Research led by Yasmin Ghazala Farooq with Kingsley Purdam, Aneez Esmail and Rob Ford at the University of Manchester has highlighted the vital contribution overseas trained doctors have made to people’s health and to the NHS in the UK.
Given the ongoing debates about immigration control it is important to recognise that Britishness is a plural identity and how our most important services often depend on the skills and professionalism of people from other countries.
It is estimated that in the early 1990s there were more than 4,000 overseas trained South Asian doctors working in the NHS, constituting 15% of the GP workforce. They were working alongside other overseas trained doctors from more than one hundred countries across Europe, Africa, the Middle East and South East Asia. The doctors were actively recruited by the UK government and their migration to the UK addressed a major shortfall in the labour force.
Our research involved in-depth interviews with this unique migrant labour force of overseas trained South Asian doctors to understand their experiences as migrants and as highly skilled professionals working with the public. Many of the doctors who migrated in the 1960s and 1970s have remained and settled in the UK, had their own families and are now close to retirement. It is an important time to capture their reflections on their careers and how Britain has changed.
Many of the recurring debates about migration focus on issues of identity and integration, and concerns about the claimed costs to the public purse. Our interviews with overseas trained South Asian doctors revealed them to be a well-integrated group. Most had spent many years in the UK, and had developed a strong identification with British ways of life and values, while still maintaining aspects of their own cultural identities. In part this came from the links between medical schools in the UK and in such countries as India, as well as through strong family attachments.
These highly skilled migrants tended to work as GPs, often in areas where there had been limited GP provision. Many set up their own practices and built up their patient lists over time. As one doctor commented:
“It was quite a risk…because you don’t know whether you will have patients…the area was quite run down….I didn’t know if I was going to have good practice”.
Professional identities were also very important to the doctors we interviewed, and helped them to integrate and become part of wider society. A number of the doctors highlighted their participation in professional and community networks that often crossed over ethnic identities. One doctor highlighted his voluntary work for a local charity. He stated:
“I am involved in charity work….We hold functions and raise funds for local causes, for example, if someone needs a wheelchair in the community and they can’t afford it. I have been a member for 37 years and have raised several hundred thousand pounds… that’s my contribution to the community”.
The evidence from the research suggests that the doctors have combined their cultural and religious values creatively in making their lives in Britain. Many of the doctors provided medical services to patients from different ethnic backgrounds to their own. This includes where doctors either set up, or took over, a GP practice often in deprived urban areas with largely white populations. The doctors reported building up relationships of trust and friendship with these communities, a challenging task given that in many cases there were the only non-white face in the local area at the time. As one doctor commented:
“I had to work hard to develop a rapport with patients…I know several generations of same families….I know families; their children and then their children. They all come here”.
However some doctors did report experiences what they saw as of unfair treatment and discrimination. As one doctor stated:
“I had a good relationship generally speaking with local patients….but I have also felt with some that there was some negative undercurrent”.
These experiences of discrimination for some doctors also included the NHS and frustrations with the development of their medical careers.
At the same time issues are raised about the loss of medical professionals from countries such as India. However many of the doctors maintained an ongoing connection with the place they migrated from. As one doctor commented:
“We are involved in charity work in India…We go to villages, we do hearing tests, give them hearing aids so that the children can integrate”.
Our research into this unusual group of highly skilled migrants highlights how ethnic and professional identities can be more plural and dynamic than some discussions of integration suggest. In the UK in our daily lives we rely on a diverse population of highly skilled professionals. Just as the doctors need to understand their patients, we need a better understanding of the doctors personal and professional struggles and successes.
The experiences of the migrant doctors who help staff our NHS, and their efforts to make a live for themselves in Britain, remain an important issue. The NHS continues to recruit large numbers of doctors from outside the UK. Nearly a quarter of current NHS GPs are overseas trained doctors.
Migration brings skilled workers who often make a contribution to the places where they settle. The meanings of the term ‘British’ will need to become more inclusive of the experiences, values and aspirations of migrants.
For further information see: Ghazala Farooq, Y. (2015) ‘Operating Beyond the Boundaries of Britain? Community Cohesion and Overseas-trained South Asian Doctors’. CMIST Working Paper, University of Manchester.
The research was funded by the Economic and Social Research Council.