Modernising Medical Careers - Proposals for managing applications from medical graduates from outside the European Economic Area
Response from the British Medical Association
22 October 2007
The BMA believes that the timescale for consultation on this document has been insufficient and is extremely restrictive. On important issues such as these the BMA requires reasonable time to consult its members and conduct informed and detailed debate. Furthermore, the limiting nature of the questionnaire, which forces respondents to agree or disagree with questions relating to a narrow Department of Health agenda, is unacceptable and, instead, the BMA has given a more general response to the issue.
The BMA is also very concerned about the terminology used within the discussion paper. The term International Medical Graduates (IMGs) is being used incorrectly and will lead to misunderstandings and misapplication of the guidance. This is because the term refers to the place of qualification and does not reflect immigration status; a more appropriate term would be ‘doctors subject to the immigration rules’. Whilst a significant number of IMGs will be subject to the immigration rules, and therefore affected by the proposals contained within the document, there are some who are not. It is wrong to suggest that an individual’s place of qualification should determine their right to work in the UK. Some IMGs are British/EEA nationals, hold indefinite leave to remain, or have permission to work without requiring a work permit, meaning that legally they must be considered on an equal footing with UK/EEA nationals who are UK medical graduates, for example.
Introduction
The BMA has sourced opinion from all its main representational committees and its International Committee. The BMA’s policy on doctors subject to immigration rules is already well established and consistent. All doctors who have entered the UK with a valid expectation to train or provide a service, and who do not require a work permit, should be eligible to apply for all posts on an equal footing with UK and EEA applicants.
However, it is acknowledged that due to poor workforce planning, restrictions on funding and a failure to expand the consultant grade as promised, the Department of Health is seeking to reduce competition for specialty training posts. If this is to be the case, it is the responsibility of the Department of Health to advise non-EEA nationals, currently outside the UK, wishing to relocate to work in the NHS or study medicine at a UK medical school, that employment prospects in the UK are minimal.
We would recommend that this is done as a matter of urgency.
It is crucial that any such advice makes it clear that this does not affect doctors subject to the immigration rules who are currently in the UK.
Highly Skilled Migrant Programme
The BMA would like to highlight that in relation to holders of the Highly Skilled Migrant Programme (HSMP) visa, the BMA sought legal advice in 2006. This advice confirmed the BMA’s belief that doctors on the HSMP should not be restricted by the duration of leave to remain that they have under the HSMP. BMA policy reflects this and the view that HSMP holders should be regarded in category one when competing for posts.
UK trained medical students
The BMA has always maintained that non-EEA nationals studying medicine in the UK should be able to complete their entire postgraduate medical training in the UK. This is especially the case for those who had accepted a place on a medical degree course or commenced their studies before the immigration rules were changed and therefore came to the UK in good faith believing they would be able to compete on an equal footing for postgraduate training posts. Reneging on this assurance would not only be perceived as a breach of faith but would also mean that the UK will no longer be an attractive place to study medicine.
International medical students pay significantly higher tuition fees: £13,000 for their pre-clinical years and £23,000 for their clinical years. If the prospect of application to UK postgraduate training posts is removed, those who face returning to countries with low salaries will have immense difficulty in repaying any outstanding debts incurred during training. It would also be expected that when conducting workforce planning the number of UK medical graduates would not be assessed by immigration status and indeed up until this point non-EEA students at UK medical schools have been included in all workforce planning. These people are expected to graduate, work and train in this country.
For these reasons, the BMA could only accept a prospective decision on this issue, and we insist that, if such a decision were to be taken, any guidance would need to be absolutely clear to prospective future applicants to UK medical schools.
The BMA is also concerned that a change of status for these people would discourage potential international applicants from applying to medical school in the UK. This could have serious financial consequences for UK medical schools who reap the benefits of the high tuition fees. In this scenario it would be unacceptable to pass the financial burden on to UK students or to make significant cuts to UK medical school budgets. DH and the Department for Education and Skills would have to find this money from elsewhere.
Refugee doctors
The BMA does not support the proposed DH guidance but, should it be implemented, current and future refugee doctors must be exempt, and thus permitted to compete directly with UK/EEA nationals.
When asylum seekers are first given a positive decision they are granted limited leave to remain. This would mean that a significant number of refugee doctors applying for posts in the UK would fall foul of the proposed DH policy guidance and be excluded from applying for posts on an equal footing with resident workers.
Refugee doctors are ready trained professionals and should be given the opportunity to practise their profession in the country that has granted them asylum, rather than being left to deskill. Furthermore, unlike migrant workers who choose to come to the UK, refugee doctors are not in a position to seek employment elsewhere.
Restriction of choice
The BMA is opposed to restricting doctors subject to immigration rules currently in the UK to apply only for short-term training grade posts, such as FTSTAs. Such a restriction would run the risk of exploitation and stigmatisation of this group of doctors.
Conclusion
The BMA maintains that doctors subject to immigration rules who are currently in the UK with a valid expectation to train or work in the NHS should be treated equally with UK and EEA nationals.
The BMA has always expressed concern at the immediacy of the application of the changes to the rules relating to the postgraduate doctor and dentist category and the effect they had on doctors in training who were subject to the immigration rules. The BMA initially called for a period of grace for those doctors already in the UK and would urge the DH to take the interests of this group into account before implementing new policy guidance.
Any new policy guidance should be widely publicised in the UK and internationally to ensure that any potential applicants see it and are adequately informed. Any new guidance must be consistent with Home Office rules to prevent having a two-tiered immigration system which unfairly disadvantages members of the medical profession. Doctors already in the UK should be given as much assistance as possible to conclude their postgraduate training. In addition, any doctor subject to immigration rules who has been allocated to a training post cannot have this retrospectively removed.
The BMA urges the Department of Health to consider the impact that the provision of training for overseas doctors has globally and that the needs of countries that rely on their doctors receiving some training in the UK should be taken into account. We also recommend careful thought about potential consequences should the UK once again require overseas doctors to staff the NHS in the future. If these proposals are implemented in full, regardless of the legitimate expectations of many overseas doctors currently working in the NHS, future overseas doctors are unlikely to apply for posts in a country which has treated their predecessors so unfairly.