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A passage from India

SHAH: The community in the Rhondda 'were brilliant and respectful'

‘They come here…’ And so goes the age-old rant about immigrants. In a new series about the incalculable benefits overseas doctors have brought to the NHS, The Doctor thinks it’s time to take that phrase back and put it to good use instead. Here’s the first profile, of south Wales GP Hasmukh Shah. Tim Tonkin reports

The valleys of south Wales have seen unimaginable change. In two generations the pits have gone and the heavy industry has largely followed. But while slag heaps have become nature reserves, and tough jobs replaced by no jobs, there has been a remarkable constant.

The GPs who cared for the miners, the ex-miners, their children and grandchildren will, more likely than not, have been of Asian origin. During the last decade it was estimated that around three quarters of GPs in the Rhondda and neighbouring valleys were Asians.

Many at that point were still the first-generation immigrants who answered the call of successive health ministers – including Enoch Powell, of all people – for doctors to help fill the gaps in UK medical provision.

The doctors came not just from south Asia, but also east Africa, particularly Uganda following Idi Amin’s expulsion of the Asian population, and Kenya.

When Dr Shah was born in western India in 1947, Britain was about to lose the jewel in its empire but gain the jewel in its welfare state.

‘Overseas doctors often work in the areas where no one else wanted to go’

He would have grown up knowing much about the former colonial power but much less about the Welsh valleys where he has spent the last 30 years.

What he did know, thanks to his parents, was that his destiny was to become a doctor.

‘My mother and father told me as a child “you have to become a doctor”,’ says

Dr Shah. ‘Back in India, being a doctor is a noble profession, to the point where you are almost worshipped by people.’


Planned to return

He came to the UK, aged 27, with a plan. He would spend some time in the NHS, complete his training to become an ENT consultant, then return to India. As with so many other NHS ‘lifers’ who have come from overseas, he didn’t mean to stay.

‘Initially, when I came, the main reason was that if you gain your postgraduate medical degree and experience in the UK, and then return home to practise, you do very well.

‘UK medical education was, and still is, seen as the best in the world.’

It was 1975. Dr Shah arrived alone at Heathrow Airport. He had £3, as there were limits on the amount of currency people could leave India with. It was the first time he had visited Britain. He had no family here, no professional connections.

Fortunately, he knew one colleague from university in Gujarat, who collected him from the airport and was his host while he applied for a job.

Immigrants often speak of the new sensations they encountered on arriving in a new country. The feeling Dr Shah had, which he had never previously experienced, was loneliness.

‘It was very lonely. I was on my own practically the whole day while my friend was at work, the only company I had was the TV. This isolation was something that I had never experienced when back in India.’ It was six weeks before he spoke to his parents by telephone.


Money woes

The three pounds did not last long, and he had to borrow money from his friend while he searched for his first job. The job came after a couple of months, a locum position at a Bristol teaching hospital, in which he was encouraged by an Australian senior registrar.

‘He was so impressed with my experience and respected my knowledge, that he told me to not waste any time, and complete your training as quickly as possible, and that I would become a consultant very quickly.’

But despite this initial encouragement, he found only a succession of locum ENT jobs rather than permanent roles.

‘Because I was an overseas graduate, the first preference for jobs tended to go to UK graduates, whether they had the same amount of training as me or not.’

Despite gaining experience working for almost 10 years in ENT, he saw no hope of becoming a consultant. By 1984, although very happy in his home life, married with two children, he was increasingly despondent over his career prospects after almost a decade in the UK.

‘I could see that I did not have any chance at becoming a consultant… because I was an overseas [graduate]. It was very demoralising.

‘Because I was an overseas graduate, the first preference for jobs tended to go to UK graduates’

‘I knew that going back to India to start in private practice, without a significant amount of money behind me, would not be easy. Both my children were also by now in the UK school system, and my family and I were happy living in the UK.’

And thus Dr Shah entered GP training and found that he loved it.

‘I knew I could not make a career for myself in ENT, and that I would try to establish myself in general practice and that if I found I didn’t enjoy it, I would go back [to India].

‘On the first day [general practice training] I met a brilliant trainer – Dr Walker. Coming home I told my wife how much I had enjoyed it.’

He finished his GP training, but immediately struggled to secure a job in the face of extremely high competition.

‘Every job seemed to have 30 to 40 applicants, even getting a locum job in general practice was difficult.’


Happy and settled

With persistence and patience, Dr Shah eventually landed his first role as a GP, setting up his practice in Llwynypia in the Rhondda Valley. He quickly fell in love with his new surroundings and professional role.

‘The people were so nice, and are still nice. They were so brilliant and respectful.’

Despite being a relatively small rural community, Dr Shah says its healthcare needs were often complex and multi-pathological in nature.

‘The unemployment rate [among the community] was very, very high,’ he says. ‘The Rhondda was a mining area, and at that time [1980s] a lot of people were unemployed.

‘Along with issues such as depression, stress, problems with alcohol and drug abuse, I would also see a lot of patients with respiratory problems, resulting from their time down the mines.’

Being the lead GP in a close-knit rural area meant becoming one of the local community’s leading and most recognisable figures, a role and responsibility that Dr Shah says he greatly welcomed.

As well as being the lead partner of his practice, Dr Shah served as a member of his local health board for nearly 20 years, became an executive member of his local medical committee, and served on the BMA Welsh GPs committee.

Latterly, he has been elected as secretary of the British Association of Physicians of Indian Origin Wales, and been appointed as visiting fellow at the University of South Wales.

Earlier this year, he received the British Empire Medal, and was invited to Downing Street as part of the NHS 70 celebrations.

Still a practising GP, his experience matches that of thousands of others who have come to the UK to lend their skills to a service in acute need. He has overcome hardship and rejection in the process.

The Asian GPs of south Wales are one part of a remarkable story of immigration, which is not just a source of pride for the UK but a source of survival for its health service. The Doctor hopes to tell other such stories in the months ahead.

It is a scenario from which Dr Shah believes everyone stands to lose out.

He says: ‘These [overseas doctors] are the backbone of the NHS,’ he says.

‘They often work in the areas where no one else wanted to go and in under-staffed areas such as general practice, geriatric medicine, psychiatry and emergency medicine and GP out of hours.

‘It is in this way that we fill up the gaps, and I think the NHS would have struggled without overseas doctors.’ 

BMA immigration advice service


Working in the UK

Doctors and medical students from outside the EEA (European Economic Area) looking to work or train in the UK have to meet certain requirements:

  • Non-EEA students looking to study medicine will need a Tier 4 visa
  • To be eligible for a Tier 4 visa, applicants need an unconditional offer from a UK medical school, a visa letter from a licensed sponsor and evidence of sufficient funds to cover their course fees and living costs for up to one year
  • Non-EEA doctors who wish to work in the UK will need a Tier 2 visa
  • Eligibility for a Tier 2, requires that doctors have a job offer, which meets the Resident Labour Market Test and receives an appropriate salary
  • Applicants will also require a certificate of sponsorship provided by an employer or deanery.

Until June this year, the Government imposed a cap on the numbers of Tier 2 visas, which could be issued each month.

The cap saw hundreds of non-EEA doctors who had secured jobs in the NHS prevented from starting work in the health service.

Following lobbying from the BMA and other organisations, home secretary Sajid Javid lifted the cap.

The BMA has this month launched a free online information sharing resource aimed at non-EEA overseas doctors looking to work in the UK. Access the service



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