By Rachel Wright

BBC Newsnight

Dr Robinski says it is normal for Polish doctors to work in two places It is very early on a cold Friday morning and Dr Piotr Robinski's alarm wakes him from a restless sleep. He turns off the clock. It is 0400 local time and he has got a very long day ahead. Having worked from Monday to Thursday in his Polish surgery, he is already tired. Six hours later, after a long drive to the airport, Dr Robinski is finally airborne. "If there will be no cheap flights I could not afford to fly to Scotland... But for me it's just like taking a bus to work now," he laughs. Dr Robinski flies to Scotland every other weekend to work for the NHS in Aberdeen. He says he is only doing the same as most of his contemporaries. "Doctors in the UK usually only work in one work... doctors in Poland work in more than one work so it is completely normal for me to take another job somewhere else. If I [didn't] go to Scotland, I would find [a] second job here in Poland." Shift shortages Doctors in former Eastern Bloc countries, such as Poland, can expect to earn less than the average wage, which is around £300 a month. Dr Robinski can earn the same amount in one shift in the UK. What's more, shifts in the evenings and at weekends need filling. In 2004, 90% of GPs' surgeries opted out of providing out-of-hours care, so health trusts had to begin employing agencies to fill the shifts. He must be a very tired man and I cannot see how he can give his full attention to patients

Dr Anthony Halperin

Patients' Association Dr Robinski was recruited by an agency called Cherry Tree Medical, which is based in his hometown of Poznan in central Poland. This agency provides many of the doctors who work in Grampian in the out-of-hours service covering most of northern Scotland. We arrive in Aberdeen at 1550 GMT, just long enough to grab half a hamburger and a shower. By 1800 GMT Dr Robinski is back at work - this time on home visits. By the end of his shift, Dr Robinski will have been on the go for around 19 hours, but he says he's not too tired to work. "My journey takes around 12 hours, sometimes less, and when I get to Aberdeen I take only a few hours of work.. then I go to bed and when I wake up in the morning I am not tired." We showed pictures of Dr Robinski at the end of his shift to Dr Anthony Halperin, who chairs the Patients' Association. "He must be a very tired man and I cannot see how he can give his full attention to patients after that amount of travelling," he said. Tiredness So who is responsible for making sure Dr Robinski is not too tired to work? Alistair Stevenson runs Cherry Tree Medical. He has 40 doctors on the books, including Dr Robinski. "We instruct them to keep their hours down in Poland so they are well rested but it's their responsibility - but in practice its hard to police" Dr Robinski says he will probably stop commuting when he is older NHS Grampian, which contracts Cherry Tree Medical to provide the doctors, says it is responsible for the doctor only once he starts his shift pattern. The British Medical Association (BMA) says the individual doctor should be fit for work, but that the buck stops with the NHS. "The more complex the system becomes the more chance there is that something will fall through the net," says Dr Hamish Meldrum, chairman of the BMA. As for Dr Robinski, he's doing what he can to provide for his family while he is young. "I'm not sure that when I get older and older whether I shall have so much fun in travelling to another place all the time. Maybe I'll just stay here in Poland," he says. Ironically, British GPs say they opted out of providing out-of-hours care because they were too tired. Now it looks like many out-of-hours doctors from overseas are also risking the same symptoms as they commute from the other side of Europe. Rachel Wright's report is on BBC2's Newsnight at 2230 GMT on Tuesday, 15 January.



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