The new ‘colour bar’ in the NHS

A rather respectable demonstration took place in central London last week. The organisers even took the unusual step of stipulating a dress code – ‘smart, lounge suits’. Protesters were urged: ‘If you are working on the day please take your annual leave to attend the demonstration. Please ensure that the patient care is not compromised. Please inform your consultant that you are attending the protest.’

These were IMGs, international medical graduates, mainly from the Indian subcontinent, protesting about new legislation which means many of them now fear for the futures they had planned in the UK. Until now, international doctors have been exempt from the work permit required for other jobs. But in March 2006, the Department of Health (DoH) quietly announced that all doctors from outside the European Union will need a work permit to train in the UK. In order to recruit trainee doctors who qualified outside the EU, NHS trusts will need to demonstrate that they could not recruit a UK or EU graduate.

Remarkably, these new regulations were introduced without consultation or warning. International doctors who have invested enormous amounts of time and money in pursuing careers and training opportunities in this country now suddenly find themselves faced with the real possibility of having to return home.

Femi, a Nigerian doctor I work with, came to the UK three years ago. Like all IMGs moving to Britain, he struggled to get himself established. First, he was required to sit an English language exam, despite the fact that, like many doctors from ex-colonies, English is his first language. (Ironically, EU doctors are not required to pass this exam.) He then passed the Professional Linguistics Assessment Board (PLAB) exam set by the General Medical Council to gain full registration. This process costs several hundred pounds, and of course doctors cannot work before gaining registration.

Femi did an unpaid clinical attachment, then locum jobs, before finally securing a place on a training scheme in psychiatry. Hundreds of other ‘post-PLAB doctors’ are not so lucky – after applying for hundreds of jobs they are forced to go home, demoralised and in debt. Femi felt secure enough to bring his wife over to Britain, and they had just made an offer on a house when he heard the news about the new government regulations. Femi and thousands of doctors like him are left in a void of uncertainty about the future.

The reasons behind the changes are twofold. A recent increase in medical school places in the UK has coincided with a drastic reconfiguration of the system of medical training. Predictably, chaos has ensued, with many UK graduates being left without a training job. A survey by the British Medical Association (BMA) found that up to a third of doctors finishing their house jobs had no post to go to. The DoH was under pressure to sort this problem out, and a clampdown on IMGs must have looked like an easy target.

‘We will continue to need small numbers of specialist doctors, who can bring their skills and experience to the NHS. However, increasingly the NHS will be less reliant on international medical recruitment’, said health minister Lord Warner. This is a highly optimistic outlook. Current estimates are that up to 15,000 IMGs, are currently working in British hospitals. It is nonsense to suggest that the NHS can suddenly manage without them. In practice, what the new regulations will mean is that foreign doctors will be forced into so-called staff-grade or trust-grade posts, providing a valuable service for NHS patients but with no obligation for their employers to provide any training or career opportunities in return. In the words of Dr Anup Gupta of the British Association of Indian Doctors: ‘In the garb of ending permit-free training, the government is downplaying a much more important point here. It is in fact encouraging the trusts to discriminate with legal authority.’

Of course, this sort of discrimination has always gone on. I still remember queasily an interview for a hospital job a few years ago. I was the only non-Asian candidate. Talking to the others while waiting for the verdict I was convinced I was unlikely to get the job. Several other candidates were better qualified than me, and my interview had gone badly. When I expressed this to one of them, an Indian man who had travelled from Scotland to the south west of England for the interview, he smiled kindly and said: ‘I think you’ll get it, don’t worry.’ I did get the job, and was never brave enough to ask why.

Despite this type of unspoken discrimination, an impressive number of international doctors have persisted and built successful careers in the UK. Others have returned home and used the skills and training they gained here to improve conditions in their own countries. At the London demonstration last week, it was a British speaker who got the biggest cheer. Dr Peter Trewby of the Royal College of Physicians told protesters: ‘This is a very, very sad day indeed for the NHS. For the first time in the history of the NHS, we are going to say that race and country of origin are going to trump merit, and that is a very sad thing indeed.’

Liz Frayn is a doctor in the south of England.

Read on:

For up-to-date information about protests against the new regulations, go to:
The IMG Peaceful March website

The website of the British Association of Physicians of Indian Origin