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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

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

Excellent question.

The UK has never trained enough doctors and has always had 'poor' work force planning. The UK Immigration system doesn't know if they are coming or going.

I am very proud of the NHS and came from India and had an amazing career. We must be very proud of the NHS and our great nation. However, the leadership from both political parties over the last few years has been pretty bad in many ways. Most of these are not due to bad people but ill considered policies implemented with good intentions but that have backfired.

In the early 1980s when I came to UK each year 2000 doctors used to come from non-EU nations and because our training was (and still is) based on the UK system and in English, most of us came to the UK and did very well. In the 1990s, when the Labour government gave a lot of money and junior doctors' working hours were reduced and consultant expansions took place, suddenly 10000 to 15000 doctors started coming from non-EU nations.

Suddenly UK graduates were unemployed so overnight the UK Immigration department introduced Immigration changes and legalised discrimination against IMGs, and this was fought by BAPIO who won the case. BAPIO or any of us were not opposed to the idea of UK graduates getting preference but it was illegal to apply regulation to those IMGs who were already in the UK!

Because of Immigration changes less and less doctors started coming from Non-UK nations and the UK hoped EU doctors would make up the shortfall but sadly not many EU doctors came. Many did come but it was not enough.

UK graduates are now working part time, doing locums and leaving the profession, going to the USA, Australia and New Zealand as working conditions in the NHS have deteriorated significantly in the last 20 years! This is mainly due to 'Management driven culture, less doctors, rota gap, doctors have lost the authority which once they had and weather and work life balance are much better in many other nations.

So, we must make sure we appreciate, value and engage UK doctors and those staff who dedicate their life to the NHS. We must find an urgent solution for the current workforce crisis. We must allow doctors from any country (only good ones) to come to UK and help us and learn NHS values and the NHS way of looking after patients, and then return to their own country. We must transform our own workforce and make sure we train our own staff, and we make sure they are trained well and we also care for them and create a culture of staff happiness. We must make sure all NHS staff work in a culture of happiness and we get rid of a culture of bullying harassment and victimisation.

We must find an urgent solution and get doctors from anywhere in the World, and India is our best bet but make sure these doctors are well trained and we look after them well and support them to do a good job and meanwhile transform our own workforce and make sure NHS and social care integration takes place and we make our NHS, our social care the safest and the best.

NHS and social care need kind, caring, compassionate leaders with courage to make all these changes. Good leaders are visionary and with great knowledge and skills, and they create a great team of leaders and make sure they succeed in their dream and their vision. Our vision must be to make our NHS and our Social care are the safest and the best. We can do it if we all work together, putting patients at the heart, and work with patients, public and our wonderful NHS staff.

Competing interests: No competing interests

06 June 2018
Umesh Prabhu
Was Medical Director in NHS for 15 years and now recruiting doctors from India to help NHS
Edgehill University