Treatment of Resident Medical Officers by UK recruitment agencies a “disgrace”, finds joint BMA and DAUK survey

by BMA media team

Press release from the BMA

Location: UK
Published: Tuesday 11 October 2022
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The experiences of Resident Medical Officers (RMOs) in the UK have been laid bare in a new survey conducted by the BMA and Doctors Association UK (DAUK), finding widespread poor conditions, low pay and excessive working hours. RMOs, doctors who provide resident services largely in the independent health sector and are most frequently recruited abroad as international medical graduates, describe pay deductions, bullying, and multiple instances of racism.

A shocking 34% of those surveyed reported bullying and harassment, with 47% reporting unfair treatment and a 31% reporting unregulated shifts. 89% report working over 70-hour weeks, far in excess of legal limits and advertised contracts. Terms like “borderline slavery” and “sh*ttiest employer anyone could ever have” were representative of the mass of comments from respondents to the survey.

Of the respondents to the survey, 92% had been recruited by agencies from African countries, raising significant question about the treatment of International Medical Graduates by private medical recruiters and by the NHS Trusts that employ their services. 81% had trained in Nigeria, a country where active recruitment by UK firms is prohibited by the Department for Health and Social Care in order to stop the “brain drain” effect that depletes developing countries of their medical workforce.

Much of the concern expressed by RMOs in the survey is for patient safety, with fatigue, lack of support and poor mental health leading to worries that they aren’t able to give patients the care they need. With doctors reporting working for 12 hour shifts for a full week, far beyond the safe limit of what can be expected for medical professionals, the agencies are seen as putting patients in danger with the way they treat their contractors.

Many deductions from pay make an already low salary (barely above the living wage in many instances) worse. Deductions from pay reported by RMOs include those for visas, appraisals, mandatory training courses and even deductions for being late. Lack of payment for annual leave and sick leave were also flagged by respondents.


Dr Emma Runswick, deputy chair of BMA council, said:

“The treatment reported by these doctors is a disgrace to UK medicine. Our international colleagues have come a long way to the UK, have left behind families and friends, and deserve to be treated fairly as employees here. What they have found instead are conditions so exploitative that it beggars belief.

"As your trade union, we are here to help. We are calling for trade union recognition to apply to all medical staff in NHS and private settings, regardless of who their direct employer is. The BMA can support international doctors new to the country with our contract checking service and we encourage those with reports of exploitative behaviour to let us know anonymously via our support channels. We are currently supporting a number of active cases of RMOs in similar situations."


Dr Jenny Vaughan of the Doctors’ Association UK said:

“Bullying, racism, unsafe hours, low pay and threats of withdrawal of visa sponsorship – it is just extraordinary that agencies have been getting away with this behaviour and it is an indictment of the authorities that they let this continue without redress. For agencies to take advantage of British hostile environment policies to push unfavourable conditions on doctors is the very worst of international recruitment practice and brings the entire model into disrepute.

“The lack of regulation in this area has meant that these practices have become the norm. The reason theses agencies think they can get away with this is because many of their doctors don’t have the local knowledge on their rights so they are ripe for exploitation. This includes foisting on them contracts that nobody would sign if they knew what the NHS standard was. Tired doctors being forced to carry on is in nobody’s interest and is unsafe for patients.

"We are jointly grateful to all who have responded to BMA and DAUK's call for testimony – this is a testament to what can be achieved with our combined efforts. There is much that needs to be done to redress the situation: duplicitous use of contracts must end and all contracts must be brought up to at least the standard of the NHS, and the basic employment rights of annual leave, and sick pay and working hours must be enforced.”


The BMA and DAUK are calling for:

  • Both the NHS and the independent sector to take responsibility for the conditions under which people are employed under their roof
  • Minimum employment standards aligned to NHS TCS and trade union recognition to apply to all agency etc medical staff who work within a Trust or other NHS environment
  • Independent operators to publish for patients the main terms and conditions of the doctors who they or third parties working for them are employed on
  • A review of the practices of the agency sector including their international recruitment practices and the involvement of the UK Government in supporting them

Quotes from the survey

“You are only as useful as the hours they can get out of you for £11.99 per hour”

“The working conditions could be likened to slavery”

“They removed me from my hospital on a false accusation when I raised serious concerns about unsafe patient practices”

“I was bullied and verbally assaulted with racist slurs, I formally reported to [recruitment company] and they threatened to send me to a hospital where I would have to travel almost 10 hours to work and 10 hours back every month. I imagine this to be my punishment for daring to speak up.”

“After spending 168 hours at work, I was made to stay an extra 24 hours in the same hospital and 12 hours again in another hospital. I was asked to go elsewhere again when I refused saying I was exhausted... It’s absurd that one would be made to work like a machine without consideration.”


Notes to editors

The survey summary can be found here.

A documentary on the experiences of international doctors including those in the survey airs on BBC Radio 4’s File on Four tonight at 8pm.

Doctors wishing to report cases anonymously can do so by getting in touch.

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives. For media enquiries please contact [email protected] or call 020 7383 6448.

The Doctors’ Association UK is led by frontline doctors and is for all UK doctors. We are a strictly non-profit campaigning and lobbying organisation comprised of UK doctors and medical students. Our collective voice aims to be at the heart of policy making for health, engaging with the media outlets whose opinions inform the public. We advocate for both the medical profession and patients, and we fight for a better NHS.