available fresh every week in any hospital library. Do not create confusions or ambiguities in answering whatever questions are asked. Basic information such as names, date of birth, address etc must be recorded correctly and uniformly every time in each application. Always keep a copy of the application and refresh you memory before the interview. Any inconsistency or mixing up facts during interview from those in application will be disastrous. Be prepared to answer some purely clinical questions during the interview. The consultant of the department, where the candidate is going to work usually asks such questions. The rational of such questions is to give you understanding of the working or policies of the department. The interview panel is chaired usually by the non-medical senior member of the trust or a local dignitary, then there might be six or eight other members. At least half the members on panel are consultants. Most important member is the consultant of the department where you will be working. The non-medical members always try to be helpful and may try to make you relax by asking questions regarding your hobbies or some other personal questions. If you are knowledgeable in cricket then you can take fair advantage by bringing this subject, you will immediately find some one jumping with delight and involve you further in cricket conversation. If such a lucky thing happens consider you got the job. The representative from the administration might ask you blunt questions, such as that you have no police record or suffer from AIDS etc. This is his duty and you must not feel insulted. Holding a clean British driving license is a credit, which must be recorded in the CV and mentioned during the interview if enquiry is made.

During an interview and even while you are conversing with senior colleagues it is not appropriate to use 'sir' repeatedly, too much use of the prefix 'sir' is irritating and sound strange to the person you are talking. It is a common observation that doctors from Pakistan are in the habit of saying 'sir' even to a female. Such a style of addressing sounds not only comical it is also a display of servile mentality. This becomes somewhat impertinent when a doctor will call sir' to a white individual but not to a black person on the panel, who might be the head or director of the department or senior most among all those on interviewing panel. Only professors and teachers out of respect are addressed as 'sir' and that also not too many times. If a senior doctor or consultant is greeted in such a manner then it must be within a reasonable manner and without projecting yourself too much a docile or subservient and never address a lady as 'sir’.

When selected for a hospital job, the recruiting department of that hospital will inform the GMC, a limited registration will be automatically allowed. The GMC will also continue your performance under observation for 12 months. A detailed report will be required from the consultants under whom you will be working. This is not just a kind of letter of good conduct but about 8-page long specified performance report. It includes many aspects, which can not be assessed in any form of examination, only close observation by experienced clinicians make final judgement during a minimum of 12 months period. A favourable report and compliance of other requirements will allow renewal of limited registration. The limited registration is renewable every year and it can last to a maximum of five years. During this period the holder will remain in hospital trainee appointments. It is important you must apply for renewal of the limited registration at least three months before the expiry date, otherwise delay may create a situation that you may have to leave the appointment due to the registration is deemed expired. If you have seriously devoted time and efforts and passed the required postgraduate examinations and proved yourself suitable to progress to higher positions, you can apply for full registration. Here you may be reminded at this stage that you will need resident visa during this period, for this and other related matters see below.

Another route to progress for full registration with the GMC is by appearing in the examination organised by the United Examining Board. The qualifications are equal to medical graduation from a recognised medical school. By passing this examination you are awarded L.R.C.P. L.R.C.S. or L.M.S.S.A. from London or Edinburgh or Glasgow. This used to be called in old days the Licentiate qualifications and now a single body called The United Examining Board holds the examination. The regulation 38b allows a doctor qualified from outside the European Community and without PLAB to appear in Licentiate examination, a person failed in PLAB is not eligible. There is another condition, that such a doctor must have completed an appropriate period of assessment at any UK medical school. This last condition is perhaps left vague and ambiguous purposely. This route may prove useful for those who have been selected for ODTS and cannot appear in PLAB. The regulations and other detailed information for this examination may be obtained from the listed addresses recorded below.

 

Admission to a British university for an overseas candidate is open to any student if the pre-admission requirements are fulfilled; it also applies to admission to a medical school. But no one seeks admission for an under graduate medical course from other countries. The medical course lasts five years and the current rate of about £20,000 per year is obviously prohibitive. It is going to increase in near future when even the British citizens will be forced to pay a substantial amount for the university education.

A doctor who has completed the required training posts will be finally eligible to progress for senior posts, such as consultant in hospital practice or a General Practitioner, if you have opted to train in this area. In order to reach here one must advance in an orderly fashion, completing the postgraduate qualifications and required training during a specified time. A detailed discussion and tips for successful progress on the ladder of medical career is not appropriate here. This is a long self-learning process, which must be learnt over a period. Although the long and all the way uphill struggle, which a newly PLAB qualified doctor faces and has to overcome plenty of ups and downs, he should not necessarily always end-up in the abyss of failure.

 

Once a doctor has obtained full registration he/she may pursue any career within medicine or out side the mainstream of medicine. There are possibilities for a doctor to train and qualify in Sports medicine, Travel medicine, law, medical journalism, medical ethics and philosophy and many others. Majority of doctors unfortunately has quite a narrow view and fixation that clinical medicine is he only profession they can or must peruse. Pharmaceutical industry is one of the largest employers in the World, where medically qualified people can find divergent and at the same times well paid openings. It used to be an area for older or those who failed in medical career, it is now quite popular among younger medical graduates, who find it exciting and fulfilling. A medical careers guide in the list of books may offer useful reading for further information. According to Conservative Party sources it is estimated that one in four British medical graduates decide not to enter clinical medicine after graduation.

Unfortunately there is no system in place from where a new in-experienced doctor in strange surroundings may turn to and seek guidance. The office of the High Commission has the moral and legal obligation to make arrangements to facilitate an advisory service. It is most disappointing state of affairs that thousands of doctors working in the UK never have any contact with their own official representatives. The only time you visit is when the passport needs renewing or visa is required. These doctors are important and reliable source of foreign currency for their country; they are also good image-makers due to their work in the community. An imaginative representative without any financial implication may organise a group of well-meaning eminent medical volunteers in an advisory capacity. In the absence of such a possibility a new doctor is advised to seek similar help from a consultant or a senior general practitioner. There is no harm in making an approach, no two individuals react in the same way, and if one is unhelpful another might be unexpectedly sympathetic.

 

In recent years few non- profit organisations have been set, which offer advice and some financial support to those doctors who have arrived as refugee or asylum seekers. This organisation for example will pay the fee for appearing in IELTS and PLAB examination, GMC registration fee and try to help them in many other ways. The current desperate shortage of doctors has influenced the government to give these groups substantial financial grants. These schemes are also supported by BMA and a refugee doctor may seek help and information by contacting BMA international department.

In the following pages few legal case histories are recorded and then there are details regarding purely legal matters of immigration, which highlight various problems a doctor might face. Some of these are quite complicated legal matters and may not be of general interest, but these are included here to give the readers an opportunity to appreciate the complexity of all the aspects in the area of migration. An overview of these problems would no doubt be beneficial.

 

Case Study One: Doctors; foreign qualifications, registration of non UK and non EU qualifiers, comparability test not applicable to non UK and non-EU applicants. Legislation Medical Act 1983 Section 19 and Section 25.

R v General Medical Council Ex parte Virik (1996) I.C.R 433 (1996) 8 Admin L.R. 325

 

Dr. Virik, who had qualified and had experience as a doctor in India, was given limited registration under the Medical Act 1983 when he came to the UK. After holding hospital posts in the UK for a number of years, Dr. Virik applied under section 25 of the Medical Act 1983 for full registration, but this was refused by the GMC. His application for judicial review of the refusal was successful in that the decision was quashed (see Times Law Report February 17th 1995). Although mandamus and declaratory was refused the GMC appealed, they contended that in view of the distinction under the Medical Act 1983 between doctors qualifying in the UK and EU and those qualifying elsewhere, and further distinction between doctors with '"recognised" qualifications where full registration was immediately available and those with "acceptable" qualifications who were eligible for only a limited registration, no single standard should be applied. They argued that the high court Judge had erred in finding that Section 25 required the GMC to make a comparison with equivalent applicant from the UK or EU. Dr. Virik, on the other hand contended that the comparability test in Section 19 (?) must be imported into applications under Section 25. The Court of Appeal held, allowing the appeal that on a proper construction of Section 25 there was no express requirement for a comparability test, or anything to suggest that it should be included. In determining the application under section 25 the GMC had to make a valued judgement to decide whether an applicant was suitable for full registration.

 

Case Study Two: Doctors: Race Discrimination; Time Limited; Registration of Doctors Qualified Abroad.

In Rovenska v General Medical Council, (1997) 3602 43264 Jurisdiction UKEW

 

GMC appealed against the decision of the Employment Appeal Tribunal (EAT) to the Court of Appeal (CA) allowing Dr. Rovenska appeal from the decision of the Employment Tribunal that she was out of time for making a complaint of racial discrimination. Dr. Rovenska was a Czechoslovakian doctor of nine years standing, who had worked in British hospitals for a further eight years. In order to qualify for a limited registration Dr. Rovenska took, and twice failed the test of professional linguistic ability from which qualified doctors from EU and certain former British Colonies were exempted. Dr. Rovenska applied for and was refused exemptions from the test on four further occasions and finally complained of racial discrimination. The GMC contended that EAT decision meant there was be no limits to the claims that could be made against them and that proceedings of discriminatory practice, rather than individual acts of discrimination could only be brought by the Commission for Racial Equality. The Court of Appeal held, dismissing the Appeal for different reasons and upholding the decision of the EAT that Dr. Rovenska's claim was a claim if discrimination and if GMC's exemption rule was inherently discriminatory, then it would be so on every application for exemption. Dr. Rovenska's latest letter asking for exemption was a valid application and was within the three months time limit. It was therefore unnecessary to consider whether it would have been just and equitable to consider the application despite it being out of time. (See also Sougrin v Haringey Health Authority).

 

The Rules for Entry Formalities and Visa to work in UK

 

After passing PLAB I the doctor must start the process of obtaining a Visa from the British High Commission or Embassy. Such a process is in fact a major part of immigration control, which is operated by the British Embassies, High Commissions. Consulate Offices and Missions. The screening before visa is granted has become an increasingly important feature of immigration control as a result of recent changes in the law. All these changes are within the remit of the Immigration 1971 Act, the 1983 Act, the 1993 Act, the 1996 Act, the 1999 Act and 2002 Act.

The Entry Clearance is defined by Immigration Act 1971 Section 33 (1) as amended:

"A visa, entry certificate or other document which, in accordance with the immigration rules is to be taken as evidence or requisite evidence of a person's eligibility, though not a British citizen, for entry into the United Kingdom (but does not include a work permit)"

The entry clearance system is a means of regulating immigration before arrival in the United Kingdom. It involves the processing the applications to enter the United Kingdom. The central plank of the system is the requirement of the law that certain categories of entrant such as student, doctors taking the PLAB test and/or taking postgraduate training must have obtained entry clearance before arrival. Someone in one of these categories who arrives without entry clearance will normally be refused entry. Entry Clearance is therefore a means of establishing, in advance of arrival, that you are qualified to enter the United Kingdom. Note that holding of an entry clearance is not an absolute guarantee that the holder will be admitted.

 

A doctor may be admitted to the United Kingdom as a student or a visitor as set out in HC 251 and 395 (as amended from April 1997) to take the PLAB Test. The entry clearance office and the immigration officer has to be satisfied that the doctor is genuinely seeking to enter for a limited period as stated by him or her and intends to leave the United Kingdom at the end of the period of the visit as stated by him or her and is eligible to take the PLAB part II. Such doctor must also satisfy that he or she is able to meet the cost of his course, accommodation and maintenance of self and any dependants without taking employment or engaging in business or have recourse to public funds.

The Entry Clearance Officer (ECO) under the rules will assess your intention, as you will appreciate there is no hard and fast method available to the intending student to prove that he has the required intention to leave on completion of his studies, much may depend on what the applicant says when interviewed by the entry clearance officer or immigration officer. Intending students will typically be questioned in some detail about their future plans and about the use to which they intend to put their qualification that the student might have achieved during his stay in the UK. The officer will be more easily satisfied if the student is able to offer a realistic and coherent career plan. Any evidence of incentive to return to the home country will help to satisfy the officer. For example the chances of obtaining entry clearance can be enhanced by the production of bank statements, ownership of properties, supporting letters from present or prospective employers from home country are valuable documents.

 

The immigration rules make special provision for the entry and stay of doctors and dentists seeking training. Their position is covered by HC 395 PARA 70 which says that either they have graduated from a United Kingdom Medical School and intending either to undertake a year's pre-registration experience, or are eligible for limited registration with the General Medical or General Dental Council and intend to do postgraduate training in a hospital They may not spend more than four years in aggregate, in this training. Leave to enter or remain would normally be given for a year at a time, up to a maximum of four years. The rules are now more liberal in that there is no longer a requirement that for pre-registration training must be in a medical school in the United Kingdom, they provide for specialist training in the Community Health Services as an alternative to a hospital and defines the permissible training posts with more clarity (see HC 251, paragraph! 13, 114 and HC 338).

 

The doctor cannot spend more than one- year as pre-registration house officer nor more than four years in aggregate, in posts at Senior House Officer or equivalent level, and they must intend to leave the UK at the end of their training period. They will normally be admitted for 12 months initially, and may be granted yearly extensions up to a maximum of four years and doctor must show that they can maintain and accommodate themselves and any dependants without recourse of public Funds. The spouses and children are eligible to enter on the same terms as those of the doctors.

 

It should also be noted that immigration rules specifically state that student doctors and postgraduate doctors must intend to leave the United Kingdom at the end of their course or period of training. However, due to the recent shortage, a concession outside immigration rules was announced by the Secretary of State on the 17l October 2001, which waives this requirement for doctors. Here it must be noted that at the time when you are interviewed by the ECO you should confirm that you would return upon completion of your training to your country of origin otherwise the Entry Clearance would be refused.

 

Work Permits (working after studies)

The Secretary of State recognised that there was a shortage of doctors in the United Kingdom and it cost on average two hundred and fifty thousand pounds to train a student to become a doctor. The Immigration Act 2002 recognised that students with degree level qualifications have a potential to produce a valuable benefit to the UK community. The 2002 Act and rules therein explicitly permit doctors to switch into work permit employment. Doctors could therefore switch their category to a work permit for a maximum of four years without having to leave the United Kingdom.

The change of the doctor's status normally would be granted if the doctor holds a valid work permit issued by the Work Permits (UK). This grant of leave and actual work permit both are now issued by the Work Permits (UK). The doctor does not have an adverse immigration history and if the doctor was sponsored by his/her governmental organisation or an international scholarship agency as a student, must also obtained the consent of such an organisation.

From 2001 Work Permits (UK) has been part of the Home Office Immigration and Nationality Directorate, although it remains based in Sheffield. A sponsor will normally be the employer such as a Health Authority, who wishes to recruit a skilled person from outside the EEA on a full time basis to fill a vacancy available to workers resident in the EEA. As the Secretary of State announced that there is a shortage of qualified doctors, therefore the procedure is easier under tier one (Work Permits Scheme). As the doctors (Healthcare) occupation is listed in tier one the Employer does not have to advertise the job, the employer only has to fill in application form WP1 giving details of the job, experience and qualifications of the person concerned. Up to date information, which is kept on the Work Permits UK Website.

There are four basic considerations: -

 

1.      Is there a genuine vacancy for the applicant?

 

2.      What skills or qualifications and experience are required for the employment (the 'skills' threshold).

 

3.      Does   the   applicant   possess   the   appropriate   skills,   qualifications   and experience?

 

4.      Are there suitably qualified or experienced 'resident workers' available?

 

The spouses of work permit holders may qualify to accompany or join a work permit holder in the UK (see HC 395 paragraph 295J and 295L). The families applying for the UK entry must obtain clearance from the British High Commission. They have to prove the relationship with the work permit holder and they will remain in the UK on the same terms as the work permit holder and that there is adequate maintenance and accommodation for them in the United Kingdom without recourse to public funds. Unmarried children of the work permit holder under the age of 18 will also be entitled to remain or join their parents provided both parents live in the United Kingdom. Single parents must show that they have a sole responsibility to a child under 18.

Under the rules it is possible to change your employment, but change of a job is only permitted if you first obtain a new work permit or permission from the Work Permit (UK). To extend or change the work permit it is necessary for the employer to complete the necessary forms. The doctor who already has a work permit there are no restrictions within the immigration rules to take additional work of a similar nature on a part time basis with a different employer outside the normal working hours. It is not necessary to obtain permission or variation of your leave to remain from the Work Permits (UK).

Doctors as work permit holders pay National Insurance (NIC) contributions and income tax to the Inland Revenue. They are therefore entitled to benefits such as contributions-based job seekers allowances, free NHS medical treatment and free education to their children under the age of 16. It should be noted that doctors in such position are unlikely to be able to extend their work permit because they are prevented from access to non-contributory benefits, they were admitted under the immigrations rules with the condition that they will not have recourse to public funds and able to maintain and accommodate themselves without recourse to public funds.

Rights of a doctor as work permit holder under the employment law are same as any other worker (EEA National), the doctor will have the right to join BMA or any other trade union, and negotiate any employment rights. However it is prudent and advisable that such doctors may be deterred from getting into disputes and or making any complaints against the employer, by the facts that the doctors training, registration with GMC depends on the good relationship with the employer. Further chance of remaining in the UK usually depends on extending the work permit.

 

Higher Skilled Migrant Programme

 

The Immigration Act 2002 is designed to meet the shortages in the sector of the UK's economy. The Higher Skilled Migrant Programme (HSMP) allows an applicant for example a doctor to enter the United Kingdom without first obtaining an offer of employment. The Programme is designed to allow individuals with exceptional personal skills and experience to come to the United Kingdom to seek and take work. Such individuals are assessed on a scoring system. In order to qualify a doctor must provide evidence and demonstrate a score of 75 points or more. The scoring areas are educational qualifications (for example a maximum of 30 points for those holding a PhD), works experience, past earnings, achievements in the chosen field.

The HSMP priority application is to encourage people particularly in the Healthcare Sector and is also designed to provide an avenue for general practitioners to qualify under this Scheme. You must show evidence of vocational training for medical practices. Leave to enter United Kingdom is granted for twelve months initially with a possibility of three years extension at the end of that period and indefinite leave to remain after four years. Details of the HSMP can be found on the Home Office Website below.

Indefinite Leave to Remain

 

If a student has lived legally (with visas) in the UK for more than ten years without any adverse immigration history the student may apply to remain in the United Kingdom indefinitely.

After completing four years service under the Work Permit a doctor can apply to the Home Office for a settlement in the United Kingdom. The doctor should make an application using form Set (0). The form sets out details of what documents need to be submitted. Before applying for such settlement the doctor must be sure that there has been four years continuous residence. If there has been a period of unemployment or absences from the UK this is not usually treated by the Home Office as a break in the continuity of employment. Short absences such as holidays, consistent with annual paid leaves or business trips are also disregarded. The family members will also be granted a settlement visa and children who have turned 18 provided they have not married and the parents financially support, them as dependants will also be eligible.

 

Right to Appeal

 

At the present, if the Work Permits (UK) refuses your application, you are allowed to appeal by completing an application to the Work Permits Appeal Team. The appeal must be lodged within twenty-eight days from the date of the decision and normally the Work Permit Team should give you a decision within fifteen working days. The application will be considered on paper without any oral representation or hearing. The Work Permits (UK) are now introducing a fee for assessing the application and therefore in order to comply with the Human Rights aspects; a doctor must be given right to appeal.

The doctor also has right to appeal to an Adjudicator Tribunal known as Immigration Appellate Authority (IAA) against a refusal of Entry Clearance, leave to enter or leave to remain as a work permit holder. The doctor only has a right to appeal if a work permit has been issued (see Immigration Act 1999 section 59 (7)(8) and section 62 (1) (2). The appeal generally concerns whether the Work permit criteria has been satisfied and whether the doctor intends to take other than the stated work in the work permit and whether he intends to leave on expiration of his work permit. The appeal to the adjudicator is not about the issue of a work permit.

The doctor may also have a right to appeal to the Immigration Appeal Tribunal (IAT). First the permission to appeal to a Tribunal must be obtained by way of a paper application. If such permission is granted by the IAT, then the appeal will be heard by way of oral hearing. In the case the Tribunal refuses permission to appeal you may seek judicial review to the High Court, however the Immigration Act 2002 makes various changes to such appeal system. The jurisdiction of the IAT has now changed and the appeal lies only on point of law. This has given many concerns as the appellants may no longer be able to obtain redress through an application for permission to appeal through a IAT, for example where fresh evidence demonstrates miss-direction by the adjudicator or where an error or omission by the representatives have caused a case to be dismissed. The judicial review will no longer exist as a mechanism to challenge a refusal of permission to appeal by the I AT. The new procedure will be challenged by way of 'statutory review". The application can be made to the High Court and determined by a single judge on paper only with no power for a judge to adjourn for an oral hearing. The test will be whether the applicant has an arguable case, if so the judge will remit it to the IAT. If the application is refused, there is no right of appeal in the Court of Appeal.

 

There is no justification in removing such an appeal. The judicial review is a form of a constitution appeal with a right to a hearing. The changes in the appeal system have removed the basic right of an appeal. The government hopes that the new procedure and that the tests will be that there may have been an error of law, rather than there has been an error of law. It remains to be seen what test is in fact applied.

The procedure for statutory review will be set out in the new Civil Procedures Rules and the Lord Chancellor gains wide new rule making powers including provision for cost orders to be made and further a person commits a summary offence if without reasonable excuse he fails to comply with the requirement imposed in accordance with the rules make by the Lord Chancellor to attend before the adjudicator and give evidence or produce a document. It is not clear how the 2002 Act will work in practice or how the Lord Chancellor's powers are going to be used. There are concerns that the Act comes into form on 1st April 2003 as the Act is not fully published yet and in addition there are only a few safeguards against abuse of fundamental human rights.

 

Dr Nasim H Naqvi FRCA

Retired Consultant Anaesthetist

 

Dr Liaqat A Malik, LLM, PhD (Manchester)

Law Society's Immigration Law Panel Member

Member, Chartered Institute of Arbitrators (Lawyer specialising in Public,

Immigration and health care law working with ethnic communities).

 

 

 

 

 

Following are some useful addresses, telephone numbers and Email addresses.

 

First Application Service

GMC

178 Great Portland Street

London

W1W5JE

UK

 

Candidate Services Tel 44 207 915 3727 Fax 44 207 915 3558 E-Mail plab@gmc-uk.or£

Application form may be down loaded from this website, www.gmc-uk.org/register/plab.htm

 

The British Council 20 Bleak House Road Near Cant. Station PO Box 10410 Karachi

Tel 21 5670391-7 Fax 21 5683694 E-mail. Irum.Fawad@bc-karachi.bccouncil.org

 

The British Council

Block 14

Civic Centre, G-6

Islamabad.

Tel 51 111424424 Fax 51 111 276683 E-mail, shahnaz farooq@bc-islamabad.bcouncil.or^

 

BMA International Department BMA House, Tavistock Square London WC1H9JR

BMJ Bookshop

Tel. 0207 387 4499 (www.bma.org.uk) E-mail, info.web@bma.org.uk

 

The United Examining Board, Apothecaries" Hall Black friars Lane, London. EC4V 6EJ

Tel 0207 383 6244

Fax 0207 383 6455

E-mail. orders@bmj bookshop.com

Tel 0207 236 1180 .   Fax 0207 329 3177

 

Royal College of Anaesthetists 48-49 Russell Square London. WC1 B 4JY

Tel 0207 813 1900 www.rcoa.ac.uk

 

Royal College of Physicians 11 St. Andrew's Place Regents park London NW14IE

Tel 0207 935 1174 www.rcplondon.ac.uk

 

Royal College of Surgeons of England 35/43 Lincoln's Inn Fields London WC2A 3PN

Tel 0207 405 3474 www.rcseng.ac,uk

 

Royal College of Obstetricians and Gynaecologists 27 Sussex Place Regents Park London NW1 4RG

Tel 0207 772 6200 www.rcog.org.uk

Tel 0207 387 7765 www.mwfonline.org.uk

 

Medical Women Federation

Tavistock House North

Tavistock Square

London WC1 9HX

 

This organisation may advise women doctors on specific issues of sex discrimination

etc.

 

Society of Doctors in Law 42 Gibson Square London Nl ORB

No Tel is listed in directory.

 

Medical Journalists Association 5 St James' Road Tunbridge Wells TNI 2JY

 

Malik Laws Solicitors, Cheetham Hill Chambers 577/579 Cheetham Hill Road Manchester, M8 9JE. UK.

Tel 01892 515857

Tel 0044 161 795 6217

Fax 0044 161 740 9949

 

Home Office,

Immigration & Nationality Directorate,

Lunar House,

40 Wellesley Road,

Corydon, CR9 2BY.

www.ind.homeoffice.gov.uk

Tel 0044 0870 2410645

 

Work Permits (UK)

Home Office, Level 5,

Moorfoot,

Sheffield, SI 4PQ.

www. workpermits.gov.uk

 

British High Commission, Diplomatic Enclave, Ramna 5, P.O. Box 1122, ISLAMABAD, Pakistan. www.britainonline.org.pk

Tel 0044 114 259 4074

Tel 0092 512206071/5

 

Some of the Books listed here may be useful for preparing the IELTS and PLAB test and may also offer much useful relevant information.

 

ILETS To Success. Preparation tips and practice tests. Eric van Bemmel, J. Tucker. Hawthorn, Melbourne. 1997. ISBN 0471339032

 

A Book for IELTS. S. McCarter, J Eastern , J. Ash. IntelliGene. 1999. Comes with audio tapes. Address for orders: Drs. B A and G M Haddock, InelliGene, Woodlands, Ford, Midlothian. EH 37 5RE. UK.

 

Insight Into IELTS. The Cambridge IELTS Course. V Jakeman, C Mc Dowel 1, Cambridge University Press. 1999. ISBN 0521011485

 

PLAB-1000 Extended Questions. Una Coales. RSM Press, 2001. 282 pages, ISBN 853154725. £17. 50.

 

PLAB 2. 100 Objective Structured Clinical Examinations. Una Coales. RSM Press. 2001. 258 pages. ISBN 1853155039. £ 19.95. This is the only book at present, which deals with the OSCE or the second part of the PLAB. It also gives a list of medical textbooks published recently, which a doctor preparing for both PLAB I and PLAB II may find helpful.

PLAB Made Easy. KP Babu. Jaypee Brothers, 2001. 244 pages. ISBN 8171798527. £ 10.99.

EMQs For the PLAB. Sherif W. Helmy, Kefah M. Mokbel. LibraPharm Limited. 2000. ISBN 1900603721

 

PLAB Part I EMQ. Pocket Book I. Jonathan Tremi. Pastest Limited. 2000. ISBN 1901198561.

 

PLAB Part I EMO. Pocket Book 2. Peter Kroker. Pastest Limited. 2001. ISBN 19011988626.

Good Medical Practice. General Medical Council. London. Sent to all registered doctors free of charge.

 

---------------------------------------------------------------------------