Overseas Doctors in UK

CSA is failing international trainees.

2012-01-28T11:21:00.000Z

The CSA is failing international trainees 23 Jan 2012 If you are an international medical graduate, your chances of failing the clinical skills assessment (CSA) are about 50%, compared with 10% for UK graduates.1 These startling statistics shock me every time I see them.General practice is currently the only specialty that has an exit examination, which implies your career is over if you fail the now limited number of attempts for the CSA. This has led to discontent among international graduates as well as the training community in general. Such high failure rates for a particular subgroup raise questions about the exam's validity and fairness. This has brought the role of the RCGP under scrutiny. Raising its bar for examination standards when it clearly expected more international candidates to fail – as Pulse revealed last year – hardly gives the impression of a fair organisation. Even though it did issue an advisory paper on the CSA, it remains guilty of introducing an exit examination without appropriate support for the subgroup it knew was likely to struggle. This rings alarm bells about revalidation too, in line with the concerns expressed by the BMA.2 The test is not just meant to examine communication but clinical skills, and yet all the explanation being given is about communication. Anecdotal evidence suggests that many candidates who fail the CSA appear to be safe and effective doctors. But why do international graduates struggle disproportionately? The common reasons given for candidates failing the CSA include not listening, not exploring ideas, concerns and expectations, and problems with diagnosis and treatment. But that is virtually all of the consultation. It also makes me wonder how they passed the PLAB exam and GP recruitment. Or did the system let them in to fill posts? Also, consultation skills are learned skills. We expect a qualified GP to be able to adapt their consultation style and yet we do not adapt our teaching style for trainees with different cultural backgrounds lacking in so-called ‘linguistic capital'. Biases and prejudices We all know that despite the UK being one of the world's more tolerant societies, there remain biases and prejudices that increase the pressures on overseas graduates. There is a plethora of evidence that suggests ethnic minority students fare less well in entry to UK medical schools, in final examinations, in job applications, in disciplinary action before the GMC and in the granting of merit awards.3 The reasons for such differences are far from clear. We need more research as to why international graduates, who constitute about one-third of the workforce, do less well. Any suggested predictive factors then also need to influence the demand-supply cycle at the recruitment stage. Most deaneries are now actively looking at ways to tackle this problem head on. Encouraging trainees to have mixed study groups to foster more social integration is laudable – integration works both ways. But being an international graduate is an immense pressure in itself. Setting very high standards to reassure the public is all very well, but the standards that have been introduced will not make the public any safer. A poor doctor with good communication skills can still pass the examination. The relationship between the non-UK workforce and the NHS has to remain symbiotic. Otherwise, we will end up causing damage to the very patients we seek to reassure. Dr Kamal Sidhu is a GP trainer in Peterlee, County Durham Competing interests: Dr Sidhu is an international medical graduate References 1 RCGP. MRCGP Clinical Skills Assessment (CSA) Information Paper. 2011. http://tinyurl.com/74dldbf 2 BMA. Health committee enquiry into revalidation. 2011. http://tinyurl.com/78l55nf 3 Woolf K, Potts M and McManus C. Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. BMJ 2011. http://tinyurl.com/6ulgbyv

We must face up to the cause of so much waste – our patients

2011-10-01T12:31:00.000+01:00

13 Sep 2011
Amid the gloom of budget squeezes and low morale, the big question is what can be done to save one of the finest health systems in the world?

There has been a huge amount of research into shifting specialist services to the community, the use of referral management centres, reclassifying low-priority procedures and even incentives to reduce referrals and admissions, as potential solutions to the shortfall in NHS funding. But something seems to be missing.

We all blame many of the current constraints on it, but are afraid to talk about it. It is politically unpopular to look at some of the patient-related factors that waste billions.

Most patients are careful and use the NHS when needed and appropriately. But there are a small fraction who do not appreciate the system that so comprehensively looks after their health and is free at the point of use.

Having worked in another healthcare system where you pay for each and every contact, I still find it amazing I can go and see my doctor and receive, usually, world-class treatment, without worrying about the cost. In many cases, even transport is provided. The NHS is the envy of billions around the world.

But who has not come across frequent callers to surgeries or out-of-hours services and patients who have numerous attendances at hospital for trivial reasons? Sadly, a minority of patients would be happy to call the doctor out in the winter, claiming their car is too cold for them to come in. Who has not heard about abuses of 999 services? What about those who refuse to listen to smoking cessation advice while their child keeps getting asthma attacks? Or those who get drunk and sober up at A&E? Abuse of the sick note system (or now, the fit note system) is no news to any of us.

There have been some efforts to tackle wasted resources as a result of missed appointments, mainly in hospitals. Even the potential savings from these are staggering – NHS North East, for example, puts the cost of missed appointments at around £20m a year. But there appears to be little research on missed appointments in primary care.

In our own surgery, during the last month, we have lost the equivalent of four days' work from a doctor. There are many other related areas of waste that have hardly been looked at – re-referrals after missed hospital appointments, wasted prescriptions, wasted treatment plans and requests for over-the-counter medicines on prescription.

Who is to blame? We, as doctors, either do not have time to carry out patient education or are afraid to do so.

But patients have to take the blame to a degree and accept that if this system has to improve, all of us have to improve. Patient empowerment can only be a good thing and I completely agree with ‘nothing about me, without me' – but power is accompanied by responsibility.

Sadly, there is little emphasis on patient factors amid all the commissioning talk. There is an urgent need to involve patient groups to find ways to reduce abuses of the system if we wish to make it work effectively. If charging patients when they fail to attend without prior notice is not acceptable, then we need to bring forward other solutions.

I would like our commissioners to take a lead on patient education and awareness. Otherwise, the question of whether we can afford the NHS risks fading away as we are left with an alternative system altogether.

Dr Kamal Sidhu is a GP in Blackhall, Cleveland

Will our training ever be enough?

2011-05-03T22:43:00.000+01:00

Will our training ever be enough?
03 May 11

The more I know about the change, the more depressing it is.

The times are changing and so is primary care, indeed beyond recognition. The more I know about the change, the more depressing it is. But what I find most annoying and frustrating is the expectations on GPs.

With every report that comes out, there is another recommendation for improving GP education.

A dementia report suggests GPs need more training. Then it is more child health training.

Then I attend a musculoskeletal course and am told that GPs can look after a lot of these patients in primary care if appropriately ‘trained’.

My problem is that these reports come not only from specialists, who clearly have a strong interest, but from some of my own GP fraternity who happen to have attended another couple of courses.

I agree that I need to keep up to date and keep learning. And honestly, I am trying my best – but is it ever going to be enough?

There is always scope for more training and improvement – but stop thinking about only dementia or depression. I deal with pretty much any disease you could ever think of.

From Dr Kamal Sidhu, Peterlee, County Durham

Add a job crisis to your list of worries

2011-02-11T23:35:00.000Z

12 Oct 10

There were concerns a while ago that new GPs might struggle to secure jobs after graduation. My experience with the job market is to the contrary. The number of applicants in general practice has fallen and sadly continues to do so.

A vacuum has been created in the job market where the number of applicants for salaried posts, and even partnerships in some cases, has slumped from double-digit figures per post to hardly any. Many trusts in England have struggled to fill short-term and middle-grade posts across other specialities too.

This is partly down to the barring of training posts to non-EU applicants and the anticipated exodus to other countries, especially Australia, compounding the shortage created by the European Working Time Directive.

The situation in general practice is only expected to get worse now, with the more difficult new MRCGP examinations and the limited attempts candidates are allowed.

If you thought all we had to deal with was the squeeze on resources, spirits dampened by the white paper and the expected fall in pay, you should add a job crisis to the list.

It is going to make the changes in the NHS even more difficult to achieve, unless the floodgates for overseas doctors are opened again by our political masters as a quick fix.Dr Kamal Sidhu

Dr Kamal Sidhu, Castle Eden, Cleveland

Migrant cap will harm care

2011-02-11T23:33:00.000Z

Migrant cap will harm care
11 Jan 11

The immigration cap proposed by the Government virtually excludes doctors from non-EU countries from working and training in the UK. It only adds to the current chaos and the perception of a lack of workforce planning across the NHS.

These changes have the potential to seriously undermine patient care.

Immigration policies have consistently been out of sync with the realities on the ground. I dread the impact of any such monthly caps on rotas of doctors. In general practice, it could have far-reaching consequences, adversely affecting the ability to meet workload and provide continuity of care.

General practice and hospitals have faced significant shortages in the last couple of years since the visa rules brought in by the previous government have started to take effect. This Government has chosen to ignore a potential crisis.

We need a fair, consistent policy. Is an effective and transparent strategy to deliver the workforce that is needed really too much to ask for?

From Dr Kamal Sidhu
Blackhall and Peterlee

Can college be trusted with revalidation?

2011-02-11T23:31:00.000Z

Letter of the week: Can college be trusted with revalidation?
09 Feb 11

Your recent story about the RCGP entrance exam was rather disturbing.

RCGP broke rules in toughening up exam

Grassroots GPs often find it hard to relate to the college, but its vital role in education and training has never been in question. That the RCGP raised the bar for success in the CSA while anticipating this would adversely affect pass figures has raised serious questions, giving credibility to the argument that the CSA has been grossly unfair and biased against doctors not trained in the UK. I am worried this can be perceived as discrimination.

The change also meant practices have continued to face recruitment problems, which can potentially be unsafe for patients.

No one questions the intention to improve the quality of GPs coming out of training, but changes should have been implemented from the bottom to the top. The college needs to explain to GPs what pilots were done to assess the impact of the change and what arrangements put in place to support trainees and training schemes adversely affected.

If there is a subgroup that lags behind in communication skills, it should be supported, not punished.

The approach should have been to raise the bar to entry to the general practice training programme, as that would have been more cost-effective, safer for the public and fairer to trainees.

Without a change in approach, GPs like me will doubt not only the college’s exams for new entrants, but also its role in the much bigger task of revalidation for existing GPs. If it can’t treat its children fairly, how much faith can grown-ups have?

From Dr Kamal Sidhu
Peterlee, County Durham

PM speech on immigration

2009-12-16T11:39:00.002Z

With reference to Mr Brown's recent speech on immigration that suggests a ban on medics from outside Europe, I am left with absolutely no doubt that the cocoon around him i.e. his advisers are completely of sync with reality. No wonder that the speech has already been correctly dismissed by most including 'migration watch' as a feeble attempt to be 'seen to be doing something'. Many trusts are already reeling in serious shortages of doctors across various grades especially Wales and Scotland. There is a fear that this may have or might lead to a drop in recruitment bars set when there was plenty of workforce around. Even in general practice, the pendulum seems to be swinging to the other side now. Some estimates suggest shortage of up to more than thousand of posts across junior grades alone. You have to be in fairyland to expect the UK qualified or EU doctors to be able to fill these posts. EWTD directives has only contributed to this shortage caused by unjust and ill thought visa changes imposed retrospectively couple of years ago coupled with MMC failures. Current point based system , which government has been boasting about , is a good system but there are some unacceptable flaws including an infamous clause where if your bank balance is less than a certain amount for even a single day, can lead to your application being refused despite being on higher than average salaries. In essence, the government policy has usually reflected contrasting intentions to the needs of NHS. Everyone has suffered as a result i.e. both NHS as well as non-EU doctors. This also leads one to question the motive behind the recruitment drives by some agencies form non-EU countries and recently rolled out Medical Training initiative. It is hard to be convinced that the only motive is filling in the gaps without any benefits for such doctors. It is also interesting to note that the group of immigrants that brings maximum economic and cultural benefits to the country and the group that can not avail any public funds including child benefits for many years, seems to be the target of the speech.
We need a concerted policy that regulates all doctors entering Britain but provides a fair deal to those who are allowed in. All they need to do is to involve doctors ie BMA, BAPIO etc to assess the ground realities and coordinate with home office.The strategy should respond to the needs of NHS and not be a knee jerk reaction to a party that does not deserve mentioning its name, winning couple of seats as public is sensible enough to make decisions and will certainly do so next year. Anyways, they trust doctors many times more than those who make policies. What an irony!

Kamal Sidhu

DoH training scheme for overseas doctors flawed

2009-05-15T19:01:00.000+01:00

Letters: DoH training scheme for overseas doctors flawed
15-May-09
I write to express my concerns regarding the recently launched Medical Training Initiative (MTI) by the DoH.
Such posts will be for a maximum of two years, will entail 'some' training and will lead to a 'certificate of experience'. Such doctors will enter under tier 5 of the immigration system and their stay will not count towards the duration required for indefinite leave to remain.
These posts seem to have been created in response to a shortage of mainly trust-grade doctors across specialities and trusts. Although the spirit behind the initiative, in theory, seems genuine, the whole process seems to have significant flaws.
The concerns are that a two-year period will certainly not be enough for any amount of 'substantial training'. Secondly, the current certificate of experience will not leave them in any better position when they go back to their country. This is complicated by what this structured training will involve.
For such doctors to derive tangible benefits from this scheme, the training period needs to be extended to at least three years in coordination with the Home Office. They should also be allowed to undertake membership examinations of their royal colleges so that their investment in the system is reciprocated.
Such schemes must be mutually beneficial, a fair deal and not just a way to fill the gaps in service. The BMA needs to at least give some priority to such issues to improve its standing amongst international doctors.
All involved should make the rules clear before recruiting applicants because this 'terms and conditions' culture may not be as prevalent in such countries.
Otherwise, the MTI will be looked back upon as another fiasco and it will take years to clear up the mess.
Dr Kamal Sidhu, Sunderland GP and GP35 member
A DoH spokesman said: 'The relaunch of an expanded MTI underlines our continued commitment to the exchange of expertise and experience between the UK and developing countries.
'International medical graduates have made a valuable contribution to the NHS for most of its history.
'The MTI was never created to provide full doctor training, it is a route that allows a restricted number of doctors to enter the UK and train for a maximum of two years to gain some valuable experience that can assist them when they return to their home countries.
'It is consistent with the UK's ethical recruitment policies and helping developing countries to develop their own health services.
'The royal colleges identify and sponsor international doctors working in their speciality in developing countries. They then work with deaneries to match them to spare training opportunities in the UK that will give them specific specialist skills and experience they cannot obtain in their own health system.'

MTI-another fiasco in making

2009-04-16T21:02:00.000+01:00

MTI-Another fiasco.
14/04/2009
Kamal Sidhu
Thanks Dr Ray and Kumar for their very informative article. Although the spirit behind the initiative, at least in theory, seems genuine but whole process seems to have significant flaws, which unfortunately have been seemingly ignored before rolling out the programme. I find it hard to convince myself as to what 'substantial training', can a doctor under the scheme get within a period of two years-even two years is subject to extension. When there are already hundreds of IMGs who would wish to get some training if offered, why we need more from overseas. Why not stop the exodus from the country itself? How can we embark on another short-sighted plan that seems to be a knee-jerk reaction to the impending shortage in non-training posts across the trust, when memories from poor and chaotic workforce planning from the disastrous last few years are still afresh? For this programme to be mutually beneficial, the training offered should be at least extended to three to four years so that tangible benefits are achieved by such doctors and experience assimilated and taken back into the source countries. Secondly, currently the doctors under MTI hope to achieve a 'certificate of experience' after completion of two years. I am not sure as to what value this certificate holds when they go back into their country of origin. This amounts to nothing less than 'exploitationâ. The way forward may be to allow doctors to undertake the Royal college membership examinations though usual channels so that they have a formal degree or additional qualification which makes it a 'fair deal'. Thirdly, we need more clarity as to what constitutes 'training' and that their salaries should be at least, equivalent to the relevant grade of UK doctors with appropriate seniority. Sadly, the argument put forward by DOH about duration of training is that Tier 1 system of immigration is only allowed for two years. But, does that justify it? Does that mean DOH can play with careers of such doctors? What is the desperation to go ahead without having a solid plan? It is a shame that in a developed country, two departments can not coordinate with each other especially when their planning in the past has been nothing less than a disaster. Sadly, despite all our concerns, there will be a lot of applicants as option of training for two years, gaining âexperienceâ and perhaps make some savings is still attractive from overseas . The role of BMA is certainly nowhere close to what is expected from the molst effective trade union of the country. As usual apart from issuing statements, it is not clear as to what efforts have they made. Such issues close to heart of IMGs seem to be of no or very low priority at the moment despite thousands of IMGs persevering to pay for their BMA membership. The standing of BMA as an organisation within ground workforce seems to be at an all time low. This seems to be reflecting on membership of BMA especially junior doctors especially IMGs. It is now up to us as IMGs to make our issues heard. BMA should in collaboration with other IMG organisations, start a campaign to create awareness amongst applicants under MTI.All leaders with ground force workers should write to the relevant authorities to modify the proposed plan so as to make it a better deal. After all, how may British graduates will take up such posts?

Hospitals struggle to find enough junior doctors to fill rotas

2008-12-30T17:05:00.000Z

Pendulum swinging the other way!!
30 December 2008

kamal sidhu, GP Sunderland
Send response to journal: Re: Pendulum swinging the other way!!
This news really comes as a shock to me though similar anecdotal incidents of shortage are starting to be heard in local circles.Is this the pendulum starting to go back the other way? How well does it reflect on the planning of workforce by NHS managers and politicians alike? Who is answerable for the inconvenience caused to patients by cancellation of surgeries, delays in assessments and procedures.What about hundreds of junior doctors who had to move to other countries like US, Australia and New Zealand? Who is going to accept the blame for a chaotic planning which resulted in hundreds of overseas doctors leaving in financial as well as psychological distress? perhaps all the surveys, pilots or studies conducted did not foresee this and if there were warning signals,were these warnings heeded to. This certainly does not reflect well on Britain as a nation and NHS as an exemplary health service but someone must have known?
Competing interests: None declared

Job crisis is 'bigger threat' than private firms

2008-12-02T23:34:00.000Z

Unemployment amongst young GPs is certainly a big challenge for the profession.Many of us chose general practice as a career because of cradle to grave relationship with the patients and career stability, both of which are lacking in locum work.Most of us want to be in stable jobs i.e partnerships which are very hard to come by in the current scenario. The current bosses at the helm clearly lack focus and long term plan.Increased intake (likely to increase even further) has shifted the pendulum to other side along with squeeze on funding for practices.Lack of workforce planning is not unheard of and chaos in NHS is reflected here as well.We only need to go back a year or two to remind us of MMC fiasco and clear failure on part of the authorities that resulted in a lot of overseas doctors coming to UK, many of whom are now stuck in non training positions or had to go back, not to mention difficulties faced by local graduates, Only a year ago, weekly newspapers carried striking headlines about thousands of GPs going to retire in next few years and creating a vacuum.I can not see that coming despite so much negative spin about GPs which will leave anyone fuming and upset, Times are certainly uncertain and so is the future of general practice as well as of future GPs. I will not take the blame by moral police of the profession for caving in to work for Tescos or Boots if it fails me now.Dr Buckman is rightly worried about this cancer but unless we get out act together and look after each other,time will run out for cure and this cancer may only be palliated.

Mumbai Blasts

2008-12-02T23:31:00.002Z

It is a horrific incident.A reminder of how dangerous the conflicts are in our region as well as how politicians and corruption in our country has always let us down.
Let us all pray together for peace for those innocents who lost their lives and for peace in whole world.

Job Scene for new GPs

2008-11-02T22:12:00.002Z

well timed article. 1. The situation is undoubtedly worse.Newly qualified GPs are struggling to find jobs.Some have to move hundreds of miles to simply get a job.Some have to chose to live separately from their family as they have been unable to find jobs around where they live.Partnerships have completely dried up.Even long term locums are difficult to get. 2. Intake of GPs has gone up in last few years, increased by government and that General practice has been attractive as never before given more stability,improved income and work life balance after the new contract.Secondly,with government trying its tricks to get money off practices along with pay freeze(in reality, pay cuts) , it is a tightrope walk for a lot of practices.It is financially damaging to employ more doctors.Instead,It is more profitable to replace partners with salaried doctors.This has created almost a second class of GPs. 4 The market is flooded with doctors. Feeling let down by the government, by the profession and by the system,it is no wonder that they will be ready to work for tescos or boots.It is not rocket science to work out that with more availability, wages are likely to go down.Is it a long devilish plan by the government or just the pendulum swinging the other way, remains to be seen. It is worth having a debate within the profession about replacing partnerships with salaried doctors.This new hierarchy may be an onset of demise of primary care specialists or primary care consultants , they might be called in future.The department of health needs to give incentives to the practices that recruit new partners. I think that is not far from true feelings of a newly qualified GP
I am fortunate to have found a job and at a place, where I am being gradually introduced to management aspects of practice.This salaried post is by choice as I did not feel ready for partnership straightaway, however out of a group of about 30 newly qualified GPs, only one was able to find a partnership after finishing VTS.This is not an unusual scenario.
Sincerely
Dr Kamal Sidhu

BMA-Is it worth for an IMG

2008-08-08T20:45:00.003+01:00

Dear Sir/Madam
In response to your recent promotional email to recruit members, Ishall like to express my disappointment with BMA.
As an international medical graduate, I feel I have been continuouslylet down by BMA in safeguarding my interests whether it was when Ineeded advice when my visa application was unfairly rejected, whetherit was stance taken by BMA when government embarked on immigrationchanges that they subsequently it lost in courts and house of lords orif it was MMC impact on IMGs.So much so. representation of IMGs in BMAis poor and I donot think if BMA has sufficient data even.
Yes, BMA did acknowledge all the changes and impact by issuingstatements but nothing more than that.
Recent report by CMO on racism clearly is evidence for failures of BMAwhether it was acts of commission or omission.
I am sure many others will share my feelings.
Until I feel BMA will safeguard my interests, I think it is a waste of money for me to join BMA .I hope things improve in future or analternative shapes up for IMGs
Hope to hear your viewpoint
Sincerely
Dr Kamal Sidhu

Second class of GPs

2008-07-12T16:21:00.000+01:00

Face of general practice has changed beyond recognition in last few years.A second class of GPs has emerged as being massively popular called as salaried GPs.New GP contract and squeeze on funds by government in last couple of years has led to rise in prevalence of thinking that a salaried GP is a relatively cheaper option.This is detrimental for profession in general and newly qualified GPs in particular.Although it allows them to settle down into the world of general practice as a clinician, they miss on administrative and business side of things.Less number of GP jobs have resulted in a surplus which currently works in favour of the government agenda of privatisation as it creates divisions amongst GPs as people without jobs will be willing to work for any hours and for anyone including Tescos and Boots. In addition, this has almost created a hierarchy of authority amongst GPs.The profession needs a debate whether this is a healthy trend for general practice lest they will have to share the blame for demise of primary care doctors.
Competing interests: None declared

NHS at 60-International perspective

2008-07-07T21:59:00.000+01:00

DR KAMAL SIDHU, SUNDERLAND, UK

When I was a medical student in India, there was an aggressive marketing campaign to recruit new doctors for the NHS. Talks at medical school promised jobs and training but when I came to the UK in 2003 I realised I hadn't read the small print. There was a surplus of doctors and it was very hard to get a job.
I finally found a great job working as a GP in Sunderland. I feel fortunate to be working in a job that I enjoy but others have not been so lucky. Sudden changes to the immigration laws have meant that lots of overseas doctors have had to leave the UK, uprooting their families and often returning home in serious debt.
In India, doctors are considered as almost equal to God but in the UK you are more answerable to your patients. There are good sides to the NHS, it's wonderful to be able to do your job without worrying about whether the patient can afford treatment, as is the case in India or the US.
My visa is due for extension next year, it's hard as I don't know what will happen. Having trained in the UK, I feel I have a moral duty to work for the NHS to pay back into the system. I enjoy working for the NHS but the immigration laws have cast a cloud over my career.

Foreign graduates ruling is lesson to authorities

2008-06-26T20:56:00.000+01:00

20-Jun-08
The House of Lords ruling that declared immigration changes for international medical graduates (IMGs) to be unlawful should serve as a lesson to the authorities.
The changes were a political gimmick in response to the looming jobcrisis resulting from poor workforce planning, job cuts and the MMCfiasco.
Hundreds of families were uprooted, and many left the country with theircareer hopes dashed and drowning in debt.
Some had to compromise on their training, which is unheard of forBritish graduates. This second-class treatment meted out to non-EUgraduates did little to help the situation. Instead, it created anatmosphere of distrust and uncertainty for IMGs.
What's more, the DoH did not try to negotiate an amicable solution andkept appealing until it could do nothing more.
On the positive side, the fight helped IMGs to demonstrate unity and putup symbolic resistance to unfair and abrupt changes. No one disagreedthat the system needed regulation but the way it was done was shamefulfor a developed country that has always stood for its values.
I now think twice before even medium-term commitments as I may wake upand find that I have been asked to leave the country because the ruleshave changed.
Dr Kamal Sidhu, High Heaton, Newcastle-upon-Tyne.

Health Secretary accuses BMA of misleading on Polyclincis

2008-06-13T16:23:00.001+01:00

Whom does public trust?
13 June 2008

kamal Sidhu, GP Sunderland
Send response to journal: Re: Whom does public trust?
Remarks made by the health secretary are entirely inappropriate for the situation and least expected to help the situation. Time and again, it has been shown that the public trust in politicians is hardly of any standing when compared to how much trust they have in their doctor.We as doctors are more than four times more trustworthy. There is no evidence behind the proposed changes. Patients do not want it.Doctors do not want it.I fail to understand how many of the surgeries will not close.Nobody wants it. At this crucial time when NHS is undergoing sea change(almost all of them controversial and embarked upon without taking on board, the profession itself), we do expect invitation to engage rather than alienating the profession further. It seems that government has simply been baffled by public response.I feel there is more to come. No one disagrees that access needs to be improved but this is not certainly the way forward. When dreams are alike, why take different tracks.But,who listens.
Competing interests: I am a GP offended by accustaions.

Changes in General Practice

2008-06-10T13:09:00.001+01:00

Is it the beginning of the demise ?
10 June 2008

kamal Sidhu, General Practitioner Sunderland
Send response to journal: Re: Is it the beginning of the demise ?
A debate on the most of the issues raised by the authors is the need of the hour.Whereas, the politicians are eager to be seen to be doing something with NHS, the medical profession stands disunited and disgruntled.
Within the last three years since I joined General Practice, its face has changed beyond recognition. Continuity of care is no longer a priority.'Cradle to grave' attitude has given way to one-stop service with the rather forced idea of polyclinics.
Miscalculations on behalf of government that resulted in significant pay rises for GPs are apparently being compensated by back door initiatives like extended hours in form of 'less damaging option A'.
Pace of the change is too fast resulting in all time low morale of the front line staff. Negative media spin about 'massive' rise in GP earnings coupled with problems with patient access had already pushed the GPs against the wall.Of course, it was the ideal time for the government to bring in its agenda of extended opening hours on its own terms, the threat of private care providers and Darji Polyclinics(even if evidence backs the contrary)
Job prospects for newly qualified GPs have dwindled and with hardly any partnerships available which is another issue the profession needs to debate amongst itself. While most will agree that patient access needs to be improved and some of the services can be moved closer to patient home,Is this the right way forward.There is a clear conflict between patient, doctor and Government agenda. Can a disheartened and disappointed GP provide quality care? Do the patients want any of the drastic changes being forced upon the profession? What is the long term future of NHS and its backbone, the primary care? Are we moving away from a health system which provides guaranteed health care to a system which is more consumer driven and a profit making organisation?
Only time will provide all the answers but one thing is for certain that if remedial steps are not taken soon,it may well be the beginning of demise of NHS.
Competing interests: I am a newly qualified GP.

The Uncertainty

2008-05-21T19:13:00.003+01:00

The Uncertainty
21 May 2008

Dr kamal Sidhu, GP Sunderland
Send response to journal: Re: The Uncertainty
The House of lords ruling that declared immigration changes for IMGs as unlawful should serve as a lesson to the authorities.The changes were a political gimmick in response to the looming job crisis that resulted from poor workforce planning, job cuts and MMC fiasco.As a consequence, hundreds of families were uprooted.Many left the country to go back with their career hopes dashed and drowned in financial debts.Some had to compromise on their training which is unheard of for British Graduates.This second class treatment met out to Non EU Graduates did little to help the situation.Instead, it has created an atmosphere of distrust and uncertainty for IMGs.Furthermore, The department of health did not try to negotiate an amicable solution and kept pushing for appeals until it could do nothing more.
On the positive side, the fight helped IMGs to demonstrate unity and put up symbolic resistance to unfair and unjust abrupt changes. No one disagreed that the system needed regulation but the way it was done is shameful for a developed country that has always stood for its values.
I now think twice before even medium term commitments as I may wake up and find that I have been asked to leave the country because rules have been changed. I hope wisdom prevails.
Competing interests: I am a overseas trained doctor not directly affected by these changes

Pulse letters

2008-05-21T15:36:00.002+01:00

Overseas doctors ruling is welcome news
20 May 08
The recent House of Lords judgment declaring immigration changes for overseas doctors unfair, though largely ignored by the media, is welcome news among otherwise disheartening developments in general practice.
Many of those who were affected by these poorly thought-out changes have already left the country with financial, social and psychological scars. The trauma they were put though cannot be compensated.
Still, this ruling is a symbolic and moral victory for international medical graduates. Efforts made by the British Association of Physicians of Indian Origin, which was a little-known organisation before this, are certainly commendable. It is also a lesson to international medical graduates who had simply given up, and those people who chose to ignore the issue as it did not directly affect them.

I sincerely hope the Department of Health learns its lesson and apologises to those doctors whose careers it played with in a knee-jerk reaction to the jobs crisis. I still wonder if the UK's credibility, so eroded by these events, will ever be regained.
Dr Kamal Sidhu, Sunderland

Overseas Docs victory in House of Lords

2008-05-12T22:06:00.000+01:00

It is a symbolic and moral victory- a slap at the face of DOH.It also proves a point to those overseas doctors who do not believe that we could do anything. What is shameful is that DOH instead of negotiating with IMGs, chose to appeal again and again. Changes did cause lots of irreversible damage but hopefully, DOH will think twice before embarking on any more such abrupt and unjust changes

Court Ruling implications BMJ

2008-03-22T12:48:00.001Z

Court ruling-a breather for overseas doctors
17 November 2007

This court ruling that declared the immigration changes for IMGs(International Medical Graduates) as unlawful is finally a welcome news for overseas doctors. It is not only the court but the executive branch of United kingdom in form of a parliamentary committee, that had also criticized these changes
It seems IMGs have become the scapegoat in the whole MTAS fiasco.Suddenly, the health ministry realized that they have not got enough posts for overseas qualified graduates.Hence, solution was to change immigration rules.As a results, thousands had to go back without any qualifications and in serious financial debt.Those left had to either opt for a career change or accept non-training posts.
Then comes the Tooke inquiry which has not only belittled IMG's contribution to NHS especially when it was in crisis but this inquiry also fails to address the current situation. Thanks to BAPIO that many of IMGs were able to secure training jobs for this year and this court ruling has given a lot of credibility to BAPIO as a representative organization for IMGs who have been generally disappointed by BMA's lip service statements.
Though the court ruling may be justice delayed as many of affected IMGs have left this country, many with their families uprooted, It is certainly a symbolic victory. I sincerely hope that Department of health embarks on properly thought and planned changes in immigration rules rather than a knee jerk reaction.
It should also be a lesson to all of the IMGs to forget regional differences and unite under one umbrella organization.
Competing interests: I am an overseas qualified doctor

Will it ever end?

2007-07-22T19:45:00.000+01:00

Woes faced by overseas doctors working in NHS refuse to abate.Firstly, the immigration changes, then MTAS fiasco and now NHS-terror link.. It was so shocking to see those highly educated people trying to bring death and misery, the very people who are trained and expected to save lives, treat everyone with utmost kindness and allay suffering of human beings. There is no excuse for terrorism and it must be condemned in any form.

Although the law will take its own course, there are fears of backlash against overseas doctors especially from the subcontinent. It is more than likely that this will have repercussion for all the migrant doctors. Recruitment reviews are planned. There are expected to be more robust criminal checks and why not. But there is an anxiety that it will make life more difficult for International graduates. Their woes in getting a job will go up. They may be viewed with suspicion because they come from a particular country or believe in a particular religion. In the worst scenario, their acceptability to patients might be questioned.

The contribution to NHS by migrant doctors is immense and must not be forgotten or overshadowed by hopefully isolated incidents. Statements from BMA have been timely and are most welcome. While oversees doctors should be more vigilant, our British colleagues need to appreciate this and stand shoulder to shoulder with migrant doctors. Let us hope for better times ahead.

PPUD syndrome

2007-04-17T12:09:00.000+01:00

PPUD (Post PLAB Unemployment Doctor) Syndrome

In an effort to keep up an old medical tradition, I report a new syndrome, prevalent in the age group 25-35, but some cases are seen in the early 40s. Both sexes are equally affected. It is endemic in east London, but sporadic cases can be seen all over Britain. It is mostly found in immigrants from the Indian subcontinent."

His treatment for the PPUD Syndrome: "Love and a healing touch. Patients should be encouraged to go back to their home country, as in Britain even local graduates find it difficult to get a job and nobody is bothered about someone with PPUD syndrome."

Sareen detailed a series of ailments such doctors suffered from, including depression, insomnia, obsessive-compulsive disorder, hallucinations, somnambulism, omniphagia, dissociative fugue and muskuloskeletal deformities.in BMJ 2006

visa worries

2007-04-17T11:59:00.000+01:00

I am one of the doctors currently working in NHS.

It has been sad times for Non-EU overseas doctors. Much awaited decision on the judicial review of immigration changes effected in April 2006 filed by Dr.Imran Yousaf and BAPIO(British Association of Physicians of Indian Origin) has failed .The situation has become very grim. Some of the IMGs(International Medical Graduates) have gone back with their families,hoping to forget the years of struggle they spent in UK as a bad dream. Some will go back with no career achievements or qualifications.Others will have to take up non-training jobs, abandoning their career aspirations,thanks to Government s poor planning and BMA's( British Medical association) not-so-helpful attitude.The court judgement does agree that the government failed to consult relevant parties and did not take a race impact assessment.

With the arrival of MMC(Modernising Medical Careers), majority of IMGs are finding that they wont be able to get any further in the career ladder as they will not have appropriate visas.Obviously, the government is not bothered.They needed us and we had an opportunity.Now, we have been dumped.The system has lost all its international credibility.

Even the media did not bother to give any coverage despite the fact that Dr.Yousaf committed suicide recently as was refused further leave to remain in this country.The changes implemented do not just affect the doctors themselves but their children and their families who have made sacrifices to come here and now are faced with the prospect of going back empty handed after investing years in NHS

Furthermore, their is a growing perception as to whether it has been any successful in representing overseas doctors.Many of my friends have cancelled their memberships.BAPIO just doesn't not seem to have the influence or resources.Other issue that worries me is whether our local colleagues understand the issues or have they been vocal enough.Finally, we as overseas doctors haven't been as united either.Many of us have just been sitting back and watching to see what happens.

Th general feeling is that the Government of United Kingdom and our respective Govts from our countries of origin have failed to protect our interests.The changes were poorly planned and implemented by various trusts with their own interpretations..

With every new day when I wake up, I hope not to read or hear any news from home office re overseas doctors.I know it wont be good.