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Proposed visa changes could starve the NHS of overseas doctors

Dr Kailash Chand

The NHS could be starved of doctors from overseas because of proposed new visa rules recommended by the migration advisory committee (MAC), that would leave them ’last in line’ for specialist and general practice jobs.

The committee has proposed to restrict the link between Tier 4 visas - for medical students and junior doctors - and Tier 2 visas  - assigned to overseas doctors in specialty training. This would mean that affected graduates would only be able to take up specialty training posts if there wasn’t a suitable candidate from the European Economic Area. This would be a huge setback to the Government’s plan to implement seven-day services, and to recruit 5,000 more GPs by 2020. 

It makes no sense to slap new charges on trusts that need to recruit from overseas

Further, proposed changes, which would increase the minimum salary requirement for a Tier 2 visa to £30,000 could penalise doctors, particularly women, who want to work part-time in order to raise children. In addition, the BMA is rightly concerned that a new levy of £1,000 for organisations that employ skilled migrants from outside the EU could cost the NHS up £3.5m a year. This political stunt could block much-needed specialist workers including GPs from settling in Britain when they are vital for our health services. The NHS is already facing a huge recruitment and retention crisis, which is bound to be aggravated as junior doctors in England consider the implications of the new contract imposed on them.

I have several problems with the recommendations of the MAC, a policy that is being proposed  to solve a political – not practical – problem, which I believe at best won’t work and at worst could inflict serious harm on the NHS. With a majority of the NHS trusts reporting severe recruitment difficulties, especially for highly-skilled and specialised positions including GPs and nurses, it makes no sense to slap new charges on trusts that need to recruit from overseas - often because they are left with little alternative due to skills gaps here at home. In some specialities, such as general practice, we know that almost a third of the emerging workforce are overseas-qualified. Without these immigrant workers the NHS would come to a standstill. Estimates indicate that black and minority ethnic (BME) doctors have saved the Britain billions in training costs alone.

Many Asian and black health professionals have been the workhorses of the NHS, concentrated in the lowest paid, least glamorous specialities, in the least popular parts of the country. Some have faced racism and slow promotion in their working life. There are only five BME chief executives across more than 300 NHS organisations. Even royal colleges and the BMA don’t do very well in representing BMEs at the highest level.

I am one of the lucky ones. Having trained in India, I went on to have a successful and rewarding 35-year career as a GP in Ashton-under-Lyne, Tameside, an active role in the BMA and in local community. However, many BME communities’ experiences of health services are quite different to mine, and to those of the white British population. A survey of every NHS trust and primary care trust in England proves that BME workers are grossly under-represented among senior management but are disproportionately involved in disciplinaries, grievances, bullying and harassment cases and capability reviews.The MAC’s recommendations add insult to the injuries of the BME workforce in the NHS family.

BME staff are an essential and irreplaceable asset to the NHS, making up a quarter of the workforce overall, and higher proportions in some sections of the emerging workforce. The MAC is wrong to recommend yet another politically driven recommendation. I sincerely believe that such a policy if accepted, could have unintended consequences by blocking much-needed specialist and GPs, from settling in Britain when they are vital for our NHS. Ministers should reject this recommendation, and tread carefully on others, including higher minimum salary thresholds, which could stop many NHS organisations getting the skills they need to deliver safe and quality care to their patients.

Dr Kailash Chand OBE is the deputy chair of the BMA, and a retired GP. 

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Readers' comments (6)

  • Well rather than getting people from outside to deal with the collapsing situation, more effort should be made to sort the current system out first.
    Secondly most immigrants will have more sense than to come to the UK now to work as GPs. Other countries have better offerings and don't treat their doctors with such distain.

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  • Why would IMGs want to work in the NHS after the appalling way in which they have been treated especially over the past 5-10 years??

    1.we have had MMC (modernising medical careers - 2006 )where permit free training was removed and many doctors lost the right to remain in the UK. I worked in a busy A&E dpt in the midlands where many excellent doctors from India, pakistan, middle east were employed as trust grades, staff grades, associates and most of them left after this debacle, snapped up by an appreciative Australian health care system. the irony is that some of the consultants from the very same hospital have actually been back to try and recruit doctors from the indian subcontinent because they were unable to fill posts with stable staff!!

    2. The CSA crisis -- An internationally respected expert on racism (Prof Aneez Esmail) had stated after a thorough investigation that unconscious bias could not be ruled out as a reason as to why BME trainees were significantly more likley to fail this exam.

    3. The infamous FTP hearings at the GMC are far more likley to feature BME doctors as a proportion of their percentage of health care workforce and they are more likely to be struck off and sanctioned that their non BME colleagues. This reason for this, despite numerous studies has never been ascertained although I am sure there is an elephant in the room somewhere one absolutely cannot insinuate in any shape or form that the GMC is an institutionally racist organisation, far from it in fact, i am sure that any IMG doctor undergoing the FTP will attest to the flawless processes the GMC undertakes and the 100% accurate and reasoned judgements it delivers!!!!

    If the system in the UK cannot treat its own doctors with dignity how will it treat the IMGs of the future based on the above?????????



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  • Why Cry for NHS which is exploitation cheap service.

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  • I do not understand your logic, Kailash. Since BME staff are so poorly treated, why do you want them to come over?
    Since all of these positions they fill are unwanted by the locals and poor pay and working conditions prevail, why do you wish BMEs to fill them?
    If it costs millions to train them, are we not depriving their countries of their expensive training, as well?
    Why are you suggesting these folks come over to fill postilions no one else wants, to be abused, racially discriminated and up before the GMC?
    Furthermore, I was working in a hospital where we had doctors recruited from secure posts in India, suddenly told to go home, as a previous writer points out.
    Kailash, this is the real problem, you as a member of the BMA cause.
    Rather than making the posts here fairly paid and reasonable, rather than make medicine attractive enough to induce local graduates to become doctors, the BMA has NEVER spoken up for doctors hours and conditions to be fair.
    Even the junior doctor hours were regulated by the EWTD, not the BMA.
    If GP land and medicine collapses, it is because conditions are so terrible here, no body wants to stay a GP.
    Yet, here you are, wishing this nightmare on BMEs.

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  • GMC and MPTS are 2 sides of the same coin. typical british red tape b... sh...

    incompetent half educated morons are writing off the fate of highly intelligent and skilled members of society. what do u expect ????????

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  • Kailash is a typical BME stooge kept to show that all is fair and nice

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