It matters where our doctors come from
‘I was also struck by the way in which anti-irish prejudices were commonplace and freely expressed’
The NHS has long had an ambivalent attitude towards the overseas medical graduates who make up a substantial proportion of its workforce, especially in general practice.
On the one hand, it actively recruits doctors from abroad to compensate for workforce shortages. On the other, it tends to discriminate against them, if they are allowed in at all. In response to the BMJ’S “Scrap the Cap” campaign, the Home Office agreed last week to relax some visa requirements. Yet, while NHS trusts are offering jobs to overseas doctors, under current immigration regulations, many visa applications will still be rejected.
Meanwhile, an exhibition at the Royal College of General Practitioners at Euston, part of the celebrations of the 70th anniversary of the NHS, commemorates the contribution of doctors trained in India, Pakistan, Bangladesh and Sri Lanka to British general practice.
Based on Julian Simpson’s historical study, Migrant Architects
of the NHS, this exhibition shows how South Asian doctors “reinvented” British general practice. In the Sixties and Seventies, GPS were held in low esteem in comparison to hospital doctors, and many British graduates joined the brain drain to America or Australia. To fill the gap, thousands of doctors trained on the Indian subcontinent were invited to work in Britain, and many set up surgeries in inner city and declining industrial areas. By the Eighties, Asian doctors made up 16per cent of the GP workforce. In many of the interviews recorded by Simpson, immigrant doctors recall their experiences of racism and discrimination.
As a medical student and junior hospital doctor in the Seventies, I well recall the climate of prejudice against Asian doctors that prevailed in the medical profession, most noticeably among consultants. As somebody of Irish origin, I was also struck by the way in which antiirish prejudices were commonplace and freely expressed. When I was growing up in Sheffield in the Fifties, many of the overseas doctors in general practice in the city came from Ireland. Yet Irish doctors have, like their Asian colleagues, generally come to be accepted in the NHS.
I was shocked to discover recently that Irish doctors who have postgraduate GP qualifications at home are obliged to undergo a protracted process of examinations and supervised practice before they are allowed to work in the UK, despite the current recruitment crisis. What would be required if a British GP applied for work in Ireland? No restrictions whatsoever. Surely, hard Brexit or soft Brexit, hard border or soft border, some mistake?
Power plants
To Regent’s Park, for the opening of the summer season of “medicinal plant lectures” and tours of the medicinal gardens of the Royal College of Physicians.
The central feature of the gardens is a magnificent oriental plane, grown from a seedling taken from the tree on the Aegean island of Kos, under which, according to legend, Hippocrates lectured medical students. Nearby is an area dedicated to growing the plants – more than one thousand – authorised for use in the first edition of the College’s Pharmacopoeia Londinensis, published in 1618. In his lecture commemorating the 400th anniversary of the Pharmacopoeia, Tony Cartwright, a pharmaceutical regulatory consultant, traced the history of this work, from its long-delayed publication, through its translation into English by Nicholas Culpeper in 1649, to current prescribing guidelines.
David Wilkinson, an anaesthetist, provided a history of plant products used in anaesthesia, including curare, opium, cocaine – and lettuce. The Royal College’s “garden fellows” reveal their encyclopedic medical and botanical knowledge in tours of the gardens.
It is fascinating to see plants from which familiar drugs are derived – and also to realise that so many plants, including some used as medications, can be toxic. As Paracelsus, the 16th-century physician and alchemist, observed: “It is the dose that makes the poison.”