Islamabad: Hundreds of Pakistani doctors were drawn into a UK training programme that promised education and skills but instead exposed them to exploitation, weak labour protections and opaque financial arrangements, leading British authorities to scrap the scheme and sever cooperation with the College of Physicians and Surgeons Pakistan, the British Medical Journal (BMJ) has reported.
The programme, run by University Hospitals Birmingham NHS Foundation Trust, recruited more than 700 doctors from Pakistan between 2017 and 2025 as “International Training Fellows”. It was promoted as a “learn and return” initiative under which Pakistani doctors would receive UK experience and then return home to strengthen Pakistan’s health system.
According to the BMJ investigation, the scheme failed on both counts as Pakistani doctors were used to fill workforce gaps in the UK’s National Health Service on inferior terms, while Pakistan lost hundreds of trained physicians, most of whom never returned.
An independent audit by KPMG, commissioned by the Birmingham trust, identified 17 serious governance failures. These included unclear salary arrangements, possible breaches of UK employment law, failure to deduct income tax, incomplete background checks and poor oversight of large public payments made in the name of Pakistani doctors’ training.
Over eight years, the trust paid £40.5 million, roughly Rs14.5 billion, to a small UK based intermediary company that handled stipends linked to Pakistani institutions. Auditors found there was no formal contract, no invoicing system and no clarity on how much money actually reached individual Pakistani doctors.
Each fellow was meant to receive £3,960 per month, about Rs1.4 million, but KPMG confirmed that neither the intermediary company nor CPSP disclosed how much doctors were paid in reality. The trust therefore had no assurance that doctors received the full amount intended for them.
The audit also found that Pakistani doctors working full time in UK hospitals were wrongly treated as “students” instead of employees. As a result, they paid no income tax and were denied basic employment rights such as sick leave, maternity leave and job security. In one case cited by auditors, a doctor’s contract was terminated after she became pregnant.
From Pakistan’s perspective, the most troubling finding was the collapse of the “learn and return” promise. Pakistan is on the World Health Organization’s health workforce red list, which discourages active recruitment due to critical shortages at home. Despite this, KPMG found that 68 percent of doctors who completed the fellowship in recent years are now working permanently in the UK.
The programme depended heavily on CPSP, which supplied the vast majority of doctors to Birmingham. Following the audit, the NHS trust has cut all ties with CPSP, ending an eight year partnership. It has also withdrawn from another overseas training scheme coordinated nationally in England, citing similar concerns.
Auditors also highlighted undeclared recruitment related trips to Pakistan by UK staff. Since 2017, these visits cost more than £122,000, about Rs44 million, with food and accommodation often provided but not properly declared under conflict of interest rules.
UHB’s chief medical officer, Kiran Patel, acknowledged serious shortcomings in how the scheme was managed but said there was no finding of fraud by trust staff. The remaining 101 Pakistani doctors at Birmingham have been offered standard NHS contracts on the same terms as locally employed doctors.
For Pakistan, the BMJ findings raise serious questions about how overseas training pathways are endorsed and monitored. Many young doctors entered the programme believing it was credible and professionally secure. Instead, they found themselves underpaid, legally unprotected and absorbed into the UK workforce at the cost of Pakistan’s already strained health system.
Health experts warn the Birmingham case may reflect wider problems across similar schemes in England. With cooperation with CPSP now scrapped, Pakistani regulators and policymakers face growing pressure to review international training arrangements to protect doctors from exploitation and prevent further loss of skilled medical professionals.
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