More than one in four GPs who graduated overseas and faced a Medical Practitioners Tribunal Service (MPTS) hearing between 2018 and 2021 did not have legal representation, figures obtained by the Medical Protection Society (MPS) show.
The total of 28% of GPs in this group who faced a tribunal without legal representation is a third higher than the figure for UK-trained GPs. Just 21% of UK-trained GPs who faced a MPTS hearing over the same period were unrepresented, the MPS told GPonline.
The lack of legal representation for these doctors leaves them at greater risk of facing harsher sanctions, figures obtained by the MPS from the GMC under the Freedom of Information Act show.
Among UK GPs who graduated overseas, just 4% of those who faced a tribunal without representation secured a 'no impairment' judgment - while 93% were either suspended or struck off.
GPs in this group with representation received a no impairment judgment in 28% of cases - and a far lower 52% were suspended or erased from the medical register.
No doctors without legal representation received a less serious 'warning' following a tribunal, whereas some doctors with representation were able to secure this lower-level penalty.
The MPS warned that doctors coming to work in the UK should be encouraged to join a medical defence organisation (MDO) to ensure they are not left without representation in tribunal cases - highlighting that the state indemnity scheme that took effect for GPs in 2019 only provides support with NHS clinical negligence claims.
The increased likelihood of overseas-trained GPs attending tribunals without representation is of particular significance because doctors in this group face a higher risk of being referred to the GMC. The GMC warned in 2019 in its 'Fair to Refer' report that non-UK doctors have a 2.5 times higher rate of being referred to the regulator by their employer compared with UK graduate doctors.
MPS President Professor Dame Jane Dacre said: 'We have been talking with doctors who qualified overseas to gauge their understanding of the healthcare system and indemnity arrangements when they arrived in the UK.
'Only 52% said they joined an MDO when they arrived and started work. The GMC figures serve as a powerful reminder of how important it is for these doctors to ensure they have support with GMC investigations as soon as they start work.
'GMC investigations often take several months - and sometimes years - to conclude and the hearings can last weeks. For some, fitness to practise proceedings have career-ending implications.
'I cannot imagine facing this process alone, without someone fighting my corner. Sadly though, 28% of GPs who graduated overseas do and the majority go on to face tougher sanctions at their hearing when compared to those with legal representation.
'The various guidelines and requirements that come with working in UK healthcare can be bewildering for any doctor. But it can be even more difficult for those who did not train in the UK. Indeed, professional protection requirements in the UK are different to those in other countries and many coming to work in the NHS may assume that the state indemnity schemes provide blanket protection.'
Professor Dacre said the GMC and the wider NHS could do more to ensure overseas doctors understand the system and how to secure support.
A GMC spokesperson said: ‘Our own published peer-reviewed research shows that any doctor who doesn’t attend their hearing or have legal representation is more likely to receive more serious outcomes at hearings. That same research shows that tribunal outcomes are unrelated to whether doctors qualified in the UK or not - non-attendance or lack of legal representation puts any doctor at a disadvantage.
‘But we know that doctors coming to work in the UK face a range of challenges and do not always get the support that they deserve and we have been working extensively with NHS England since 2019 to develop an induction programme for international medical graduates.'