by Karen Allen
BBC Health Correspondent
The World Health Organisation is calling for tighter controls on countries like Britain that poach foreign doctors from the developing world.
Britain needs more doctors
The issue of ethical recruitment has inched its way onto the global health agenda - with the chair of the South African Medical Association urging compensation from countries that recruit medics from overseas.
Though doctors from overseas have a long history of coming to Britain for training and extra experience now we need them more than ever before.
A team of 40 South African doctors and support staff have been flown in to Merseyside to get waits for knee and hip operations down at Southport General Hospital.
The initiative has already had impressive results. For patients like Robert Birchall it has meant the usual 12 month waiting list has been trimmed to a matter of weeks.
"South Africa is only 11 hours away, and if it is only to cost £2.5m to reduce the list by nearly 400 patients, lets spend £2.5m and get them back next week."
But it is not just about money, but manpower too. With pledges to expand capacity within the NHS, the government has promised 7,000 more senior doctors by 2004.
However, the British Medical Association claims only a fraction of this have been taken on - so will doctors from countries like South Africa help to prop up the NHS until enough home grown talent can be trained?
And what about the new fast track treatment centres announced for the NHS earlier this month?
The rules are that they get their doctors privately or from overseas - and South Africa is one of the places they have got their eye on.
Both are trends that have left many health specialists in the poorer world worried that they simply can't compete with the salaries offered here.
They fear their own struggling health services will be depleted of vital medical staff.
And although the Health Department insists they are recruiting ethically, Kgosi Letlape, from the South African Medical Association fears Britain will gain at his country's expense.
"You are increasing your ability to poach by opening these centres that you cannot man yourself."
Dr Mike Hatchett is an anaesthetist with the South African team in Southport. Like other doctors he is inundated with offers to come and work here for good - doubling his salary instantly.
He is here for just a fortnight, but will be replaced with another South African doctor when he leaves - the company running the scheme ensures the doctors jobs are held open back at home.
But Dr Hatchett knows other agencies will bring doctors over and they'll simply stay.
"I certainly feel very disappointed every time I see another doctor emigrating, and I know most of my colleagues feel the same way - it is depressing for the doctors that are left.
"But if you are coming across for a short-term stint which supplements your income, that is more likely to encourage you to stay back home."
Southport's chief executive Allan Stephenson knows recruiting overseas has had good results for his patients, but he says it has been a one off project for a set period of time.
He argues this isn't state sanctioned poaching but admits other hospitals may be tempted to recruit long term.
"We have got to be careful about that, both here in the UK and in South Africa.
"We gave a contractual agreement not to recruit any of the staff that have come over for a period of two years - I think that is a good principle to follow."
The British Government signed a deal at the Commonwealth health ministers conference earlier this year pledging to recruit medical staff responsibly. But it carries no legal weight.
Health minister Melanie Johnson said "only a fraction" of doctors were recruited internationally.
Health trusts were guided by a code which bans recruitment from 120 countries which cannot afford to lose staff, she said.
"They are effectively forbidden from using agencies that do recruit from those countries."
Seven thousand South African doctors are now on the permanent register of the UK's general medical council - equivalent to half the number working South Africa's public health service.
Though they have all have come under their own steam, the trend now is for systematic recruitment.
However, Ms Johnson said many of those registered would not take up positions in the UK.
"The UK government does not recruit from South Africa," Ms Johnson said.
Dr Letlape is amongst a growing chorus of voices calling on richer nations to pay compensation. This is how he thinks it should work.
"You say, OK, it costs us £1.2m. You pay us the £1.2m for the one that we have lost, but you then fund another one that comes into training.
"So not only do you pay us for the lost one, but you finance us to replace them."
Although the quality of care delivered by doctors from overseas is not in dispute, ministers from the developing world are keen to put what they say is a culture of "exploitation" onto the global health agenda.
The WHO's Orvil Adams says tough legislation should be considered as well as compensation, and the WHO should consider taking on a wider policing role.
"WHO needs to bring the international community together to address this, and to link the movement of doctors and nurses to the health conditions within countries."
Whilst many applaud the free movement of doctors, there are real worries that in the dash to get our own waiting lists down we are turning to doctors from the developing world that can ill afford to lose them.
A lot rests on this government delivering on its health promises of treatment more quickly and more staff - but at what price to countries where their own health services are already struggling to cope?