In a statement the GMC said reforms, which will be introduced shortly, include an induction programme, stringent checks and a review of the present evaluation procedures. A new system of checks based on annual appraisals and feedback from patients, doctors, nurses and other colleagues began this month, designed to ensure all doctors have kept their professional development up-to-date and are fit to practice. The assessment will comprise online training in British medical practices and a one-day course on key issues. A review of the Performance and Linguistic Assessments Board (PLAB) test the system whereby doctors have to demonstrate their clinical skills and competence before they can join the medical register in the UK is also expected. Niall Dickson, chief executive of the GMC, said: “We absolutely acknowledge that when it comes to the serious end of the scale, those from overseas are more likely to appear, and we have set about a series of reforms to address this.” The figures for disciplinary action were obtained by the Sunday Telegraph . They revealed that, in the past five years, 669 doctors were either struck off or suspended; of this number 420 were trained abroad. A series of cases have raised concerns about the competence of doctors from countries where training is deemed to be not as rigorous as in Britain. In 2008, pensioner David Gray died while being treated by a German-trained doctor, Daniel Ubani working as a locum who gave him ten times the recommended dose of pain relief medication . Ubani, who was born in Nigeria, was working his first shift in this country later said he had never heard of the drug diamorphine, which is not commonly used by GPs in Germany. Other cases at the GMC cited included Vladan Visnjevac , struck off after a baby girl he was delivering died of a fractured skull and brain injuries through incorrect use of forceps and Navin Shankar, who had failed to spot a young woman’s cancer for more than six years before her death. The GMC says the UK is the first country in the world to introduce a comprehensive assessment system for foreign doctors. They make up 36% of doctors on the medical register. Dr Vivienne Nathanson, British Medical Association director of professional activities, said: “It is clear that doctors who have qualified overseas are more likely to be subject to disciplinary action.