Since its inception in 1948, the NHS has benefited from the contributions that overseas doctors, nurses, midwives and other allied health professionals have made to the NHS. Without the skills and commitment of these staff, the NHS would be in dire straits.
NHS leaders from the Secretary of State for Health downwards have publicly welcomed and praised this invaluable contribution to the health and wellbeing of the UK population.
The need now is for better integration not further fragmentation of the workforce
It is, therefore, worrying that statements made at the Conservative Party conference recently have had the effect of demoralising large numbers of such staff.
The proposal that a new NHS workforce strategy will seek to turn overseas doctors into an ‘interim’ workforce creates a grave risk for the NHS and may make the supply of doctors worse in the short and medium term. This risk is particularly the case for shortage specialties such as psychiatry, obstetrics and gynaecology, paediatrics and emergency medicine, which remain heavily reliant on international medical graduates (IMGs) despite a nationwide effort at improving recruitment rates. And not forgetting the current recruitment crisis in general practice.
Coming on top of the uncertainty EU medical staff are facing post Brexit, this proposal can only have the effect of severely demoralising doctors already working for the NHS and risk deterring others whom the UK may wish to recruit.
The GMC State of Medical Education and Practice in the UK report states that in 2015 77,714 doctors (33.1% of doctors working in the NHS) completed their primary medical qualification outside of the UK. Of the 59,068 GPs, 12,864 are overseas doctors accounting for 21.8% of GPs. Of the 72,024 specialists in the country, 28,190 are overseas doctors, accounting for 39.2% of specialists. In 2014, there were 8574 psychiatrists on the specialist register and of these 3638, 42% of all psychiatrists, were not originally UK trained.
It is evident that the NHS makes substantial savings on training costs from the presence of these overseas doctors. Even assuming a conservative assumption of the training cost of £250,000 per doctor, this group of doctors have saved the NHS and the Treasury a whopping £19 bn. Only a tiny proportion of this saving is used to support the integration of these doctors in the NHS. In the absence of such support and additionally due to medico-political or immigration regulation, many have fallen off the conventional career path, unable to become consultants and end up working as staff grade, associate specialists and specialty doctors, a group who have often complained of being used and abused as workhorses by the NHS. Differential pass rates in exams between IMGs and UK-qualified candidates have furthered this perception.
Despite this, they constitute an indispensable part of the frontline NHS workers. In addition to the financial gains, we must not forget the vast clinical and administrative experience this subset of workforce brings into the NHS as the achievements of many of these alleged ‘interim’ workforce demonstrate.
On 4 October 2016, the Prime Minister told BBC Breakfast, before an announcement at the Conservative Party conference by Jeremy Hunt, that whilst overseas NHS staff were welcome to stay for now, ‘there will be staff here from overseas in that interim period – until the further number of UK doctors are able to be trained and come on board in terms of being able to work in our hospitals.’ Although Ms May backtracked from this comment, she did so only to insofar as saying that it was upto local hospitals to make that decision. There was a failure by her to recognise that recruitment of medical trainees is a job for Health Education England and not local hospitals and of course this would have been a splendid opportunity for her to recognise the contribution of overseas doctors in the NHS.
Doctors in the NHS are working harder than ever. Teams of doctors from all corners of the United Kingdom work alongside colleagues from many parts of the world. Given the current increase in racism experienced post Brexit, and compounded by proposals to force employers to publicly announce how many ‘foreign’ staff they employ, much overseas staff are becoming increasingly apprehensive.
While it is vital to have a long-term NHS workforce strategy, it is dangerous to make even the subtlest hint that may suggest the move to a Government that does not recognise the value of migrants. It is dangerous to propose a future self-reliant workforce strategy based on poor financial modelling and assumptions. Whilst recruitment and retention worsens, the NHS will continue to rely on the expertise of overseas doctors who have time and time again, helped to hold the NHS together.
Understandably, there have been concerns about ‘brain drain’ from the developing world. The Medical Training Initiative (MTI) scheme was initially set up as a fixed two-year term training scheme with aims to provide advanced medical training and service experience for overseas doctors to improve the management and treatment of patients around the world. However, this scheme does not now appear to be funded or supported to deliver these aims and instead some MTI trainees have felt exploited as cheap labour.
Several Colleges supported by the GMC, BMA and diaspora doctors’ associations have been working hard over the past few years to address the notion that overseas doctors are used as a cheap fodder to cover rota gaps across the UK. The message of classifying international medical graduates as an ‘interim’ workforce runs the risk of demoralising, dehumanising and objectifying these doctors and flies in the face of these endeavours and the very values of a fair society. Medical leaders and organisations would do well to pool their resources to address the issue, as this is going to be a recurring theme for the coming years.
Political leaders would do well to remember this before they add fuel to the fire with irresponsible comments that aggravate the ‘them’ vs ‘us’ paranoia and worsen the divide at a time when attacks on overseas workers and their families have sharply increased. Many NHS leaders have shared our concerns publicly but with no obvious change in policy focus or rhetoric from politicians. It is worth remembering that a significant number of originally ‘overseas doctors’ are now UK citizens, having dedicated most of their professional life to the UK health service. While rifts and divisions continue to emerge, it may be a worthwhile exercise for the Government to reflect on what the definition of a foreign trained doctor even is.
The NHS has spent millions to improve engagement with clinicians because evidence shows that a well-engaged workforce is a key to providing a safe and efficient service for patients. The current xenophobic stance is not only antithetical to the UK culture of acceptance and tolerance but is likely to disengage in one fell swoop, a large part of the workforce with the attendant risk of worsening the quality of care provided to patients.
We call upon politicians, and ministers in particular, to reflect on their statements and withdraw the suggestion that overseas doctors are required to be here only for an ‘interim’ period. Until more robust financial and workforce modelling is available, this suggestion will worsen not improve the current workforce pressure, particularly in shortage specialties. We also call upon the Government to ensure that adequate funding is provided to engage and support all current employees of the NHS.
The need now is for better integration not further fragmentation of the workforce.
Dr Farah Jameel, GP, national executive member BIDA, chair of Camden LMC
Dr JS Bamrah, consultant psychiatrist, medical director of Manchester Mental Health and Social Care Trust, BMA Council member, National Chairman, BAPIO
Roger Kline, director Workforce Race Equality Standard, NHS England
Dr Subodh Dave, consultant psychiatrist, associate dean for trainee support Royal College of Psychiatrists
Mr Babatunde A. Gbolade, consultant gynaecologist and president of MANSAG
Dr Kailash Chand OBE, former chair of NHS trust and former deputy chair BMA council
General Medical Council, BME Forum
British Association of Physicians of Indian Origin (BAPIO)
British International Doctors Association (BIDA)
British Islamic Medical Association (BIMA)
Medical Association of Nigerians across Great Britain (MANSAG)
Pakistan Medical Association UK (PMA)
Association of Cameroonian Doctors and Dentists in the UK (CamDocUK)
Association of Pakistani Physicians and Surgeons (APPS)
British Indian Psychiatric Association (BIPA)
Doctors in Unite (DiU)
Progressive Muslims Forum (UK)
Panjabi Doctors and Dentist association (NE)
Sudanese Medical Association in UK & Ireland (SMA UK&I)
British Arab Psychiatric Association (BAPA)
Iraqi Mental Health Forum (IMHF)
Junior Doctors’ Alliance
Sri Lankan Psychiatric Association (UK)
Dr Seri Abraham, ST6 trainee, psychiatry
Mr SK Farid Ahmed, deputy chair of SASC UK, BMA
Dr Kavya Ahuja, GP
Dr Rachel Ali GP, GPC member and member Devon LMC
Dr Arun Batra, consultant radiologist
Dr Prun S Bijral, consultant psychiatrist and medical director
Dr Ravi Boora, GP
Dr Sadia Chowdhury, GP trainee
Dr Paul Crilley, GP
Dr Patrick French, consultant physician FRCP
Dr Simran Gandhi, GP
Professor Chitramohan George, consultant old age psychiatrist
Dr Mohan George, GP (GP for more than 35 yrs)
Professor Clare Gerada, ex-chair RCGP
Dr Talvinder S Gill, consultant colorectal surgeon
Dr Surya Ginjupalli, consultant psychiatrist
Dr Anne Harrison, GP and GP trainer
Dr Eleanor Holmes, GP
Dr Inderpreet S Jassal, consultant psychiatrist
Dr Mahadev Jasti, consultant psychiatrist
Dr Ram Jha, GP
Dr Veena Jha, GP
Dr Coral Jones, GP
Dr Sahitya Kamineni, consultant psychiatrist
Dr Asha Kasliwal, consultant in community gynaecology and RHC
Dr Dinesh Khanna, CAMHS consultant
Dr Amit Kochhar, chair of SASC UK, BMA
Dr Sudhakar Koduri, consultant physician
Dr Amit Kishore, GP
Dr Sandeep Kumar, consultant psychiatrist
Dr Savitri Laloo, GP and GP trainer
Dr Kamal Mahawar, consultant bariatric surgeon
Dr Chethan Majjiga, consultant psychiatrist
Dr Aseem Malhotra, consultant cardiologist
Dr Rajiv Mansingh, GP and GP trainer
Dr Jaikiran Maram, specialty doctor, psychiatry
Dr Karina McCaffer
Dr Katherine McConnachie
Dr Helena McKeown, GP in Wiltshire, deputy chair of representative Body, British Medical Council
Dr Kishen Neelam, consultant psychiatrist
Dr Funmi Nixon, GP
Dr Ambalal Patel, GP
Dr Chandrakant Patel, consultant pathologist
Dr Latifa Patel, Paediatric trainee
Mr Ashok Pathak MBE, consultant orthopaedic surgeon (Rtd)
Dr Bathika Perera, consultant psychiatrist
Dr Nilika Perera, consultant psychiatrist
Dr Sarah Pillai, associate specialist, contraception and sexual health
Dr Georgy Pius, consultant psychiatrist
Professor Allyson Pollock, consultant in public health
Dr John Puntis, consultant paediatrician in Leeds
Dr Puneet Ranote, consultant anaesthetist
Dr Sandeep Ranote, CAMHS lead NHSE Clinical Networks
Dr Gerard Reissmann, GP
Dr Nitish Sahoo, GP and GP trainer
Dr Solomon Satananda, ST trainee in psychiatry
Dr Samir Shah, consultant in liaison psychiatry
Dr Radhakrishna Shanbhag, immediate past chair SASC UK, BMA
Dr Devena Sharma, ST4 trainee psychiatry
Dr Kirti Sharma, cConsultant pathologist
Dr Parveen Sharma, consultant psychiatrist
Dr Raj Sharma, specialty doctor, family planning
Dr Julie Sharman, medical director & LMC secretary
Dr Vimmi Shryian, GP trainee
Dr Preeti Shukla, GP and member GP survival
Dr Gurvinderpreet Sidhu, GDP
Dr Kamalpreet S Sidhu, GP, GP trainer, vice-chair of County Durham and Darlington LMC
Dr Amit Sindhi, consultant psychiatrist
Dr Gurpreet Singh, consultant urologist and associate postgraduate dean Health Education North West
Professor Iqbal Singh, chair of GMC’s BME Forum and Consultant Geriatrician
Dr Rishika Sinha, GP and GP trainer
Miss Beryl De Souza, plastic surgeon, council member Medical Women’s Federation
Dr Winnie Stack, GP
Dr Manjit Suchdev, GP
Dr Kiran Tangirala, consultant psychiatrist
Dr Jackie Turner, GP in London, London Regional Council
Dr Madhuri Urlam, GP
Mr YKS Viswanath, consultant upper GI surgeon
Dr Philippa Whitford, MP
Dr David Wrigley, GP in Carnforth Lancashire, chair Doctors in Unite (DiU), Medical Practitioners Union (MPU)
Rt Hon Phillipa Whitford, SNP health spokesperson and consultant surgeon
Dr Hasanen Al-Taiar, consultant forensic psychiatrist
Dr Arokia Antonysamy, consultant psychiatrist
Professor Chitramohan George, consultant old age psychiatrist
Dr Anand Rajasekaran, consultant anaesthetist