NHS trusts exploit overseas doctors for cheap labour, investigation reveals
Physicians have the opportunity to serve as fellows in English hospitals for two years, aimed at acquiring experience to apply in their respective countries
Pramod Thomas is a senior correspondent with Asian Media Group since 2020, bringing 19 years of journalism experience across business, politics, sports, communities, and international relations. His career spans both traditional and digital media platforms, with eight years specifically focused on digital journalism. This blend of experience positions him well to navigate the evolving media landscape and deliver content across various formats. He has worked with national and international media organisations, giving him a broad perspective on global news trends and reporting standards.
FOREIGN doctors received lower pay and reduced benefits compared to their UK counterparts under a controversial scheme in English hospital trusts, an investigation has revealed.
Doctors from outside the UK arrive at NHS trusts as ‘fellows’ under the Academy of Medical Royal Colleges’ medical training initiative (MTI) scheme, spending two-years in the NHS to acquire experience they can later apply when they return to their home countries.
However, a British Medical Journal (BMJ) investigation said such doctors might receive lower compensation than UK-based doctors hired by trusts. Foreign doctors can also be returned to their home country if they get pregnant, the BMJ found.
At certain NHS trusts, fellows are provided with identical compensation and advantages as doctors who are formally employed.
However, the University Hospitals Birmingham NHS Foundation Trust, Dudley Group NHS Foundation Trust and Walsall Healthcare NHS Trust have an exclusive arrangement with the College of Physicians and Surgeons Pakistan (CPSP).
The BMJ found fellows received lower pay and had reduced benefits than trainees employed by these trusts under this agreement.
Critics, including employment lawyers, doctors, and the fellows themselves, condemned the arrangement as “exploitative”.
Since its commencement in 2009, approximately 7,000 participants from countries such as Pakistan, India, Sri Lanka, Egypt, Nigeria, and Saudi Arabia have engaged in the programme led by the Academy of Medical Royal Colleges (AoMRC).
An internal document obtained by the BMJ revealed that fellows save the trust money, as their remuneration is lower than the standard pay for junior doctors’ posts.
Further investigation highlighted that fellows under the CPSP’s agreement received a stipend ranging from £32,400 to £43,200 a year, while the equivalent pay for ST3 doctors employed by the trust ranged from £51,017 to £55,328 a year, excluding additional or enhanced hours, on-call work or pension deductions.
In 2017 the Birmingham trust terminated the contract of a fellow who became pregnant, the BMJ report said.
She described her ordeal, saying, “I informed my department about my pregnancy at around 20 to 24 weeks. They asked me to tell the international team so that, if there was a maternity package, I could get one. The moment I involved the international team, doctors at the trust who ran the scheme arranged for a meeting. I have tried to forget the way it was all dealt with, but I still get flashes of how rude and inconsiderate they were and the remarks they made.
“The international team told me that they would terminate my fellowship and my contract would end on 30 June. My baby was born on 27 of June, only eight weeks before the end of the fellowship.
“The mental stress had an effect on my physical health. So after my baby was born I just let it go. My husband got a job in the UK and could sponsor us on his visa. The whole thing was a traumatic experience, and it shook my trust on so many levels.”
Hassan Bin Ajmal, a fellow at University Hospitals Birmingham NHS Foundation Trust, said he used two weeks of annual leave when his daughter was born because paid parental leave was not available.
The CPSP promised to review and restructure its guidelines after criticisms emerged regarding the harsh conditions imposed on the fellows.
Asad Rahim, a consultant endocrinologist at Birmingham Heartlands Hospital and regional director of the CPSP’s centre in Birmingham responsible for trainees in the UK, said the scheme had benefits. He was quoted as saying, “Since the scheme, the mortality rates for pregnant women in Pakistan have decreased and there’s been an improvement in medical oncology care and paediatric care, which are demonstrable in the data.”
He added that lack of maternity pay needed to be balanced against the greater good the scheme was having in terms of improving healthcare in Pakistan.
Rahim said fellows receive 25 days of yearly leave and an additional 10 days that can be used for unforeseen situations, such as family emergencies. If they take more time off, it could affect their two-year training term. They are advised to return to their home country, pause their training duration, and resume in the UK when feasible.
Depending on specific circumstances, the CPSP might consent to continue paying the fellows their stipend during leave. For instance, there was an instance where a fellow was given their stipend for four months while caring for their ailing father in Pakistan.
The Ceylon College of Physicians informed BMJ that in the past, some trusts collaborated with Sri Lankan trainees as honorary fellows. These trainees received a £2,000 monthly stipend from the Sri Lankan health ministry.
Unfortunately, due to economic challenges in Sri Lanka, this funding was discontinued for new fellows, although existing trainees in the UK continued to receive their stipends.
In the east of England, Sri Lankan trainees are currently paid by the trust, with additional payments formerly provided by the Sri Lankan government for on-call and weekend work.
Meanwhile, the British Association of Physicians of Indian Origin (BAPIO) established its own training programme due to concerns about the misuse of fellows to cover staff shortages in some NHS trusts. The organisation’s aim was to treat international medical graduates as trainees rather than just additional staff.
“I think what we really wanted to create is a system whereby all these international medical graduates are treated as trainees rather than as pairs of hands,” said Parag Singhal, executive director of BAPIO Training Academy, an organisation in the UK that recruits Indian doctors on behalf of trusts and manages their training.
A representative from the Academy of Medical Royal Colleges expressed concern about the issues highlighted by BMJ. They emphasised the importance of all doctors receiving fair compensation for their work, whether they are part of the MTI scheme or not. However, they noted that this matter pertains to the doctor’s agreement with the NHS trusts that employ them.
University Hospitals Birmingham NHS Foundation Trust told the BMJ: “Undoubtedly the programme benefits the NHS system, but in return it benefits the overseas healthcare structure. Programmes which encourage the upskilling of medical practitioners from countries with less developed healthcare systems have been described by the [World Health Organization] as a ‘brain gain and not a brain drain.’”
A spokesperson for the Academy of Medical Royal Colleges told the report: “The issues The BMJ is raising here are very concerning. All doctors should be paid the correct rate for their work, regardless of whether they are on the MTI scheme or not. But this is a matter between the doctor and the NHS organisation that employs them.”
CEO of the Dudley Group NHS Foundation Trust, Diane Wake, was quoted as saying, “As we do not directly employ staff who are a part of the medical trainee scheme, we are therefore not responsible for their remuneration. Our trust has not received any concerns from our MTI colleagues.”
Minouche Shafik named chief economic adviser to Keir Starmer.
Darren Jones moves into Downing Street role; James Murray replaces him.
Wider reshuffle includes changes in Starmer’s private office and communications.
Appointment comes ahead of a budget expected to include further tax rises.
Prime minister Keir Starmer has named Minouche Shafik, a former deputy governor of the Bank of England, as his chief economic adviser. The appointment comes as he looks to strengthen his team ahead of what is expected to be a difficult end to the year.
Shafik’s arrival, along with the decision to bring Darren Jones, deputy to chancellor Rachel Reeves, into his Downing Street office, signals Starmer’s focus on economic advice before a budget later this year that is likely to include further tax rises.
Jones will be succeeded by Labour lawmaker James Murray, who previously held a junior post in the finance ministry, Starmer’s office said in a statement.
Wider changes in Downing Street
Starmer has also reshuffled his Downing Street operations, replacing his principal private secretary and naming a new director of communications.
After more than a year in power, Starmer’s government has faced criticism from within Labour for struggling to explain difficult policy decisions and highlight its achievements. Labour’s poll ratings have dropped in recent months.
The changes could strengthen the economic advice available to Starmer before Reeves presents a budget with limited scope, as she remains committed to her fiscal rules aimed at balancing day-to-day spending with tax revenues by 2029.
"I think the creation of a role for Darren Jones is a good move," one Labour lawmaker said.
"He’s clearly got an eye for the details but understands the politics too."
Shafik to bring ‘additional expertise’
Shafik served as deputy governor for markets and banking at the Bank of England between August 2014 and February 2017, leaving early to become vice chancellor of the London School of Economics.
In 2023, she was appointed president of Columbia University in New York but resigned after little more than a year following criticism over the university’s handling of student protests related to Israel’s war in Gaza.
Earlier in her career, Shafik was the top civil servant in Britain’s foreign aid ministry and later deputy managing director at the International Monetary Fund. At the IMF, she oversaw work in Europe and the Middle East during the euro zone debt crisis and the Arab Spring.
"This role and the additional expertise will support the government to go further and faster in driving economic growth and raising living standards for all," Starmer’s office said.
Shafik’s background
Shafik, who is also a non-partisan member of the House of Lords, was born in Egypt and grew up in the southern United States before earning a doctorate in economics at the University of Oxford.
In a 2021 book, she argued for policies that included income floors with work incentives, pensions linked to life expectancy, and early childhood interventions to equalise opportunity.
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Before their formal meeting, Putin offered Modi a ride in his Aurus limousine.
INDIAN prime minister Narendra Modi met Russian president Vladimir Putin and Chinese president Xi Jinping on the sidelines of the Shanghai Cooperation Organisation (SCO) summit in Tianjin, China.
Modi pressed for ending the Ukraine conflict at the earliest, reaffirmed India’s long-standing ties with Russia, and discussed trade and border issues with Xi.
Modi, in his address, called the Pahalgam terror attack “an assault on India’s conscience” and “an open challenge to every nation that believes in humanity.” He said combating terrorism is a “duty towards humanity.” The SCO declaration echoed this, with leaders strongly condemning the attack and stressing the need for united global efforts against terrorism.
“The member states strongly condemned the terrorist attack in Pahalgam on April 22,” it said.
“They (member states) expressed their deepest sympathy and condolences to the families of the dead and the wounded. They further stated that perpetrators, organisers and sponsors of such attacks must be brought to justice,” the declaration said.
2. Modi–Xi meeting on trade and border issues
Modi and Xi agreed to expand trade and investment ties to stabilise global commerce and deepen cooperation to address common challenges.
Modi thanked Xi, the Chinese government and the people of China for the successful organisation of the summit, his first visit to the country in seven years.
Modi said an atmosphere of "peace and stability" has been created on their disputed Himalayan border, the site of a prolonged military standoff after deadly troop clashes in 2020, which froze most areas of cooperation between the nuclear-armed strategic rivals.
3. Modi–Putin meeting on Ukraine and bilateral cooperation
Modi told Putin, “The call of humanity is to end the conflict as soon as possible and find ways to bring permanent peace to the region.”
He welcomed peace initiatives and emphasised a durable settlement. Putin, addressing Modi as “Dear Mr Prime Minister, dear friend,” said Russia and India had maintained “friendly and trusting” ties for decades.
The leaders discussed cooperation in trade, fertilisers, space, energy, security and culture, reaffirming the “Special and Privileged Strategic Partnership.”
4. Modi–Putin private conversation in limousine
Before their formal meeting, Putin offered Modi a ride in his Aurus limousine.
The two leaders held a one-to-one conversation for nearly an hour inside the car.
Modi later shared a photograph on social media, writing, “Conversations with him are always insightful.”
Modi said India is waiting to receive Putin later this year. The Russian president is scheduled to travel to India in December for summit talks.
5. Xi’s call for SCO development bank
Xi Jinping said the SCO’s “international influence and appeal are increasing day by day.”
He urged members to accelerate creation of a development bank and announced initiatives including scholarships, PhD programmes, livelihood projects and AI cooperation centres.
He also proposed closer cooperation in energy, infrastructure, digital economy, science and green industries.
6. Condemnation of Gaza strikes
The SCO members also criticised the military strikes by Israel in Gaza, noting that they have caused civilian casualties and created a humanitarian crisis in the region.
The SCO also condemned terror strikes in Pakistan’s Balochistan province, including those in Khuzdar and on the Jaffer Express.
(With inputs from agencies)
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Afghan volunteers and Taliban security personnel carry an earthquake victim evacuated by a military helicopter from the Nurgal district of Kunar province onn September 1, 2025.
A MAJOR rescue operation was underway in Afghanistan on Monday after a powerful earthquake and several aftershocks destroyed homes in a remote mountainous region, killing more than 800 people, according to Taliban authorities.
The quake struck just before midnight and was felt as far as Kabul and in Pakistan’s capital, Islamabad.
The US Geological Survey (USGS) said more than 1.2 million people likely experienced strong or very strong shaking.
Heavy toll in Kunar province
Near the epicentre in eastern Afghanistan, about 800 people were killed and 2,500 injured in Kunar province alone, Taliban government spokesman Zabihullah Mujahid said.
In neighbouring Nangarhar province, another 12 people died and 255 were injured, he added.
"Numerous houses were destroyed," interior ministry spokesman Abdul Mateen Qani told AFP.
Many Afghans live in mud-brick homes that are highly vulnerable to collapse.
Remote villages cut off
Some villages in Kunar province remain inaccessible due to blocked roads, the UN migration agency said in a statement to AFP.
The Taliban authorities and the United Nations mobilised rescue efforts in the worst-hit areas. The defence ministry said 40 flights had been carried out so far.
A member of Kunar’s agricultural department in Nurgal district said locals had rushed to clear blocked roads to reach cut-off villages, but the areas worst affected were remote with limited telecoms access.
"There is a lot of fear and tension... Children and women were screaming. We had never experienced anything like this in our lives," Ijaz Ulhaq Yaad told AFP.
He added that many people in the quake-hit villages were among the more than four million Afghans who have returned from Iran and Pakistan in recent years.
"They wanted to build their homes here."
Quake details
According to the USGS, the earthquake struck at a shallow depth of eight kilometres and was located 27 kilometres from Jalalabad in Nangarhar province.
Both Nangarhar and Kunar provinces border Pakistan. The nearby Torkham crossing has seen repeated waves of Afghan returnees, often with no jobs or shelter.
International response
UN Secretary-General Antonio Guterres expressed condolences, joining the Taliban government and several nations in offering sympathy.
"I stand in full solidarity with the people of Afghanistan after the devastating earthquake that hit the country earlier today," he said.
Aftershocks and frequent quakes
At least five aftershocks followed the initial quake, the strongest a magnitude 5.2 just after 4:00 am (2330 GMT Sunday).
Afghanistan experiences frequent earthquakes, particularly in the Hindu Kush mountain range where the Eurasian and Indian tectonic plates meet.
Nangarhar province was also hit by flooding between Friday night and Saturday, which killed five people and destroyed crops and property, provincial officials said.
In October 2023, a 6.3-magnitude earthquake struck western Herat province, killing more than 1,500 people and damaging or destroying more than 63,000 homes.
In June 2022, a 5.9-magnitude quake hit eastern Paktika province, killing more than 1,000 people and leaving tens of thousands homeless.
Ongoing crises
Afghanistan, already facing humanitarian challenges after decades of war, has limited capacity to respond to disasters. Since the Taliban’s return, foreign aid has been sharply reduced, further straining resources.
(With inputs from agencies)
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The Ganpati festival celebrates Ganesha as the god of new beginnings, and the god of wisdom and intelligence. (Photo: Getty Images)
A HINDU community centre in east London caught fire on Saturday evening, causing major damage to the building. The London Fire Brigade brought the fire under control and confirmed that no injuries were reported.
The incident took place at the Shree Sorathia Prajapati Community Centre on Cleveland Road in Ilford, which had been decorated for a Ganapati Visarjan event attended by members of the Hindu community.
Some reports suggest that fireworks could be a possible cause. The Metropolitan Police, however, said its investigation has so far found no evidence that the fire was started deliberately.
“No one was injured in the incident, however the building suffered significant structural damage. The cause of the fire is under investigation – at this stage, the investigation team have found no evidence to suggest that it was started deliberately,” a Metropolitan Police spokesperson said.
“We are working closely with Redbridge Council to support the local community. Residents are advised to keep windows and doors closed due to smoke,” the spokesperson added.
The Met Police said neighbourhood officers on patrol discovered the fire and alerted the London Fire Brigade.
“We were called at 2000 (hours) yesterday (Saturday) to reports of a building fire on Cleveland Road in Ilford. Firefighters attended and discovered a single-storey community centre fully alight,” a London Fire Brigade spokesperson said.
“The fire was safely brought under control by crews by 2121 (hours) and there were no reports of any injuries. However, the building has sustained a significant amount of damage as a result of the fire,” the spokesperson said.
The brigade said it received about 14 calls regarding the fire. Six fire engines and around 40 firefighters from Ilford, Barking, Stratford, Leyton, Hainault and Romford fire stations were sent to the scene.
“A 32-metre turntable ladder from Dagenham Fire Station also attended and was used as a water tower to help extinguish the fire from above,” the spokesperson added.
Ilford South MP Jas Athwal expressed his gratitude to the fire crews. “A fire at Shree Sorathia Prajapati Community Centre on Cleveland Road has been extinguished,” he said in a post on social media.
“Grateful to the brave crews for their swift response and for keeping our community safe. I am in contact with the emergency services and the advice is to avoid the area,” Athwal said.
The leader of Redbridge Council also urged residents to avoid the area while assessments of the fire damage were carried out. “Neighbouring buildings have been evacuated and I’m grateful to the efforts of the emergency services,” he said.
The fire came just a week after another incident in Ilford, when an Indian restaurant was set alight in an arson attack that seriously injured five people.
The Metropolitan Police said a 15-year-old boy and a 54-year-old man had been arrested on suspicion of arson with intent to endanger life in connection with that case at the Indian Aroma restaurant in the Gants Hill area of Ilford.
(With inputs from agencies)
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Narendra Modi talks with Vladimir Putin and Xi jinping ahead of the Shanghai Cooperation Organization (SCO) Summit 2025 at the Meijiang Convention and Exhibition Centre in Tianjin on September 1, 2025.
SCO condemns terror attack in Pahalgam and echoes India’s stance on “double standards”.
Leaders call for justice for perpetrators of attacks in Pahalgam and Balochistan.
Declaration criticises Israeli military strikes in Gaza causing civilian casualties.
SCO stresses UN’s central role in global counter-terrorism strategy.
THE SHANGHAI Cooperation Organisation (SCO) on Monday condemned the terror attack in Pahalgam and agreed with India’s position that “double standards” in tackling terrorism are not acceptable.
The grouping outlined its position in a declaration at the end of its two-day annual summit in the Chinese port city, attended by Indian prime minister Narendra Modi, Chinese president Xi Jinping, Russian president Vladimir Putin and other leaders.
SCO stance on regional security
The declaration highlighted regional security as a priority and described terrorism as a major challenge.
“The member states strongly condemned the terrorist attack in Pahalgam on April 22,” it said.
The SCO also condemned terror strikes in Pakistan’s Balochistan province, including those in Khuzdar and on the Jaffer Express.
“They (member states) expressed their deepest sympathy and condolences to the families of the dead and the wounded. They further stated that perpetrators, organisers and sponsors of such attacks must be brought to justice,” the declaration said.
Condemnation of Gaza strikes
The SCO members also criticised the military strikes by Israel in Gaza, noting that they have caused civilian casualties and created a humanitarian crisis in the region.
No place for double standards
Reaffirming its commitment to fighting terrorism, separatism and extremism, the SCO said it opposed attempts to use such groups for “mercenary purposes.”
“The member states strongly condemn terrorism in all its forms and manifestations, stress that double standards in the fight against terrorism are unacceptable, and call on the international community to combat terrorism, including cross-border movement of terrorists,” it said.
The SCO underlined the role of sovereign states and their authorities in countering terrorist and extremist threats. It also said the United Nations has the central role in implementing relevant Security Council resolutions and the UN Global Counter-Terrorism Strategy, in line with the UN Charter and international law, to jointly counter terrorist groups.