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A GP appraisal of Brexit

I came to the UK in 1989, after graduating in medicine. What was meant to be a temporary adventure in a new country became permanent and I settled here, raised a family and never gave a thought to my being here.

At 4am on 24th June 2016 I was woken by panicked texts from my children. That date changed everything for us. I see myself as a European with German citizenship living in the UK. After nearly 30 years here I now face having to ask for a permit to stay in a country I suddenly don’t recognise anymore as the tolerant and open place it used to be. I probably won’t apply.

Last week I had my annual appraisal. Nothing remarkable really, but soon after I tweeted:

Going through my appraisal process turned the reflection on my personal life in Britain into a professional one. My appraiser went through the appraisal template. We talked about a seminar I attended, held by an orthopaedic consultant, from Holland. The NHS wouldn’t function without recruits from Europe. The Italian nurse specialist, the Spanish MSK expert, the French radiographer. Medicine is an international profession, it relies and it thrives on exchange across borders.

We talk about some of the media work I was involved in – the BMA gave me the opportunity of an interview to talk about Brexit. I pointed out that many GP practices are operating near a cliff edge. Many are closing, leaving thousands of patients in search of a new GP. The loss of a single GP could push them over the edge. The BMA is lobbying for a special deal for NHS workers, a futile attempt to mitigate for what is becoming a national disaster. Not only are Europeans starting to pack their bags, fed up with the uncertainty and chaos over their status, but the UK’s attempts to recruit doctors and nurses from Europe is met by incredulity and ridicule there.

My appraiser asks about my personal development plan. I have filled in the usual things. He knows most is just ticking boxes and I know he knows. ‘Where do you see yourself in a year’s time?’  I wish I knew. I tell him about contingency planning. I’ve become a grandfather recently, my daughter’s little family is working hard to make their own way in life. Her partner isn’t British. My other children are starting out in their own careers. Would I leave them behind, having brought them over here when they were babies?

I tell him about patient feedback, recounting a conversation with one. ‘Isn’t it great?!’ this patient asked me, with delight. He is retired, owns a house and likes holidays abroad. ‘We’ve shown them,’ he added, clearly expecting me to join in. I asked this patient: ‘What are your kids going to do?’ I know he has children with successful careers in Spain. It took a while to work out he didn’t realise that Brexit is not just about ‘them foreigners’ not coming here.

His mother relies on carers, none of them English. Most are Eastern European. Some are Asian. The local nursing home has just closed down. Its residents – most have dementia and are utterly confused and uprooted – had been looked after by nurses and carers, all from abroad.

I tried to explain to this patient why he had to wait two weeks for a routine appointment with me. He blamed the foreigners getting in before him. Apparently you can’t go to a park these days without hearing Polish spoken everywhere. Apparently we are a drain on services, schools, the NHS! I pointed out that he was talking to one of these foreigners. ‘Oh no, you’re different!’ I’m not one of them, he reassured me.

‘Is it true you’re leaving?’ he asked. The rumour mill in the village has been turning. ‘Well, it’s not necessarily up to me, is it?’ I replied.

I’m lucky. The Cambridge bubble I live in provides me with plenty of friends who don’t buy into the xenophobia and hysteria the hyperbolic media likes to spread, but you can’t escape it.  Listening to the radio on the way to work, on social media, on the front pages of the rags in the supermarkets. Every day. So many seem to be resigned to it, feel they have to just get on with it. It won’t be so bad in the end. You’ll be ok. I don’t think so.

My patient left the room but quickly returned. ‘I just wanted to say that everyone here really appreciates you,’ he said, and left again quickly.

Resist. Don’t buy into it. This is not about me, not about my fellow Europeans. This is about you, your country, your NHS, your place in a modern world. Most of all this is about the future of our children. 

Dr Hubertus von Blumenthal is a GP in Bedfordshire