Recent incidents have raised questions about the effectiveness of flying in teams of surgeons from abroad to help reduce NHS waiting lists.

While certain initiatives have been considered successful, others have seriously misfired. One surgical team left without completing its work, and another went home without performing a single operation.

But claims that some English consultants are deliberately thwarting the policy to retain control over lucrative private practice are being vigorously denied.

A review was ordered last month by trust management at Mid Staffordshire General Hospitals NHS Trust after complaints that an ophthalmology team flown in from Germany to do cataract operations at Cannock Chase Hospital, Cannock, withdrew “to catch a plane,” leaving NHS staff to complete the list. Only two of five scheduled operations were completed.

Nick Price, clinical director of Wolverhampton Eye Infirmary, was one of four local consultants who raised fears for patient safety, claiming that preparations made for the visit were inadequate as a result of “pressure” to proceed with the scheme.

But he refuted any suggestion that colleagues were intent on scuppering the initiative out of self interest, saying: “The work that was being done by the overseas team was not work that was a threat to the private practice of those consultants.”

In a separate incident, it was reported recently that a German cataract team visiting Birmingham City Hospital was “turned away” without performing any operations.

The hospital's chief executive, John Adler, said that the team arrived only for “exploratory talks,” which, despite goodwill, proved fruitless. “There was no question of us sending them packing,” he told the BMJ. However, German Medicine Net, the agency negotiating for the surgeons, still maintains that the team flew in “on the basis they would do cataracts.”

Mr Adler accepted that some local consultants may have felt “peeved” when talks were first mooted, perhaps suspecting the initiative as “some sort of bail-out.” But media hints that the venture was grounded by “consultant sabotage” simply fail to add up, he said.

Health officials remain guarded about why initiatives have come unstuck. Peter Huntley, who heads one of the two overseas commissioning bodies set up by the Department of Health to identify and accredit visiting teams and help trusts where necessary in local contract negotiations, accepts there have been some “objections.”

Huntley, who is based at Kent and Medway Strategic health authority, insists that all schemes have to adhere to strict clinical governance protocols and says there are already signs that significant numbers of patients are “being moved.”

Six hospital trusts in England have overseas clinical team initiatives under way—at Hillingdon, Central Middlesex, Morecambe Bay, East Somerset, South Tyneside, and Taunton and Somerset. A second wave is due to follow next year.

At Morecambe Bay Hospitals NHS Trust, managers say that thorough planning with local clinicians to fully integrate a 40 strong South African team has paid off, achieving results “beyond expectations.” Through the use of spare capacity at evenings and weekends, 950 cataract operations were performed over six weeks.

The trust's chief executive, Ian Cumming, who secured £750000 ($1.2m; €1.2m) under the government's overseas teams initiative, said it represented “competitive” value, although a full clinical evaluation has yet to be done.

“I don't think we should use visiting teams to reduce waiting lists only to allow these to go up again, or as an alternative to current investment,” he said. “We've reduced a lot of that backlog and I believe we can sustain it.”

The Royal College of Surgeons of England, while opposed to the use of NHS funds to “hire an overseas workforce,” said it was cooperating with the initiative, provided that schemes adhere to its own recent guidance on safeguards. This covers, among other things, appointment procedures, qualifications, training, safety, support services, and communication.

Charles Collins, who drafted the college's guidance, said he can't be sure that all trusts are following it but has not been made aware of specific breaches. “Surgeons in this country know there is a crisis in manpower and would welcome properly qualified surgeons to join their team.”

He is concerned, however, about the involvement of commercial agencies acting as intermediaries, which, he claims, add to “pressures” on the NHS and make schemes more likely to fail.

“When commercial agencies are the employing body, the standards of the surgeons are not the direct responsibility of the NHS but are an unknown quantity,” said Mr Collins. “Nor is there the same opportunity for patients seeking recompense.”

Peter West, director of the York Health Economics Consortium, said the use of overseas clinical teams raises “potential sensitivities around waiting lists and tensions around private practice,” as well as less self interested concerns about professional standards and care quality.

“Nobody really likes someone giving their work to someone else,” said Dr West, who earlier this year evaluated the pilot commissioning schemes that organised treatment abroad for some UK patients.

He said that the study, in its early stages, found evidence that some managers struggled to get hold of lists of “long waiters” who might be deemed eligible for the schemes.

Hans Finck, chief executive of German Medicine Net, one of the firms used by the Department of Health as an intermediary, said there is a misplaced perception here that foreign doctors' training and skills are not as good as their UK counterparts.

“I don't think that the constant questioning of foreign doctors' qualifications is justified.”

Mr Finck was involved in the recent negotiations at Birmingham, but, bound by non- disclosure agreements, called the episode a “big misunderstanding.”

He defended the use of intermediaries, saying other options were not viable. Neither NHS staffing agencies, he said, nor the human resources departments of foreign university hospitals, were equipped to do the job.

Mr Finck said that certain UK managers have told him that some consultants might have a vested interest in blocking visiting teams but he refused to give details.

However, he believes that the issue will gradually lose its “political edge” as it becomes accepted that this is an interim measure to ease UK staff and capacity shortages.