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A faulty production line

The NHS has always relied on Asian GPs, and will need them even more in future

Retired GP Dr Nagendra Sarmah on his own experience coming to the UK from India, and why South Asian GPs’ contribution deserves greater recognition

I came to England in July 1965 to work in a rural hospital in Nantwich, Cheshire. Coming from the India’s Assam region, I was excited to work in England but I was also apprehensive as a newcomer. I soon found my feet, and felt confident as my consultant praised my command of English, both spoken and written, but the future of my career depended on just one consultant´s reference.

When I joined the NHS in 1965, there were few black and Asian consultants. Neither did we see many black and Asian patients, certainly not in rural Cheshire. Globalisation and ease of travel have changed that, and the UK´s ethnic composition has obviously changed from the Sixties.

Never the less, I am somewhat worried about Government’s new proposal for GPs to charge migrants (non EU) for care unless they pay an NHS ‘levy’ of between £200 and £500 per year. It will be inhumane for Britain being such a generous country to charge migrants for emergency treatment. Britain is benefiting from foreign students coming to study in British universities. Besides, it will also be huge administrative burden.

After working for nearly two years for the south Cheshire group of hospitals, I moved to Manchester for my surgical training. Six months later, I was offered an SHO position at Wythenshawe Maternity Hospital.

Although this was a teaching hospital, my job was not easier. I recall I was left in charge for the whole weekend - Friday evening to Monday morning, with only the help of two medical students to cover the 84-bed maternity unit and 25-bed gynae unit. To add to this, the two units were located half a mile apart from each other. The senior registrar, who was supposed to supervise me, was busy in another hospital a few miles away and we only had phone contact with each other.

During the 1960s and -70s, it was very difficult for an Asian doctor to get a senior position in a hospital. Despite my extensive experience, I could not get a registrar post. I moved around several times, but during my last hospital post, this time in Liverpool, I was told that there were no married quarters for me there. By then I was married with two small children.

The time had come for me to end my hospital career so in 1972 I started out as a GP in Stoke-on-Trent and soon took on a single-handed practice in south Manchester where I was responsible for 3,300 patients single-handedly, 24/7. The Manchester Family Practitioner Committee did not allow us to use the out-of-hours service except for one night per week. As a family doctor I was involved even in providing home deliveries for some of my maternity patients, at their request.

Passing examinations like the MRCGP was always a hurdle for doctors from Asian and African countries. As I understand it, doctors from overseas usually do well with their papers but their performance can suffer in practical exams and vivas when they have to face the examiner. Professor Aneez Esmail’s recent investigation into the CSA has apparently showed graduates from non-white ethnic groups did worse in the examination. This is a concern.

Doctors have become a commodity

I saw a lot of changes in the NHS, from the days when Kenneth Robinson and Sir Keith Joseph were health secretary. I still remember Kenneth Clarke´s reorganisation of the health service, including creating a competitive culture amongst hospitals and imposition of the Government´s new contract on the GPs. This created unhappiness amongst hospitals, and most of the GPs did not approve of the new contract.

After facing my own health problems I decided to retire in 2001. This was a sad moment for me, but I am still involved in service design as a lay person.

In the 1950s and -60s, a doctor was a respected figure of the community and it was a highly regarded profession. I am not sure that this is still the case. A doctor is now a service commodity. I still recall the creation of the community health council, whence society became increasingly litigious and a doctor-bashing culture arrived in the UK.

Although I thoroughly enjoyed my career in the NHS, and am proud of my continual service of care, I regret that people in the authority, the Government and the rewarding authorities, did not show this same care and, in my experience, did not appreciate my service to the community and the country.

I devoted my time to the care of my patients but in doing so did not find sufficient time to spend with my family. This I regret now.

Dr Nagendra Sarmah is a retired GP from Manchester. He recently contributed to the book, Nurturing the Nation: The Asian Contribution to the NHS.

Readers' comments (9)

  • Dr Sarmah.

    Your own record of selfless service to the care of patients is very common in doctors who arrived from the Indian subcontinent. It is a pity that your compassion, hardwork and dedication were never properly acknowledged by other doctors in charge who turned a blind eye to discrimination. This prevented you from completing your hoped for path towards consultant status. For some doctors still, "training" will never end.

    May your retirement continue to be a long and happy one.

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  • I disagree the NHS should provide free emergency treatment to non eu residents, They should be charged not a levy but pre billed for their treatment, the free for all model is not sustainable

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  • Great to hear dr Sarmah's experience and congratulations on a long career. Working overseas for the Ministry of Health, UAE in Dubai, for 30+ years, I have realised that one should not look for appreciation, as it is such a large faceless organisation. Individuals do respect you, and I have had tremendous job satisfaction. I am sure Dr Sarmah's has done a great job, and can look back with pride, and gratitude for being able to work here for so long!

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  • My belief has always been, if you haven't paid in you shouldn't be allowed to take out, that includes benefits as well as health care. Care shouldn't be charged AFTER it has been received, migrants should have insurance before care is offered.
    A free for all cannot be sustained.
    Whilst Asian doctors may be good at their job, it is their language skills that are the problem fro many patients, but may not include all asian doctors.
    Many have very strong dialects and talk too fast which makes them hard to understand, with patients being uneasy about constantly asking then to repeat what they have said.

    I have met many Asian doctors that speak better English that some English doctors. I do find it worrying that finding an English 'born and bred doctor' has become almost an impossibility. For this reason I worry that our own doctors are set aside because when a job becomes vacant, Asian consultants will employ another Asian doctor with the English doctors having little hope of getting a job, I would like to know where they all go?
    Flipping the coin, I suspect doctors generally, do not get a good deal, are not appreciated and are expected to be the 'be all end all' in health care.

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  • whilst its nice to read this, it is becoming harder to be a GP with the CSA especially with the unexplained difference in failure rates between Asian born in Britain and their white counterparts

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  • The frustrating thing about all CSA Saga is the indifference of RCGP and denial that there is a problem despite huge huge difference in pass rate. I am not saying that there is a racial bias necessarily but what have they done to calibrate the training schemes ! nothing. They are busy in letting rooms at Euston square. BMA acted only after coming under pressure .

    If we are not welcome here! its time to leave the the country.

    good luck.

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  • This comment has been moderated

  • @8:08 - This problem has arisen because many of those who are in trusted positions, namely trainers, have not done enough to help their trainees. the spotlight needs to turn on them

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  • @1.46- hear hear! many trainers have not passed the CSA and either don't have clue or don't give a toss.

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  • Edoardo Cervoni

    Great letter. Thank you Dr Nagendra Sarmah. Positive changes can happen if we are able to identify what's wrong with the status quo. You gave us a quite clear picture.

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