Immigration changes will deprive UK of doctors, says BMA leader - 14 May 09

Source
Dr Hamish Meldrum, Chairman of BMA Council, has today (14/05/09) written to the Secretary of State for Health, Alan Johnson, to request that he intervenes to ensure that the UK does not lose further doctors as a result of recent changes to the immigration system. The changes restrict international medical students, who are studying in the UK, from continuing with their medical training beyond the two-year postgraduate Foundation Programme.

On 31st March 2009, the Home Office changed the academic requirement for the Tier 1 immigration category1. Doctors applying to Tier 1 now need the minimum of a Master's degree to be accepted onto it. A medical degree is classified as a Bachelor's degree and as a result many medical students and junior doctors who have been studying in the UK for up to seven years2 could be lost to the NHS.

The NHS is already facing understaffed workforce rotas in a range of medical specialties; a problem which the Department of Health has acknowledged was caused, in part, by previous changes to the immigration system.3

In August 2009, the European Working Time Directive will be fully implemented, reducing the working week of junior doctors to 48 hours, placing further pressure on staffing.

In the letter to Alan Johnson, Dr Hamish Meldrum says:

• “The change to the Tier 1 requirements will seriously restrict international students, who have completed their undergraduate studies at UK medical schools, from continuing with their postgraduate medical education beyond the Foundation Programme. These individuals have been included in workforce planning statistics and restricting their ability to progress with their postgraduate medical training contradicts the Government’s previously stated aim of maximising training opportunities for UK-trained doctors.
• “The full implementation of the European Working Time Directive and its impact on junior doctors’ training hours, coupled with a situation in which a proportion of prospective trainees can no longer continue with their training due to ever-tightening immigration rules, is likely to exacerbate rota gaps, putting patient safety at greater risk.
• “Restricting their career options to such an extent represents a huge waste of taxpayers’ money and may lead to affected doctors leaving the UK permanently.”

He adds:
“The BMA is requesting that the Department of Health intervenes to ensure that the changes to Tier 1 are prospective and do not impact upon either those individuals who are recent graduates of UK medical schools or existing international medical students who began their studies prior to the increased Tier 1 requirements of 31 March 2009.”

Notes:

1. The Government has overhauled the immigration system within the UK with the introduction of a five-tiered immigration system. The system is points-based and individuals must score a minimum number of points within a given Tier to be given leave to enter or remain in the UK. Tier 1 is the highly skilled worker category.
2. Doctor training in the UK typically involves five years of undergraduate study followed by a two year postgraduate Foundation Programme.
3. In March 2006 permit-free training for doctors ceased although international graduates of UK medical schools remained able to continue with their training via the Postgraduate Doctor and Dentist Visa and the Highly Skilled Migrant Programme (HSMP) immigration routes. When Tier 1 replaced the HSMP in February 2008 certain doctors were restricted from working as a doctor-in-training. The introduction of tighter immigration requirements for doctors has led to a reduction in the numbers of overseas doctors coming to the UK. One result of this has been that trusts are finding it harder to find locum doctors to fill rota gaps.

The BMA also wrote to Immigration Minister, Phil Woolas to raise this issue on May 6th 2009.

The full text of the letter to Alan Johnson follows

Rt Hon Alan Johnson MP
Secretary of State for Health
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS

14 May 2009

Impact of recent immigration rule changes on the medical workforce
I wish to bring to your attention recent correspondence sent to the Immigration Minister, Phil Woolas MP in respect of recent changes to the Tier 1 immigration category and their impact on doctors. In addition, I would also like to take the opportunity to explain in more detail the BMA’s concerns in relation to the impact that the immigration rule changes will have on the medical workforce.

As documented in the correspondence to Mr Woolas, the raising of the minimum educational requirement needed to apply to Tier 1 from a Bachelors level degree to a Masters level degree has significant implications for doctors. It is the BMA’s view that in further restricting the ability of non-UK/EEA doctors to continue to train and work in the UK, workforce capacity will be reduced and standards of patient care may suffer as the result.

The change to the Tier 1 requirements will seriously restrict international students, who have completed their undergraduate studies at UK medical schools, from continuing with their postgraduate medical education beyond the Foundation Programme. These individuals have been included in workforce planning statistics and restricting their ability to progress with their postgraduate medical training contradicts the Government’s previously stated aim of maximising training opportunities for UK-trained doctors.

The full implementation of the European Working Time Directive and its impact on junior doctors’ training hours, coupled with a situation in which a proportion of prospective trainees can no longer continue with their training due to ever-tightening immigration rules, is likely to exacerbate rota gaps, putting patient safety at greater risk.

The BMA understands that 5% of medical training posts remained vacant at the close of medical training recruitment in 2008 at a time when the immigration rules were more relaxed than they are now. In addition, the supply of international doctors has already been reduced due to earlier changes to the immigration rules and there has been a tightening in the supply of medical locums. In restricting the immigration rules even further, these existing problems are likely to worsen.

Whilst accepting that Tier 2 is still an immigration category within which international doctors can work, recruitment under this Tier is more time consuming and costly due to the requirements employers must satisfy to demonstrate that roles satisfy the resident labour market test. Tier 2 does not offer employers a means of recruiting staff quickly and efficiently to fill rota gaps, again hampering the ability of NHS Trusts to source additional personnel when needed.

Furthermore, in changing the immigration rules with virtually no notice and with no transitional arrangements in place to protect recent graduates of UK medical schools and existing international medical students, there has been a complete failure to acknowledge the legitimate expectations of those individuals who now find their future career options significantly reduced. Restricting their career options to such an extent represents a huge waste of taxpayers’ money and may lead to affected doctors leaving the UK permanently.

The BMA is requesting that the Department of Health intervenes to ensure that the changes to Tier 1 are prospective and do not impact upon either those individuals who are recent graduates of UK medical schools (i.e. those on postgraduate doctor and dentist visas or the Fresh Talent Working in Scotland scheme) or existing international medical students who began their studies prior to the increased Tier 1 requirements of 31 March 2009.

Dr Hamish Meldrum
Chairman of Council
British Medical Association

Back to news index