The British Medical Association (BMA) last Wednesday, raised that overseas doctors are experiencing discrimination as a result of new immigration restrictions.
Since last month, NHS trusts have been barred from recruiting junior doctors from outside the European Economic Area (EEA) if there are suitable candidates from the UK or the EEA.
The BMA is worried that some trusts are misinterpreting the new rules. Doctors who have refugee status, or who are on the Highly Skilled Migrant Programme, have reported problems finding posts, even though the new rules should not apply to them.
Dr Edwin Borman, chairman of the BMA’s International Committee, says: ‘The NHS is rapidly losing its international reputation as a fair employer.
‘Some trusts are effectively telling doctors not to bother applying for jobs if they’re from outside Europe, even if they’ve worked in the UK for years, or qualified from a UK medical school.
‘It’s shabby, it’s unfair, and in some cases it may be discriminatory.’
Some posts have been advertised on the basis that they will not attract a work permit for doctors from outside the EEA.
The BMA has written to the Commission of Racial Equality requesting an opinion on whether this amounts to discrimination.
In a letter to the Home Office, the BMA has criticised ‘the continuing dissemination of conflicting information’ about the changes.
It also voices dissatisfaction with the English Department of Health today after it said it would not consider a grace period for overseas doctors which would allow them to complete their training in the UK.
Dr Jo Hilborne, chairman of the BMA’s Junior Doctors Committee, says: ‘The government says it has put in place transition arrangements, but most junior doctors are on short-term posts that end in the next few months.
‘After that, it’s going to be difficult, if not impossible, for them to get another job.
‘That’s hardly enough time to arrange to take your children out of school and find accommodation and a new job back in your home country.’
A Home Office consultation last year on wider immigration reforms made no mention of the plan to scrap permit-free training for overseas doctors, and suggested they would be able to continue to train in the UK.
Neither the BMA nor the British International Doctors Association, or the British Association of Physicians of Indian Origin, were approached for their opinions about the changes before they were announced.
Dr Prasad Rao, chairman of the British International Doctors Association, says: ‘This change was sudden and unexpected, and the way it has been interpreted in the NHS has caused a lot of confusion.
‘Fair transitional arrangements need to be put in place to ensure that doctors already in the system can complete their training.’
Dr Ramesh Mehta, President of the British Association of Physicians of Indian Origin, says: ‘We call upon the NHS to end all practices that discriminate unfairly against the thousands of international medical graduates in the UK.
‘There are alternative methods of workforce management which would not harm the welfare of overseas doctors, and which we are very keen to investigate with the government.’
The BMA is calling for:
The government to urgently provide clearer information about the new rules to NHS trusts and postgraduate medical deaneries (local bodies that oversee doctors’ training).
Overseas junior doctors who are currently working in the UK to be allowed to complete their whole training, rather than just their existing six-month contract, as proposed by the government.
Overseas doctors who are living in the UK, but are not currently employed, to be given a grace period of up to two years in which to find a training post.
Doctors who come from overseas, but who graduated from a UK medical school, to be allowed to complete all of their training in the NHS, not just the two years stipulated by the new rules.
The BMA has been contacted by around 300 overseas doctors expressing concerns about the changes.
No-one knows how many doctors are having difficulty finding posts as a result of the changes.
However, the grades most likely to be affected are PRHOs (first year house officers) and SHOs (senior house officers), who are usually employed on short term contracts, often six months.
As of 2004 in England and Scotland, between nine and ten thousand doctors from outside the EU were employed in these grades.
There are also large numbers of overseas doctors in the UK who currently do not have posts, and will now need a work permit to get one.
In addition to this, the BMA estimates that there are around 2,250 students currently at UK medical school from non-EU countries who will be affected.
l Three quarters of GP practices responding to a BMA survey say their premises are not suitable for anticipated future needs.
The survey results, published today describe how family doctors are prevented from expanding their patient services by lack of space, coping instead with a daily round of ‘hot desking’, room juggling and even using the coffee room for immunisations.
In contrast to government announcements proclaiming record investment in primary care premises, the BMA’s GPs Committee (GPC), which commissioned the premises survey, says general practice is being prevented from reaching its potential by the way the – insufficient – funds are channelled.
Dr Hamish Meldrum, chairman of the GPC, comments: ‘Despite all the fine talk by ministers of money for new buildings, the fact remains that general practice is bursting at the seams.
‘The GPC survey results paint a picture of surgeries where every conceivable space has been converted for clinical use, with consulting rooms in former storage areas and doctors doing their paperwork in the kitchen.’
Just under six in ten of the 251 UK practices who took part in the survey said their premises were not suitable for their present needs.
And 182 of them (three quarters) felt their surgeries were not suitable for their expected future needs.
Dr Meldrum commented: ‘With such a high proportion of GP practices saying their surgeries are not suitable for their future needs there is little hope of implementing the English Department of Health’s plans to move care from hospitals closer to patients’ homes unless a significant amount of resources are set aside for practice premises development.’
The survey also found that lack of space is hampering practices from training the next generation of GPs.
Only 46 per cent of practices felt they had enough room to provide training for GP registrars.
Worryingly, over a third of the practices responding were unable to make the necessary adjustments to their premises to ensure compliance with the Disability Discrimination Act.
A quarter of respondents felt their practice premises posed some risk to the health and safety of their staff and or patients.
Cramped conditions also meant that confidentiality was an issue.
Dr Meldrum said: ‘If the government is serious in its intentions to transfer healthcare out of hospitals and into the community it has to recognise that we need somewhere to treat these patients.
‘General practice premises are very clearly overstretched. The money for premises has been too little, too late, and with too many strings attached.
‘What is needed is a longer-term commitment to regular revenue funding so that GPs can seriously plan for the 21st century.
‘One-off PFI or capital assistance schemes might provide a short-term political fix but GPs want to plan for the future.
‘That means recognising the need and providing for the cost of being able to give patients the primary health care they need in the environment they deserve.’