FAIRNESS FOR ALL

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Since the inception of the NHS, doctors trained overseas (commonly called IMGs [international medical graduates]) have been recognised as an integral part of the workforce. They make up approximately a fifth of all licensed doctors in the UK.

Better pay and conditions will not be won unless UK-qualified doctors and IMGs stand together.

Migrants have a long and successful history in the British trade union movement alongside British workers, from historic dock and factory disputes to now, such as in the Unite logistics disputes.

There is a similar and opposite history of governments, employers and others attempting to divide workers by race and nationality. The latest government attempt to pit workers against each other with its decision to fund its sub-inflationary pay offer to public sector staff through punitively increasing the immigration health surcharge (the fee paid by international workers to access NHS services) and increasing visa costs is just one such example.

Beneficial effects

Without solidarity, workers will be divided and cannot organise successfully. One of the ‘wins’ predicted by supporters of Brexit was that it would reduce immigration in the agricultural sector, meaning there would be more and better paying jobs for British-born workers in farming. But despite this, pay hasn’t improved and conditions for workers in the sector, particularly migrant workers, remain brutal.

Migrants in general are good for the economy and society – there is lots of evidence that migrants are a net positive for economic growth and productivity.

There are more than 8,500 medical secondary care vacancies in England alone, even with the contributions of our current international colleagues, and these vacancies are having a huge impact on doctors. The majority of us work well beyond our rostered hours (70% of doctors in 2022 report working over and above their hours, up from 59% in 2021) and more than one in five doctors (22%) took a leave of absence due to stress in the last year. There is plenty of demand for our work, and not enough supply.

Labour demand and supply are not the driving factors in the exploitation of farming, social care or medical workers. Like medicine, both farming and social care serve crucial needs, they are labour intensive, and they are understaffed. Wages and working conditions in these sectors are currently far more influenced by the relationship between workers and employers, and the relative power they have. Like medicine, both sectors are also heavily influenced by government policies and subsidies. The number of UK-trained doctors in training has continued to slowly increase following the addition of all doctors to the shortage occupation list in March 2021, despite competition ratios increasing and the growing number of IMGs joining the workforce. Competition ratios have of course skyrocketed. Despite this, IMGs acquire training jobs at a lower rate than their UK-trained colleagues.

Artificial competition

The real source of the problem, however, is that despite increasing numbers of medical school graduates, and growing need in our population, the number of training posts has insufficiently increased. Now a workforce plan has been published, but it has no specific targets for postgraduate medical training places, which unless rectified will exacerbate the issues.

This has created artificially high levels of competition amongst colleagues, causing some to target each other rather than the government responsible. The problem with pay and conditions of doctors in the UK is not IMGs – it is the Government’s refusal to invest in the workforce. Many other countries offer better pay and conditions than the UK. We are currently haemorrhaging UK-qualified doctors to other countries, where they can earn more: one in seven UK-qualified doctors are currently practising abroad.

There have been suggestions that international medical colleagues, who are already vulnerable to visa restrictions and culture shock, should be prevented from direct entry to nationally recognised terms and bma.org.uk/thedoctor conditions and training roles to preserve access for the UK-trained. Creating a cohort of doctors who must endure locally employed (exploited) service to progress in the NHS is not to the benefit of those doctors, doctors in training or our patients.

In the choice between solidarity with colleagues and the threat of deportation, solidarity will not always win. This would create conditions of fear around whistleblowing and around challenging unfair treatment, including in situations shared by doctors in training. It would weaken doctors in pay disputes. Dividing doctors by calling for restrictions on visas and immigration, by punitively increasing fees for migrant workers, or by placing additional barriers to access nationally agreed terms and conditions, is unhelpful and will make it harder to fight and win together. Doctors are vital to society and there aren’t enough of them – in the UK or elsewhere.

All doctors should be paid fairly and have access to professional development. If the NHS wants to be an attractive place for doctors to work, it needs to pay better wages for all doctors working in the UK, regardless of where they qualify. This will only happen if doctors stand and fight together.

Emma Runswick is BMA council deputy chair

From September, the BMA will offer New to the UK – Free BMA membership, a special introductory rate for IMGs. For more information visit: bma.org.uk/join

RUNSWICK: All doctors should be paid fairly and have access to professional development

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