Intended for healthcare professionals

Feature NHS at 70

Where are UK trained doctors? The migrant care law and its implications for the NHS–an essay by Julian M Simpson

BMJ 2018; 361 doi: (Published 31 May 2018) Cite this as: BMJ 2018;361:k2336
  1. Julian M Simpson, writer, Lancaster, UK
  1. simpsonjm{at}

Locally trained doctors tend not to want to work in areas of high deprivation and need, and we continue to rely on foreign trained doctors to fill massive gaps. Medicine should acknowledge this historical trend and tackle the dysfunction arising from its contemporary manifestations, writes Julian M Simpson

When I started researching my recent book,1 and speaking to members of the first generation of South Asian GPs to work in the NHS, I was struck that I kept returning to parts of the UK that for the first four decades of the NHS were predominantly industrial and working class. The people I was interviewing had mostly had careers in inner cities and industrial areas. I met them at their homes and practices in the former coalfields of South Wales, Fife, and Yorkshire, and in the urban areas that made up Britain’s industrial heartlands: Glasgow, the Midlands, Manchester, and the East End of London.

This was no coincidence. Medical migration from the former British empire in South Asia was a fundamental aspect of the working class experience of healthcare in Britain in the period I researched (from the 1940s to the 1980s) and beyond. By the end of the 1980s, although about 16% of GPs in England and Wales were from South Asia, their distribution was hugely uneven.

In fact, there was a stark divide. Few South Asian doctors practised in areas that were generally more middle class and rural. In Somerset or Cornwall or the Isles of Scilly, for instance, less than 1% of doctors in 1992 had qualified in South Asia. GPs from the Indian subcontinent were largely catering to the residents of generally working class and industrial areas. In some parts of England, such as Walsall in the Midlands and Barking and Havering in Greater London, they …

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