BAPIO, The BMA, and other medical organisations and colleges are calling for a change to visa rules for NHS doctors

The NHS has a long history of relying heavily on overseas workers—often referred to as “foreign workers.” There are approximately 153,000 non-British workers in the NHS, making up 13.3% of the workforce in hospitals and community services, with 8.3% from non-EU countries. For doctors, this proportion is 39% among hospital doctors and over 20% of GPs in England qualified outside the UK.

It is no exaggeration to say that the system would seriously struggle, if not collapse, without these doctors. This has become even more apparent in the pandemic, with many working extra hours and shifts, especially in less popular specialties. This debt of gratitude may never be fully repaid.

One would hope that such a vital part of the health service workforce would be treated fairly and on a par with British citizens, but the immigration rules increasingly tend not to reflect fairness and justice. Adult Dependent Relative (ADR) rules introduced in 2012 have made it almost impossible for immigrant doctors to bring their older parents to the UK to fulfil their filial obligations. 

According to a Home Office review in 2016, the number of approvals under the ADR rules fell from 2325 to 162 in a year. The rigidity of the rules deprives doctors of their human right to be with and help their parents, leaving them feeling torn, guilty and stressed. The Joint Council for the Welfare of Immigrants (JCWI) has found the ADR rules “harsh, unjust, and unnecessary.”

A joint survey about this issue by the British Association of Physicians of Indian Origin (BAPIO) and Association of Pakistani Physicians of Northern Europe (APPNE) found:

• 91% of respondents reported feelings of anxiety, stress and helplessness
• nearly 60% felt their work and professionalism was adversely affected
• almost 85% had considered relocating back to their country of birth or to another country with more humane regulations
• only 10% felt their employer was able to offer flexibility when they needed to take emergency leave. 

The added complexities of quarantine mean that the obstacles have only worsened during the pandemic. We have been contacted by a number of members who have not been able to attend to their dying parents, or who have had to travel to and from the UK to be with them, risking their own health as well as taking them away from their NHS duties.

For some, the emotional strain of having to make the choice between their professional and family duties can prove too much and they choose to leave or not to make the UK their home because of these discriminatory and divisive rules. The NHS, in turn, loses some of its finest professional capital. 

The “clap for carers” was particularly painful, not least because many healthcare workers from ethnic minority communities lost their lives, but also because it highlighted the sheer hypocrisy of the system. While being hailed as heroes, the same NHS staff face unjust laws such as the ADR rules. 

We have seen how hard social distancing has been for grandparents in the UK during the pandemic. Compare that with the permanence of such distancing for many immigrant doctors and the heartache this causes all around. 

Once again, the NHS faces acute staff shortages, predicted to rise to 250,000 in the next decade, risking longer waiting times and a deterioration in the quality of care. This has led to a fresh drive for international recruits. Migrant NHS doctors save the UK taxpayer thousands of pounds in training and make further significant contributions to the Treasury as well as to the communities they serve. They are less likely to call on the state for financial help—on the contrary, there is evidence that migrants use NHS services less frequently than citizens born in the UK. 

The UK public is sympathetic to a different approach for key workers. A YouGov survey for JCWI found 54% of those surveyed are are in favour of loosening immigration restrictions for key workers and 47% feel that immigration has had a positive impact, compared to 29% who think otherwise.

Given the contribution that migrants have made to the NHS over such a sustained period—and the personal sacrifices of many during the pandemic—surely it is time for the government to review its policy. The emotional strain of not having older parents and grandparents in closer proximity cannot be understated. The Home Secretary, Priti Patel, must recognise this injustice and make amends. The government must do what is morally right and make provision to address this issue sooner rather than later.

Kamal Sidhu is chair of GP Forum, BAPIO

J S Bamrah CBE is chair of BAPIO 

Irfan Akhtar is general secretary of APPNE

Terry John is chair of the BMA international committee.

Usha Sood is a human rights barrister and head of Trent Chambers, Nottingham, UK.

Competing interests: None declared