The UK's dysfunctional relationship with medical migrants: The Daniel Ubani case and reform of out-of-hours services

Julian M. Simpson, Aneez Esmail

    Research output: Contribution to journalArticlepeer-review


    In 2008, a patient died in the UK after being given an excessive dose of diamorphine by an overseas-trained doctor working in out-of-hours (OOH) primary care. This incident led to a debate on the recourse to international medical graduates and on the shortcomings of the OOH system. It is argued here that a historical reflection on the ways in which the NHS uses migrant labour can serve to reframe these discussions. The British Medical Association, the General Medical Council, and the House of Commons Health Committee have emphasised the need for more regulation of overseas graduates. Such arguments fit into a well-established pattern of dependency on and denigration of overseas graduates. They give insufficient weight to the multiple systemic failings identified in reports on OOH provision by the Department of Health and the Care Quality Commission. Medical migrants are often found in under-resourced and unpopular parts of healthcare systems, in the UK and elsewhere. Their presence provides an additional dimension to Julian Tudor Hart's inverse care law: the resources are fewer where the need is greatest, and the practitioner dealing with the consequences is more likely to be a migrant. The failings of the UK OOH system need to be understood in this context. Efforts to improve OOH care should be focused on controlling quality rather than the movement of doctors. A wider reflection on the nature of the roles that international medical graduates are asked to play in healthcare systems is also required. ©British Journal of General Practice.
    Original languageEnglish
    Pages (from-to)208-211
    Number of pages3
    JournalBritish Journal of General Practice
    Issue number584
    Publication statusPublished - Mar 2011


    • Medical history 20th cent
    • Medical history 21st cent
    • Medical staff
    • Migrants
    • Out-of-hours medical care
    • Primary health care


    Dive into the research topics of 'The UK's dysfunctional relationship with medical migrants: The Daniel Ubani case and reform of out-of-hours services'. Together they form a unique fingerprint.

    Cite this