Memorandum by the British Association
of Physicians of Indian Origin (BAPIO) (MMC 55)
MODERNISING MEDICAL CAREERS
1. SUMMARY OF
RECOMMENDATIONS
1.1 There is a need for urgent and comprehensive
review of workforce estimates which are specific to specialities
and regions.
1.2 Entry of international medical graduates
(IMGs) in the future should be regulated by requirements dictated
by workforce estimates.
1.3 All IMGs then working in the UK should
be treated solely on merit for job appointments.
1.4 PLAB part 1 examinations overseas should
be reconsidered.
1.5 Doctors on Highly Skilled Migrant Permit
(HSMP) should be treated on par with UK and EU citizens for applications
to postgraduate training posts.
2. INTRODUCTION
2.1 The British Association of Physicians
of Indian Origin (BAPIO) is a voluntary organisation and represents
the interests of medical doctors from the Indian sub-continent.
2.2 BAPIO is grateful to the Health Select
Committee for giving us the opportunity to submit evidence to
its inquiry into Modernising Medical Careers.
2.3 The Tooke enquiry into MMC has flagged
up lack of recognition of rights of HSMP holders as one of the
issues along with MTAS application process as problem areas. This
evidence will concentrate mainly on the issue of IMGs including
those on HSMP.
3. BACKGROUND
3.1 International Medical Graduates (IMGs),
majority of who originate in the Indian subcontinent have historically
played a significant role in the provision of healthcare of the
British people. This has been especially so in specialities and
regions traditionally under subscribed by UK graduates.
3.2 IMGs have contributed immensely to the
success of the NHS. In 2005 27.8% of doctors on the GMC register
had qualified outside the EEA. The magnitude of contribution from
these doctors was amply highlighted by Professor Aneez Esmail
as part of the 2005 William Pickles lecture in the Spring Conference
of the Royal College of General Practitioners.[3]
The DH document also acknowledges this contribution in service
provision as well as professional skills.[4]
3.3 It is estimated that the cost of training
a Medical Graduate in the UK is around £262,000. There are
over 40,000 IMGs working for the NHS and this translates into
a saving of £10 billion pounds for the British taxpayer.
Further any references to the loss to the UK taxpayer if a IMG
doctor is appointed to a post instead of a UK graduate are flawed
as for every doctor the UK "loses" it gains another
it did not pay to train.
3.4 In April 2006, immigration rules were
changed abruptly, without warning and without consultation. These
were rushed through Parliament. The rules were applied retrospectively
so that all IMGs on permit free training (PFT) had to satisfy
a residence labour test to be eligible for postgraduate training
posts. The effect of this was a huge economic and emotional trauma
to thousands of doctors who suddenly had no choice but to leave
the country. We estimate that about 8,000 IMGs had to leave the
UK in the aftermath of the new immigration rules.
3.5 The consequence of the new immigration
rules is that the number of IMGs coming to the UK for postgraduate
training has been significantly reduced.[5]
3.6 BAPIO is grateful to all the medical
fraternity, politicians and public who supported the IMGs against
their obvious unfair treatment.
3.7 Doctors on Highly Skilled Migrant Permit
(HSMP) are those who were already in employment at the time of
the new immigration rules. Thus these doctors bring both much
needed skills as well as experience of working in the NHS to the
British people. They are committed to settle in the United Kingdom
and are an important resource for the NHS.
3.8 The Tooke Report, an independent inquiry
into modernising medical careers led by Professor Sir John Tooke,
concluded that there must be clear shared principles for postgraduate
medical training that emphasise flexibility and an aspiration
to excellence.[6]
It has always been our contention that principles of merit should
be applied and IMGs should be allowed to compete on equal footing
for training. This will encourage excellence and the best doctors
will be able to progress in their chosen careers. This can only
be advantageous in the long run for the NHS and for UK.
4. COMPETITION
FOR PLACES
4.1 There has been concern regarding the
paucity of training places compared to the number of applicants
and it has been implied that this is primarily due to IMG applicants
on HSMP. We disagree with this assumption.
4.2 At the end of round 1 of MTAS 2007 process,
HSMP doctors obtained 2,679 of 14,247 appointments (around 18%
of all appointments). 10,856 of 14,247 appointments (76%) went
to UK graduates, and UK and EU citizens. We expect that the appointment
rates for UK/EEA nationals would be even higher at the end of
Round 2. The majority of unsuccessful UK candidates would have
applied to highly competitive specialties like Surgery and Orthopaedics.
We do not have statistics regarding the appointments of HSMP doctors
but believe that many of these would be in specialities and locations
not preferred by UK graduates and a significant number may have
been to FTSTA posts (described as the new lost tribe in the Tooke
report as they do not lead to completion of training).
4.3 It is anticipated that there would be
about 8,400 to 8,700 training posts in the coming years. We think
it is correct to assume that the current slack of about 1,200
UK graduates and remaining 5,600 HSMP holders will be absorbed
slowly into the system in a few years time, with some doctors
gravitating towards service and career grade posts.
4.4 The competition from HSMP holders in
the coming years will decrease dramatically. Many doctors on PFT
visas and Work Permits (WP) were able to "switch" to
HSMP as they had been in the UK at the time of announcement of
the new immigration rules. This is no longer the case as PFT has
been abolished, and issuance of a WP requires a Resident Market
Labour (RLM) test. It is very difficult for a newly arrived IMG
to accumulate enough points to apply for HSMP status.
4.5 The DH occasionally refers to the high
attrition rates amongst IMGs but the statistics used are from
a time frame when different immigration rules existed. These do
not apply to doctors on HSMP.
4.6 DH suggests that it has reached self
sufficiency in medical manpower. However Sir Liam Donaldson has
said in his evidence that there is no over supply of doctors and
UK will continue to need doctors from overseas. We are in agreement
with this assumption.
4.7 UK continues to need IMGs in under subscribed
specialties. Obstetrics & Gynaecology received only 0.5 UK
applicants for every post in the current recruitment session.
Similar situations exist in the specialties of Psychiatry, Anaesthesia
and Paediatrics amongst others.[7]
4.8 There is however a need for urgent and
comprehensive workforce estimations which are specific to specialities
and regions. Entry of IMGs in the future may be regulated by requirements
dictated by such workforce estimates. All IMGs who will then work
in the UK should be treated solely on merit for job appointments.
Conduct of PLAB part 1 examinations overseas may need to be reconsidered.
4.9 We believe there is no reason for British
Graduates to fear competition as they are extremely well trained.
5. EQUALITY OF
OPPORTUNITY
5.1 The Appeal Court has now declared that
the DH guidance on excluding HSMP holders from training is illegal.
Lord Justice Sedley said "The guidance, in my judgment, directly
and intentionally affects immigration law and practice by imposing
on the possibility of employment in the public sector a restriction
beyond those contained in the Rules."[8]
5.2 The House of Lords and House of Commons
Joint Committee on Human Rights (JCHR) ruled recently against
retrospective application of immigration rules as follows: "The
Committee concludes that the changes to the HSMP are clearly not
compatible with the right to respect for home and family life
under Article 8 ECHR and contrary to basic notions of fairness.
It recommends that the Immigration Rules should be amended so
that the changes apply only prospectively, that is to future applicants
to the HSMP, and that those already granted leave to remain under
HSMP when the relevant changes took effect should be treated according
to the rules which applied before those changes.[9]
5.3 It further censured the government as
follows: "The Committee recommends acceptance by the Government
that it does not have unfettered power to make changes to the
Immigration Rules which engage Convention rights and would interfere
with a right, that such changes should be prospective only, and
that changes to the Immigration Rules should always be accompanied
by a statement as to their compatibility with the ECHR".[10]
5.4 There is a strong argument that the
Department of Health as one of the largest employers in the world
should set a good example and show due regard to the principle
of equality of opportunity in recruitment of its work force.
5.5 We would also like to point out that
Mr Justice Stanley Burnton in his judgement on the Judicial Review
Action brought by BAPIO commented that the Home Office had failed
to undertake the Race Equality Impact assessment in line with
the Requirement of the Race Relations legislation. It is unfortunate
that a statutory body disregarded their own regulation.
5.6 We believe that had the DH undertaken
expected adequate steps to consult all the stakeholders including
IMG organisations prior to issuing guidance on PFT and HSMP, they
would have gained the insight to the most likely impact of their
proposals and some of the problems of MMC could have been avoided.
We would like to acknowledge the contribution
of Dr Joydeep Grover, Dr Asha Reddy, Dr Vinay Shanthi, Dr Ashok
Beckaya, Mr Buddhdev Pandya and Dr Raman Lakshman in the compilation
of this document.
Ramesh Mehta
President
December 2007
Table 1: Reduction in number of doctors
taking the PLAB examinations subsequent to new immigration rules
introduced in April 2006. Figures Based on verbal communication
with GMC
PLAB PART 1—PRIMARY
QUALIFICATION FROM
INDIA
|
| Year | Number of candidates
who passed
|
|
| 2005 | 3,268 |
| 2006 | 902 |
| 2007 | 368 |
|
| |
PLAB—PART 2 ALL
CANDIDATES
|
| Year | Number of candidates
who sat the examination
| Number of Candidates
who passed
|
|
| 2005 | 8,569 | 6,585
|
| 2006 | 2,936 | 2,166
|
| 2007 | 1,379 | 1,080
|
|
| | |
3
British Journal of General Practice: Asian doctors in the NHS:
service and betrayal pp. 827-834(8) Author: Esmail, Aneez Back
4
MMC: Modernising Medical Careers (MMC) England Recruitment to
foundation and specialty training-Proposals for managing applications
from medical graduates from outside the European Economic Area,
Dept of Health, 8 October 2007 Back
5
Verbal communication from GMC-see Table 1 Back
6
Aspiring to Excellence: Independent Inquiry into Modernising Medical
Careers, Professor Sir John Tooke Back
7
Fourth Report from the Health Committee, Session 2006-07, Workforce
Planning HC 171-II. Back
8
Bapio Action Ltd & Dr Imran Yousaf (on the application of)
v Secretary of State for the Home Department & Secretary of
State for Health. Back
9
Twentieth Report from the Joint Committee on Human Rights, Session
2006-07, Highly Skilled Migrants: Changes to the Immigration Rules,
HL Paper 173/HC 993, paras 27-51 Back
10
HL Paper/HC (2006-07) 173/993, paras 52-56 Back
| 
