BMJ  2006;332:932 (22 April), doi:10.1136/bmj.332.7547.932

News

Tossed aside

London

As overseas doctors in Britain protest that they are being thrown out by a government that is anxious only to placate its critics, Lynn Eaton looks at what the new regulations on work permits really mean

Media headlines last summer proclaimed that 1000 British medical graduates could not find work in the NHS. In apparent response, the Home Office announced last month that all doctors from non-EEA countries who are working in training posts in the United Kingdom will need work permits.

The announcement, which has taken everyone, including the BMA, by surprise, will have major implications for overseas doctors who are currently midway through their training in the UK.

When they apply for a new job—and many of them are on contracts of only six months—they will always be in second place, behind UK graduates and graduates from the countries of the European economic area (the European Union countries, and Iceland, Liechtenstein, and Norway) who are protected by the rules of the EEA. Any UK trust wishing to employ non-EEA medical staff will have to prove that no home grown doctors or EEA doctors are available to fill the post.

Until now work permits have been needed only for consultant jobs. Doctors working in training posts (house officer or specialist registrar grades) were exempt. As far as the immigration authorities were concerned they were on what is called "permit-free training." It suited the UK very well: the NHS needed the staff. It also suited the overseas doctors: a UK training opened doors here and abroad.

But the growth in the number of medical graduates in the UK (table), combined with EEA regulations that give doctors from other EEA countries equal status to UK medical graduates, has put paid to all that.

View this table: [in this window] [in a new window]   Numbers of doctors entering medical school in England and in the UK as a whole

 

No one can be sure of the extent to which a survey by the BMA last summer may have set the scene for this latest development. The survey, in June 2005, was of just 235 junior hospital doctors, and it showed that a third of those had not yet successfully obtained a post for when their existing contract expired, two months later, in August. Extrapolating from this the BMA claimed that as many as 1000 doctors in training in the UK were unable to secure senior house officer jobs. It is unclear whether the actual number was ever that high.

Announcing the changes on 7 March the health minister Norman Warner said: "We now have more than 117 000 doctors working in the NHS, 27 400 more than in 1997, as well as record levels of doctors in training in UK medical schools."

The NHS has long depended on overseas medical graduates to fill its training posts. Now this is set to change abruptly Credit: PHOTOS.COM

 

It is not known exactly how many doctors will be affected by the new regulations, but it could be as many as 16 000 of the 49 000 junior doctors in the UK.

One such doctor is Saqib Ghani, who came to the UK from Pakistan in April 2004. He had passed the initial examination set by the General Medical Council's Professional and Linguistic Assessment Board (PLAB) in Pakistan. Once in the UK he took the second part of the exam and found posts in Southend, Basildon, and then Birmingham, where he secured a second year foundation post. He is also studying for membership of the Royal College of Physicians (MRCP) and was due to take the first part of the college's three part exam in November.

Now that is in jeopardy. When his current post ends in August 2006 he could be forced to go home. Without a work permit Dr Ghani can't get another training post, and without another training post he can't complete his MRCP exams.

"I'll have to go back home empty handed, and the two years I have spent in this country go to waste," said Dr Ghani. "I would have to start again from scratch."

"This is a disaster for those affected," said Baldev Singh, director of education and training in Royal Wolverhampton Hospitals NHS Trust and a member of the West Midlands deanery.

"I don't disagree there was a need to turn off the tap [of overseas doctors]," said Dr Singh, "but it shouldn't affect those already in employment. They are already part of the NHS workforce. We've just shot ourselves in the foot."

Satheesh Mathew, honorary general secretary for the London division of the British Association of Physicians of Indian Origin, is angry that so many overseas doctors have been allowed to take the PLAB test if the jobs for them don't exist here.

The Home Office and the Department of Health insist that transitional arrangements have been made for doctors in training. They say there is a concession for any doctor offered a foundation year 1 or senior house officer post before the new arrangements came in or who are due to take up such a post before 4 August. They can stay on in that post without the need for a work permit.

It seems that specialist registrars, who are mostly on five year contracts, may also have some degree of protection. Under the old permit-free training system, overseas medical graduates were granted "leave to remain" if they were employed in a training post, and such leave was granted in three year blocks. When one period of leave expired it was more or less renewed automatically.

Under the new system, when a period of leave expires employers have to apply for a work permit but will not need to demonstrate that a UK or EEA doctor is not available for the post (as they would have to do when recruiting a new person for a post), so the leave to remain should be renewed automatically. But the situation is not entirely clear, and the BMA is seeking assurances on this point next week.

A spokesman for the Home Office explained the policy: "The point is, it [permit-free training] is meant to fill out where there are gaps. If the gaps are filled from the UK then the gaps are not there."

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Longer versions of these articles are on bmj.com

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