£40m spent on training overseas doctors
Discussion
From 2017 to 2025 has been suspended. The original report came out July 2025 but was never released publicly until someone asked some questions.
https://www.bmj.com/content/392/bmj.s39
A £40.5m programme to train doctors from overseas at a Midlands NHS trust has been discontinued after an independent review raised a host of red flags.
These included failures to ensure that doctors were paid fairly, undeclared hospitality linked to overseas recruitment trips, and evidence that most participants, recruited mainly from Pakistan, did not return to their home countries as intended.
The discovery has prompted calls for all national programmes involving international training fellows (ITFs) to be paused pending an urgent review of employment conditions to identify and prevent exploitative practices.
University Hospitals Birmingham NHS Foundation Trust (UHB) one of the UK s largest trusts commissioned auditors from the accounting firm KPMG to review its international training fellowship programme after concerns were flagged by consultants. This followed a BMJ investigation in 2023 that exposed serious concerns that ITFs were being used as a source of cheap labour.1
KPMG s review, seen by The BMJ, identified an unusual financial arrangement in which stipends paid by the trust for ITFs were routed through a third party company, leaving UHB without clear assurance over how much money ultimately reached the doctors themselves. The review s 17 findings also included possible breaches of UK employment law, potential tax irregularities, and a failure to carry out routine criminal record checks on new fellows.
UHB confirmed this week that it was resetting all its international training fellowship programmes, including cutting ties with the College of Physicians and Surgeons Pakistan, which supplied the vast majority of the more than 700 ITFs to the scheme since 2017.
The remaining 101 fellows at UHB have been offered employment on the same contractual terms as locally employed doctors. The trust is also ending its participation in a separate scheme the International Postgraduate Medical Training Scheme, coordinated by NHS England citing concerns.
Kiran Patel, UHB chief medical officer, who ordered a review into the workings of the scheme after his arrival at the trust in 2024, acknowledged that mistakes had been made, adding that there was no suggestion, or findings, of impropriety or fraud by any trust employee.
A trust spokesperson added that a number of actions need to be taken which are complex and will continue to take time to work through. However, they could not confirm whether any staff would face disciplinary action over the management of the scheme.
Payments and tax
One of the most serious issues to emerge was the unusual arrangement under which UHB paid a monthly stipend for ITFs through a small UK company operating from a residential address in Birmingham. In 2025, the last year the scheme operated, the stipend paid for each ITF was £3960 a month, equivalent to £47?520 a year.
Over the scheme s lifetime from 2017 to 2025, a total of £40.5m had been paid by UHB to Scholar and Trainee Services Ltd, which managed the contributions on behalf of colleges in Pakistan and one college in India. However, the trust had no contract or agreement with the company, did not receive invoices, and had no oversight of what money was passed on to individual doctors.
KPMG stated, The trust does not know how much of the £47520 is received by each ITF. There is no written agreement setting out the current value of the stipend amount, and what the obligation is for the overseas organisation to pass on to each ITF, provided ITFs receive more than £30000 per year.
Patel said that when UHB had sought clarification on payments, neither the College of Physicians and Surgeons Pakistan nor Scholar and Trainee Services Ltd would confirm how much individual fellows were receiving.
The review found that none of the ITFs had paid tax on the income earned while working at UHB. Previous legal advice relied on the assumption that the ITFs were students and not employees.
KPMG has urged the trust to seek new advice, judging it unlikely that this is correct given that the doctors were providing a level of service comparable to that of resident doctors, who are taxed.
Employment concerns
The review also found that the training and education agreement used for ITFs could be in breach of employment law because it failed to mention basic employment rights, such as entitlement to a minimum wage, sick pay, and other types of leave.
UHB had also failed to do complete pre-employment checks on the fellows, including routine criminal record checks an oversight that the trust says is now rectified.
Concerns were also raised that the fellowship s stated aim of allowing doctors to gain skills in the UK that they could then take back to their home nation, also known as learn and return, had fundamentally failed.
KPMG surveyed a group of 80 graduate doctors who had completed the ITF two year programme at UHB in the past two years and found that 68% were now registered with the General Medical Council and working in the UK. This is despite Pakistan being on the World Health Organization s health recruitment red list, meaning that UK employers should not be recruiting doctors from there.
The review also identified problems with undeclared overseas recruitment trips taken by UHB staff in relation to the programme, particularly to Pakistan. Auditors were told how it was common for these trips to last as long as two weeks, during which trust staff would be provided with food and accommodation. However, KPMG found that this hospitality was not declared under the trust s conflict of interest policies and was not consistently recorded or scrutinised.
It found that, since 2017, trips to Pakistan had cost the trust £122564.50, including a single visit in May 2024 that alone cost almost £20000.
Responding to KPMG, the trust said, We have a number of channels where such expenses can and should be declared, including travel costs. We do not have a specific travel policy; however, we will be developing one early in 2026.
Tip of the iceberg
Partha Kar, a consultant endocrinologist and former Royal College of Physicians councillor who has campaigned on ending the exploitation of international medical graduates, said that the findings in Birmingham pointed to wider systemic problems.
There are many examples of the UK not delivering what they are promising, and it is frankly exploitation, he said. Birmingham is probably the tip of the iceberg. It shows that trusts have been so desperate to get workforce gaps filled, they have taken their eye off the governance. All schemes should be paused until we are clear where we are and make sure that people aren t being exploited.
The College of Physicians and Surgeons Pakistan has been approached for comment.
https://www.bmj.com/content/392/bmj.s39
A £40.5m programme to train doctors from overseas at a Midlands NHS trust has been discontinued after an independent review raised a host of red flags.
These included failures to ensure that doctors were paid fairly, undeclared hospitality linked to overseas recruitment trips, and evidence that most participants, recruited mainly from Pakistan, did not return to their home countries as intended.
The discovery has prompted calls for all national programmes involving international training fellows (ITFs) to be paused pending an urgent review of employment conditions to identify and prevent exploitative practices.
University Hospitals Birmingham NHS Foundation Trust (UHB) one of the UK s largest trusts commissioned auditors from the accounting firm KPMG to review its international training fellowship programme after concerns were flagged by consultants. This followed a BMJ investigation in 2023 that exposed serious concerns that ITFs were being used as a source of cheap labour.1
KPMG s review, seen by The BMJ, identified an unusual financial arrangement in which stipends paid by the trust for ITFs were routed through a third party company, leaving UHB without clear assurance over how much money ultimately reached the doctors themselves. The review s 17 findings also included possible breaches of UK employment law, potential tax irregularities, and a failure to carry out routine criminal record checks on new fellows.
UHB confirmed this week that it was resetting all its international training fellowship programmes, including cutting ties with the College of Physicians and Surgeons Pakistan, which supplied the vast majority of the more than 700 ITFs to the scheme since 2017.
The remaining 101 fellows at UHB have been offered employment on the same contractual terms as locally employed doctors. The trust is also ending its participation in a separate scheme the International Postgraduate Medical Training Scheme, coordinated by NHS England citing concerns.
Kiran Patel, UHB chief medical officer, who ordered a review into the workings of the scheme after his arrival at the trust in 2024, acknowledged that mistakes had been made, adding that there was no suggestion, or findings, of impropriety or fraud by any trust employee.
A trust spokesperson added that a number of actions need to be taken which are complex and will continue to take time to work through. However, they could not confirm whether any staff would face disciplinary action over the management of the scheme.
Payments and tax
One of the most serious issues to emerge was the unusual arrangement under which UHB paid a monthly stipend for ITFs through a small UK company operating from a residential address in Birmingham. In 2025, the last year the scheme operated, the stipend paid for each ITF was £3960 a month, equivalent to £47?520 a year.
Over the scheme s lifetime from 2017 to 2025, a total of £40.5m had been paid by UHB to Scholar and Trainee Services Ltd, which managed the contributions on behalf of colleges in Pakistan and one college in India. However, the trust had no contract or agreement with the company, did not receive invoices, and had no oversight of what money was passed on to individual doctors.
KPMG stated, The trust does not know how much of the £47520 is received by each ITF. There is no written agreement setting out the current value of the stipend amount, and what the obligation is for the overseas organisation to pass on to each ITF, provided ITFs receive more than £30000 per year.
Patel said that when UHB had sought clarification on payments, neither the College of Physicians and Surgeons Pakistan nor Scholar and Trainee Services Ltd would confirm how much individual fellows were receiving.
The review found that none of the ITFs had paid tax on the income earned while working at UHB. Previous legal advice relied on the assumption that the ITFs were students and not employees.
KPMG has urged the trust to seek new advice, judging it unlikely that this is correct given that the doctors were providing a level of service comparable to that of resident doctors, who are taxed.
Employment concerns
The review also found that the training and education agreement used for ITFs could be in breach of employment law because it failed to mention basic employment rights, such as entitlement to a minimum wage, sick pay, and other types of leave.
UHB had also failed to do complete pre-employment checks on the fellows, including routine criminal record checks an oversight that the trust says is now rectified.
Concerns were also raised that the fellowship s stated aim of allowing doctors to gain skills in the UK that they could then take back to their home nation, also known as learn and return, had fundamentally failed.
KPMG surveyed a group of 80 graduate doctors who had completed the ITF two year programme at UHB in the past two years and found that 68% were now registered with the General Medical Council and working in the UK. This is despite Pakistan being on the World Health Organization s health recruitment red list, meaning that UK employers should not be recruiting doctors from there.
The review also identified problems with undeclared overseas recruitment trips taken by UHB staff in relation to the programme, particularly to Pakistan. Auditors were told how it was common for these trips to last as long as two weeks, during which trust staff would be provided with food and accommodation. However, KPMG found that this hospitality was not declared under the trust s conflict of interest policies and was not consistently recorded or scrutinised.
It found that, since 2017, trips to Pakistan had cost the trust £122564.50, including a single visit in May 2024 that alone cost almost £20000.
Responding to KPMG, the trust said, We have a number of channels where such expenses can and should be declared, including travel costs. We do not have a specific travel policy; however, we will be developing one early in 2026.
Tip of the iceberg
Partha Kar, a consultant endocrinologist and former Royal College of Physicians councillor who has campaigned on ending the exploitation of international medical graduates, said that the findings in Birmingham pointed to wider systemic problems.
There are many examples of the UK not delivering what they are promising, and it is frankly exploitation, he said. Birmingham is probably the tip of the iceberg. It shows that trusts have been so desperate to get workforce gaps filled, they have taken their eye off the governance. All schemes should be paused until we are clear where we are and make sure that people aren t being exploited.
The College of Physicians and Surgeons Pakistan has been approached for comment.
Edited by Downward on Sunday 11th January 17:38
Downward said:
"Woke scheme"Well that seals it then. Lefty plot, obvs.
M.
Mortarboard said:
Downward said:
"Woke scheme"Well that seals it then. Lefty plot, obvs.
M.
Downward said:
Corruption within the NHS?UK doctors striking due to lack of opportunities?
Cheap south Asian labour shovelled in?
DM - Must be a load of tosh then
Firstly, well done to Kiran Patel, one of the very few in public service that appears to be capable of doing their job.
Kiran Patel, UHB chief medical officer, who ordered a review into the workings of the scheme after his arrival at the trust in 2024, acknowledged that mistakes had been made, adding that there was no suggestion, or findings, of impropriety or fraud by any trust employee.
A trust spokesperson added that a number of actions need to be taken which are complex and will continue to take time to work through. However, they could not confirm whether any staff would face disciplinary action over the management of the scheme.
Payments and tax
One of the most serious issues to emerge was the unusual arrangement under which UHB paid a monthly stipend for ITFs through a small UK company operating from a residential address in Birmingham. In 2025, the last year the scheme operated, the stipend paid for each ITF was £3960 a month, equivalent to £47?520 a year.
Over the scheme s lifetime from 2017 to 2025, a total of £40.5m had been paid by UHB to Scholar and Trainee Services Ltd, which managed the contributions on behalf of colleges in Pakistan and one college in India. However, the trust had no contract or agreement with the company, did not receive invoices, and had no oversight of what money was passed on to individual doctors.
Unfortunately it will be even worse than what is being intimated here. I would be willing to bet everything i own that not only did none of the money paid end up in the hands of the trainee Doctors but that those trainees were actually paying someone from the Colleges in India and Pakistan for the privilege to work in the UK.
Kiran Patel, UHB chief medical officer, who ordered a review into the workings of the scheme after his arrival at the trust in 2024, acknowledged that mistakes had been made, adding that there was no suggestion, or findings, of impropriety or fraud by any trust employee.
A trust spokesperson added that a number of actions need to be taken which are complex and will continue to take time to work through. However, they could not confirm whether any staff would face disciplinary action over the management of the scheme.
Payments and tax
One of the most serious issues to emerge was the unusual arrangement under which UHB paid a monthly stipend for ITFs through a small UK company operating from a residential address in Birmingham. In 2025, the last year the scheme operated, the stipend paid for each ITF was £3960 a month, equivalent to £47?520 a year.
Over the scheme s lifetime from 2017 to 2025, a total of £40.5m had been paid by UHB to Scholar and Trainee Services Ltd, which managed the contributions on behalf of colleges in Pakistan and one college in India. However, the trust had no contract or agreement with the company, did not receive invoices, and had no oversight of what money was passed on to individual doctors.
Unfortunately it will be even worse than what is being intimated here. I would be willing to bet everything i own that not only did none of the money paid end up in the hands of the trainee Doctors but that those trainees were actually paying someone from the Colleges in India and Pakistan for the privilege to work in the UK.
wc98 said:
Firstly, well done to Kiran Patel, one of the very few in public service that appears to be capable of doing their job.
Kiran Patel, UHB chief medical officer, who ordered a review into the workings of the scheme after his arrival at the trust in 2024, acknowledged that mistakes had been made, adding that there was no suggestion, or findings, of impropriety or fraud by any trust employee.
A trust spokesperson added that a number of actions need to be taken which are complex and will continue to take time to work through. However, they could not confirm whether any staff would face disciplinary action over the management of the scheme.
Payments and tax
One of the most serious issues to emerge was the unusual arrangement under which UHB paid a monthly stipend for ITFs through a small UK company operating from a residential address in Birmingham. In 2025, the last year the scheme operated, the stipend paid for each ITF was £3960 a month, equivalent to £47?520 a year.
Over the scheme s lifetime from 2017 to 2025, a total of £40.5m had been paid by UHB to Scholar and Trainee Services Ltd, which managed the contributions on behalf of colleges in Pakistan and one college in India. However, the trust had no contract or agreement with the company, did not receive invoices, and had no oversight of what money was passed on to individual doctors.
Unfortunately it will be even worse than what is being intimated here. I would be willing to bet everything i own that not only did none of the money paid end up in the hands of the trainee Doctors but that those trainees were actually paying someone from the Colleges in India and Pakistan for the privilege to work in the UK.
Yeah he’s come in seen the big spend areas asked for the contract and invoices to look at to see what is being charged and what they are paying for. Once someone sheepishly has said erm we have no contract and they don’t always invoice yet we pay them he has called in the auditors.Kiran Patel, UHB chief medical officer, who ordered a review into the workings of the scheme after his arrival at the trust in 2024, acknowledged that mistakes had been made, adding that there was no suggestion, or findings, of impropriety or fraud by any trust employee.
A trust spokesperson added that a number of actions need to be taken which are complex and will continue to take time to work through. However, they could not confirm whether any staff would face disciplinary action over the management of the scheme.
Payments and tax
One of the most serious issues to emerge was the unusual arrangement under which UHB paid a monthly stipend for ITFs through a small UK company operating from a residential address in Birmingham. In 2025, the last year the scheme operated, the stipend paid for each ITF was £3960 a month, equivalent to £47?520 a year.
Over the scheme s lifetime from 2017 to 2025, a total of £40.5m had been paid by UHB to Scholar and Trainee Services Ltd, which managed the contributions on behalf of colleges in Pakistan and one college in India. However, the trust had no contract or agreement with the company, did not receive invoices, and had no oversight of what money was passed on to individual doctors.
Unfortunately it will be even worse than what is being intimated here. I would be willing to bet everything i own that not only did none of the money paid end up in the hands of the trainee Doctors but that those trainees were actually paying someone from the Colleges in India and Pakistan for the privilege to work in the UK.
Good move because he can’t be implicated as even though he came in 2024 it still carried on until July 2025.
As someone above said you can’t order a pen without an order. Not like we are in a world of writing cheques. The P2P systems need transactions to create the electriconic payment. So one has had to create a dummy invoice at the instruction of someone at the very top level given the amount of money spent and the levels of budget authorisation
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