Memorandum submitted by the British Medical
Association
EXECUTIVE SUMMARY
1. The British Medical Association (BMA)
is an independent trade union and voluntary professionalassociation
which represents doctors from all branches of medicine throughout
the UK. It has a membership of over 141,000 doctors.
2. This response will highlight the BMA's position
in relation to the cap on non-EU economic migration. There are
three principle areas of interest to the BMA:
— the impact of the proposed cap on international
doctors who have qualified in the UK and are working in the NHS;
— the impact of the cap on international
doctors who are not UK qualified but have already committed themselves
to working in the NHS; and
— the impact of the cap on the ability
of employers to recruit additional staff from overseas when it
has not been possible to fill vacant posts using the resident
workforce.
BACKGROUND
3. In submitting this evidence the BMA would
like to reaffirm its support for the long-term aim of self-sufficiency
in NHS medical staffing but in doing so would highlight that workforce
gaps remain in certain regions of the UK and within particular
medical specialties. These gaps necessitate that employers remain
able to recruit doctors from outside of the European Union (EU)
if the resident workforce cannot produce suitable candidates for
specific vacancies. The BMA does not support unfettered migration
of doctors to the UK but believes that a system in which employers
are able to recruit doctors from outside the EEA to fill vacant
posts must remain in place for those situations where suitable
applicants cannot be found from within the resident workforce.
4. The interim cap on skilled migration and the
forthcoming permanent cap are the latest in a series of measures
which have affected international doctors and the career opportunities
available to them in the UK. These measures include the end of
permit-free training, Tier 1 (General) restrictions preventing
employment as a doctor in training[21]
and changes to the points requirements that applicants must meet
in order to secure a Tier 1 (General) visa. Whilst measures to
ensure that UK-trained doctors are not being displaced have been
necessary and welcome, there remains a need to allow sufficient
flexibility to allow for recruitment from outside the EU if posts
remain unfilled.
IMPACT OF
CAPPING NON-EU
ECONOMIC MIGRATION
ON THE
MEDICAL WORKFORCE
5. As with so many of the immigration rule
changes of recent years, the true impact of the cap on non-EU
economic migration is unlikely to be completely clear until after
the policy becomes fully operational. The interim cap on skilled
migration has already created a number of problems; not least
employers' difficulties in securing sufficient certificates of
sponsorship to meet workforce needs and doctors who are already
working in the NHS facing delays and uncertainty due to their
employers being unable to issue them with certificates of sponsorship
to extend their leave. The imposition of a more rigorous, permanent
cap is likely to exacerbate this problem further.
6. Of particular concern to the BMA is the impact
of the cap on international graduates of UK medical schools. The
current route for such doctors involves them completing the two-year
Foundation Programme under Tier 4, taking up specialty training
posts under Tier 1 (Post-Study Work) for two years and eventually
switching to Tier 1 (General). The BMA is apprehensive that the
inclusion of in-country applications in the migration cap may
lead to some UK-trained doctors being unable to secure a Tier
1 (General) visa to continue their training despite having completed
a number of years of postgraduate medical training and being part-way
to achieving specialist status. The number of doctors this could
potentially impact is hard to gauge although it is estimated that
about 500 medical school graduates per annum are from outside
the EU. These doctors have been factored into future workforce
planning for the NHS.
7. Furthermore, the BMA is uneasy that the
cap has the potential to impact non-UK qualified doctors who are
already working in the NHS under Tier 1 (General) or Tier 2 visas
and may lead to employers losing members of their existing workforce.
Whilst we acknowledge that the cap on migration is being implemented
to reduce net migration levels, it has the potential to drive
out existing NHS workers as opposed to simply restricting the
flow of additional workers into the UK. This could result in existing
NHS doctors being forced to return to their country of origin
due to not being able to secure extensions to their leave and
employers having reduced options to try and source replacements.
Ultimately the medical workforce could be diminished and this
poses significant implications to the delivery of care to patients.
8. Whilst the Government might ultimately
achieve its policy objective to reduce net migration by capping
non-EU economic migration, it will have been accomplished not
only by preventing additional migrants from entering the UK but
also by thwarting migrants from obtaining further leave to remain
in the UK. The BMA recognises that it is unavoidable that the
policy of capping migration will have a detrimental impact on
some but as far as possible, a scenario must be avoided where
the NHS is unable to retain staff from outside of the EU due to
a lack of visa availability.
9. In addition to concerns relating to the
potential impact of the migration cap on existing NHS employees,
the BMA remains concerned that the cap will prevent or unnecessarily
delay future recruitment from outside of the EU even when exhaustive
attempts to recruit from the resident workforce have been unsuccessful.
NEGATIVE IMPACT
OF THE
MIGRATION CAP
ON PUBLIC
SERVICE PROVISION
10. Much of the rhetoric about immigration
has focused on the pressures that increased migration has placed
on public services including the health service, housing and schools.
The debate frequently fails to acknowledge the significant impact
that highly skilled migrants such as doctors have played, and
continue to play, in delivering and sustaining public services
such as the NHS. The strong economic rationale for justifying
the cap on skilled migration ignores the potential negative repercussions
of the cap on public service delivery with employers facing increasing
barriers to retaining and recruiting the staff they need.
11. The anticipated consequences of capping skilled
migration cannot be oversimplified by emphasising reduced stress
on public services and increased job opportunities and career
prospects for resident workers. It must be subjected to more rigorous
scrutiny and measures must be taken to ensure that public service
delivery is not compromised as a result of the migration cap.
POOLING SYSTEM
FOR TIER
1 VISAS
12. The pooling system for Tier 1 visas
appears to be a workable proposal provided that its structure
allows for the identification and prioritisation of individuals
with the most sought-after skills at that time. As with other
facets of the PBS the pooling system must not be predicated on
purely economic or business- related criteria but must allow for
the identification of skills vital to the public sector.
"FIRST COME
FIRST SERVED"
TIER 2 VISA
ALLOCATION
13. The BMA has concerns related to the
proposed `first come first served' method of allocating Tier 2
visas and believes that if the allocation of Tier 2 visas is not
managed effectively then employers could face significant delays
in recruiting staff to the detriment of NHS service delivery.
For example, a yearly allocation of Tier 2 visas could pose practical
problems for employers if the annual allocation is used up many
months before the 12 month timeframe expires but workforce gaps
persist. This scenario would leave employers having to wait months
for the next year's allocation to become available. A more practical
solution would be monthly allocations of certificates of sponsorship
to reduce the potential for employers to face lengthy delays in
obtaining a certificate of sponsorship.
14. In addition to monthly allocations being
a more practical option, consideration must be given to those
times of year when visas are more frequently required within particular
sectors. For example, demand for certificates of sponsorship for
Tier 2 visas for doctors is likely to be highest from June until
September to allow for recruitment to specialty training.
AUCTION SYSTEM
FOR TIER
2 VISAS
15. The BMA has significant concerns in
respect of the auction system for skilled migrants under Tier
2 which has been proffered as an option within the UK Border Agency's
consultation "Limits on non-EU economic migration".
The concept of organisations bidding for visas with those prepared
to pay the largest sums securing the visas at the expense of less
wealthy organisations does not constitute an appropriate use of
public funds. At a time when huge cuts are being made in public
sector budgets, forcing organisations to use much-needed resources
as part of a bidding war for staff does not seem apt. Such a practice
might be more acceptable within the private sector where companies
will often commit significant resources to attracting the right
individuals to work for them, but within the public sector this
option appears dubious and impractical.
MERGING THE
RESIDENT LABOUR
MARKET TEST
WITH THE
SHORTAGE OCCUPATION
LIST
16. The BMA believes that the proposed merger
of the Resident Labour Market Test (RLMT) with the Shortage Occupation
List has several worrying implications not least the potential
for regional shortages to be ignored and potentially exacerbated.
The RLMT currently provides a valid route for employers to recruit
staff from outside the UK when the resident workforce can't fill
vacancies. Merging the RLMT route and shortage occupation list
would only allow for recruitment to take place if there is a national
shortage in that occupation and the job has been extensively advertised
and no one suitable has applied from the resident workforce. Ultimately,
this would mean that regional shortages would be ignored and employers
would be unable to recruit on this basis alone. The RLMT in its
current form has been widely used by employers and merging it
with the shortage occupation list is likely to exacerbate shortages
that exist in certain regions of the country.
17. It is the BMA's view that any merging of
the RLMT with the Shortage Occupation List must involve a review
of how shortage occupations are identified and whether any allowances
can be made for regional shortages in particular professions/
medical specialties or in situations where an individual employer
is suffering significant staff shortages.
REDUCING DEMAND
FOR SKILLED
MIGRATION BY
UPSKILLING THE
RESIDENT WORKFORCE
18. In principle, the BMA supports the concept
of upskilling the resident workforce to reduce the demand for
skilled migration. In practice this will be difficult to achieve
in respect of the medical profession due to the length of training
required to become a doctor and the intellectual ability needed
to take up a medical degree.
19. In relation to medical vacancies there remains
a need to ensure that posts in less popular medical specialties
and in less popular regions of the country are made as attractive
as possible to generate greater interest from the resident population.
This is likely to take time and investment but is not necessarily
a process that requires any significant upskilling of the resident
medical workforce outside of the existing training structures
in place.
August 2010
21 The Tier 1 restriction on employment as a doctor
in training does not apply to those who graduated from UK medical
schools. Back
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