Dr Terry John, Chair of the BMA International Committee, is a GP and senior partner of a practice in North-East London, tutor for medical students in the community, a trainer for GPs on the GP training programme and Programme director.
Read about his journey from Trinidad to East London.
What made you want to become a doctor?
Many doctors have stories about a doctor or event that inspired them to become a doctor. In Trinidad, where I grew up, the idea was instilled in me that it would be a great occupation and something that I could be proud of. My dad was a ship's engineer and wanted me to go down that engineering route, but I was quite good at languages and did my O and A levels in French, Spanish and Latin. I won the Island scholarship which entitled me to go and study abroad. Nevertheless, I was fascinated by medicine and so whilst I was good at languages, medicine held a greater allure.
Where did you study medicine?
Back in the late sixties and early seventies, the obvious choices to study for someone from the Caribbean, were one of the Caribbean islands, the US, Canada or the UK. I chose Birmingham, in the UK, because it meant I could use my first MB and continue in medicine, I wouldn't have to do an introductory degree as I would in the US.
I also wanted to go to a campus university where I knew it would be easier to find colleagues and be part of a community. I met many others from the Caribbean and other parts of the world. I did my first MB as it was called then; a basic grounding in science which covered Physics, Biology and Chemistry. After that I was able to continue into medicine. Making the transition from languages to medicine was difficult at times, but I got through it.
Where did you do your training?
I did my house jobs in Birmingham in both medicine and surgery and afterwards worked as a SHO in the care of the elderly in a hospital in central London.
But in those days, the understanding was that you would return and do some medical work for your country of origin, so I also stayed in touch with the Trinidad and Tobago High Commission and discussed my transition back.
After getting my degree, I sold up everything, returned to Trinidad and moved back in with my parents. I had discussions with the Ministry of Health and the Ministry of Education for nearly a year, trying to find out more about what I needed to do, now I had qualified. I eventually got fed up with the back and forth meetings and got on a plane and came back to London, as nobody was offering to employ me. Immediately I got a job as a resident officer and then made the decision to go into General Practice. I then went on to do my training at North Middlesex Hospital and then qualified as a GP and the rest is history.
General practice is under huge pressure at the moment, recruitment is a big issue, what do you enjoy about being a GP?
I enjoy being a GP for a variety of reasons. The one-to-one relationships with patients is splendid. I enjoy the challenge of caring for individuals and families.
I got involved in education, and I’ve been a tutor for medical students, a GP trainer and a program director. I got interested in the BMA, joined the General practitioners committee and then the International Committee where I became Chair.
I am very proud of the fact that our practice is highly representative of the surrounding diverse community and that our patients feel confident to come to us at all times. Many of our patients are British, many are from the Asian sub-continent but we have patients from Africa, Caribbean and Eastern Europe too.
What is the make-up of your practice?
I am the senior partner, the other partners are from Nigeria and India. In all we are one female and two male partners. We also have two female salaried doctors, one of whom is English and the other is Indian. The practice manager is from Mauritius and then we have a diverse group of receptionists, who are able to reflect the multi-ethnic community. I'm very proud of the diverse team that I have at my GP surgery. When students are reporting back they often comment on how being part of such a diverse team has made the GP surgery feel more welcoming.
This isn’t typical though is it?
No. We see a number of young Asian doctors in training coming through,
but we might see only a one or two black doctors come through each year, however this year we saw one black doctor come into the scheme. I was beginning to wonder where all the black doctors had gone.
Of the people I know in the Caribbean, their children are choosing to be medical students in America and Canada in preference to coming here. We need to investigate why black British youngsters are not entering medicine.
Why do you think this is?
I think a big issue is finance. The cost of training has gone up significantly over the past few years. I don't know if there are many scholarships still on offer, and that could be a factor because some of the countries in the Caribbean may not be able to access many scholarships. What we do see is doctors coming in from abroad who are paying their way or their family is paying. As far as black British youth is concerned, we are in need of sufficient black medical role models.
The GMC’s list of registered medical practitioners and national training census records show that there are only 3% black or black British doctors, why do you think there are so few?
We need to have more black doctors putting themselves forward and talking to children earlier, which would encourage children earlier, which would encourage children at a very early age to feel that they can become the doctors of the future. Children and young adults need role models.
Black footballers are very visible and that has encouraged more children to want to go into this field. We need to put the right structures in place to ensure children are not put off, and that they have the proper support to get the right grades.
I would love an opportunity to be invited to go into some inner city schools to speak to young people and say “well I'm a doctor, let me tell my story” to encourage others to come forward.
Once they do make it into medicine, do you think there are particular challenges facing young black doctors today?
As a GP and a programme director, I see the trainees on a weekly basis. I do a bit of teaching, and have a kind of pastoral role, finding out if they have any problems or issues that may need to be addressed. It is a three year scheme; in the first and second year they spend a lot of time in the hospital and in the third year they go out into practices.
I have been doing this for six years now so I am seeing many people coming through the system and then leaving the UK to go abroad.
Racism used to be very common, very overt and often unchallenged, but nowadays, although of course it's not acceptable, it still exists. The medical profession is also facing numerous pressures, making it even harder for the few black doctors to be in a position to encourage other prospective young black doctors into the profession.
What do you think could be done to support black medical students?
Mentoring would help and having the resources to provide a direct intervention. Using CCG’s as a springboard for this would be very effective. I think it’s necessary and I think we just have to do our best to promote it. I was asked to be a mentor many years ago, to a young black woman at a London university. I was sent a briefing telling me what I needed to do and what the content of the mentoring should be. She came to see me at my surgery and we talked about issues such as how she was approaching things, what the barriers would be and how she should address her exams. She passed her exams and I was very pleased.
What has been your greatest achievement to date?
Improving my practice and making it into a respected surgery in Waltham Forest.
When I joined I was the fifth person down in the hierarchy. There were four above me and it stayed that way until the people at the top retired. The practice was managed differently then; I felt that we needed to make some changes, so I managed to get the practice more involved in GP education and developed further options.
I got medical students and trainees on board, who improved the quality of the practice. We have a great practice manager and now we have a practice we are all proud of.
The GPs have been through really good training schemes and we all get on well together. We have a training practice which includes medical students, F2 Junior doctors and GP doctors in training, so a lot has changed since I joined and our practice is recognised as one of the best teaching practices in Waltham Forest.
Looking to the future, what do you think will be your biggest challenge in the next five years?
I'm getting older now, so I recognise I can't go on and on forever. My biggest challenge will be stepping away from my profession because when you've been a doctor for many years, it's a big part of your life. The biggest challenge will be putting into place the things that will keep me cheerful and active when I'm no longer seeing patients regularly or when I'm no longer at so many meetings at the BMA. So that may mean looking at things such as charities. I'm looking at areas such as management of prostate cancer, because of the high incidences in black males.
What do you think the future looks like for black doctors?
I think we are in for some more hard times before the return of good times.
Brexit is a massive headache as we don't know where it's going to lead us. Concerns over the movement of doctors in Europe and cross border healthcare have created an atmosphere which is causing discomfort, particularly amongst European people working in the UK, but also amongst black British doctors, because there are so many references to immigration.
I think more people will finish their training and emigrate and I think fewer black doctors may want to come to the UK.
The whole nature of the UK has always been a welcoming, progressive country. I hope that doesn't change in the future. But we need to be prepared and optimistic, to keep going and be prepared to do the best we can.