Healthcare workers from ethnic minorities have long contributed to the NHS. It is time to recognise this, say Paramjit Gill and Kiran Patel
Doctors from ethnic minorities have been supporting the NHS from its inception. Their continuing contribution has been highlighted by the covid-19 pandemic and the disproportionate effect that covid-19 is having on healthcare workers from ethnic minorities. Reports suggest that the majority of healthcare workers who have died from covid-19 have been from ethnic minorities, even though they make up about a third of doctors working in the NHS. [1]
Long before the covid-19 pandemic started in the UK, NHS hospitals and general practices were already experiencing high demand for healthcare. The “summer and winter effects,” once synonymous with quiet or busy periods in the NHS, no longer exist. The population in need of healthcare is growing. People are living longer than previously. With longevity comes multimorbidity and the health needs associated with older age. [2] General practice is facing particular challenges in meeting demand, compounded by austerity and workforce challenges.
What does this mean for NHS staff working in deprived areas? Many general practitioners, particularly from ethnic minority backgrounds, have been instrumental in serving deprived areas. They were initially welcomed during the early years of the NHS to address workforce shortages in hospitals, and were incentivised with opportunities to undertake sought-after postgraduate qualifications from our Royal Colleges. [3,4] By 1972, 42% of doctors working in the UK obtained primary medical qualifications from countries other than the UK. [4]. These International Medical Graduates (IMGs), who often aspired to consultant positions in hospital medicine, ended up in general practice. This was due to a number of reasons including discrimination leading to lack of career progression and change in career, with many IMGs ending up in deprived single-handed practices which were not as attractive to work in for UK graduates entering general practice. [6] They provided healthcare to many patients from diverse backgrounds, living in inner cities. The conditions in deprived inner city general practices were extremely challenging.
Recent changes in migration, particularly from Europe, have transformed population diversity in deprived areas. It is not uncommon for GPs to have 50-60 patient contacts a day, managing a wide spectrum of problems encompassing medical and social issues. In any inner city practice, a typical morning consultation list deals with 1-2 telephone interpreter consultations that require more than the allocated 10 minutes. Staff caring for these patients groups need to be aware of not only common diseases such as diabetes and hypertension; but also infectious diseases including latent TB and hepatitis. [7] Many of these patients visit their country of origin for various tests and return demanding referral or treatment. It is not uncommon to be told that they have been treated with antibiotics and that this needs to be continued. This adds to time pressures as GPs have to explain their rationale for not complying with these requests, which takes time and patience. Meanwhile, the number of patients waiting for their appointment grows, breeding patient discontent and GP anxiety. Other primary care staff are also under pressure. For example, reception staff are under pressure from patients to provide a same day appointment or to ensure that the GP completes an urgent form. The rates of people attending for screening and health checks can be low and vaccination rates are also low in deprived and diverse areas.
What can be done? First of all we must acknowledge and thank our IMGs who buttressed, and continue to underpin, a health system in need, by working in less attractive areas of the NHS. Their continuing and substantial contribution has been highlighted by the current covid-19 pandemic. Secondly, we must support the transition from overworked single handed general practices to networked and transformed primary care provision. This will liberate “workhorse” GPs from deprived areas and create more equity in terms of workload between them and colleagues in more prosperous areas. A rotation of staff between different practices might ensure that those working in areas most in need in terms of deprivation and health inequality, are less likely to burnout. The inverse care law must in some way be challenged if we are to achieve better and more equitable health outcomes at a population level. [8]
Paramjit S Gill, is a GP and Professor of General Practice, Warwick Medical School.
Kiran Patel, Chief Medical Officer, University Hospitals Coventry & Warwickshire NHS Trust
Conflicts of Interest: KP is Chair and PG Trustee of the South Asian Health Foundation
References:
- Covid-19: Disproportionate impact on ethnic minority healthcare workers will be explored by government. BMJ 2020; 369.
- Mercer, S. W. , Zhou, Y., Humphris, G. M., McConnachie, A. , Bakhshi, A., Bikker, A., Higgins, M., Little, P., Fitzpatrick, B. and Watt, G. C.M. (2018) Multimorbidity and socioeconomic deprivation in primary care consultations. Annals of Family Medicine, 16(2), pp. 127-131.
- Esmail A. Asian doctors in the NHS: service and betrayal. Br J Gen Pract. 2007 Oct 1; 57(543): 827–834.
- Dr Luisa M. Pettigrew (2014) The NHS and international medical graduates, Education for Primary Care, 25:2, 71-75
- Doctors by World Region of Primary Medical Qualification (PMQ) GMC 2016 report
- Gill PS. General practitioners, ethnic diversity and racism. In: Coker N (ed). Racism in Medicine. An agenda for change. London: King’s Fund;2001.
- Bivins R. Contagious Communities: Medicine, Migration, and the NHS in Post War Britain (Oxford: Oxford University Press, 2015
- Watt G. The inverse care law revisited: a continuing blot on the record of the National Health Service. British Journal of General Practice 2018; 68 (677): 562-563