Refugee Doctors: Briefing note


November 2007 Refugee doctors share the problems of all asylum seekers and refugees in the UK: forced to flee their homes, jobs, families and friends, they arrive in a new country where they may be isolated by language and culture and subject to unprovoked adverse publicity. Asylum seekers are dispersed throughout the UK, often far from established national communities and support networks, and required to live on less than £42 per week (for a single adult).

Many refugees will have been professionally trained in their own countries, and some will have been doctors or other health professionals. Yet, when refugee doctors come to the UK, their experience and skills will be wasted if they are not given the support they need to return to medicine. These doctors are desperate to work. They want to give something back to the country which has given them sanctuary, but the obstacles they face can be overwhelming, and many refugee doctors have ended up living on benefits or working in menial jobs for which they are vastly overqualified.

In recent years, interest has continued to grow in relation to helping refugee doctors and a network of resources and projects has developed throughout the UK. The BMA has played a coordinating and lobbying role in this work, following a series of Annual Representative Meeting resolutions since 1999, and work is being led by the International Committee.

In summary the BMA has:
  • Publicised the problems faced by refugee doctors
  • Lobbied the government for action
  • Set up the Refugee Doctor Liaison Group to co-ordinate activities
  • Created a special package of membership benefits
  • Assisted refugee doctors with PLAB fees through BMA Charities
  • Set up and maintained the national Refugee Doctors’ Database, with the Refugee Council
The following note looks in detail at some of the areas in which there has been progress.

Publicity and goodwill
The Department of Health established a Refugee Health Professionals Steering Group in November 2000 following the launch of the Advisory Group on Medical Education, Training and Staffing (AGMETS) report on refugee doctors and dentists. The Steering Group, chaired by Dame Lesley Southgate, oversaw the distribution of over £2 million for projects to help refugee health professionals. Dr Edwin Borman, former chairman of the International Committee, was an active member of the Steering Group. An evaluation report detailing the Steering Group’s work is due to be published shortly.

Refugee doctors have become a significant ‘good news’ story. Articles have appeared in the national, regional and medical press and have generated an enormous amount of interest and offers of help. The BMA Press Office has a list of refugee doctors who are willing to share their experiences with the media. It is particularly helpful to have comments from refugee doctors who have first hand experience of the process of gaining registration in the UK. For more information contact the BMA Press Office on 020 7383 6512.

The BMA International Department often receives calls from doctors and others throughout the UK asking how they can help refugee doctors, and BMA representatives are frequently invited to participate in meetings and/or studies and to give presentations to or about refugee doctors. For example, BMA representatives have spoken at a refugee doctor event organised by the Science Museum’s Dana Centre and a job skills training course for refugee women doctors.

The Refugee Doctor Liaison Group
The BMA convenes an informal communication and action group which brings together representatives of a wide variety of organisations and individuals currently working with refugee doctors. The group meets three times a year with most communication outside meetings being done by email. In many ways, the most important function of the group is to facilitate interaction amongst a loose network of interested organisations. The group serves as a forum in which individuals and organisations can exchange information, share experiences and work together on specific projects. It can also highlight issues and/or problems on which lobbying is needed. As a demonstration of the amount of interest in refugee doctors, the BMA holds a contact list of over 150 individuals working in the field of refugee healthcare professionals.

Many London based members of the Liaison Group have participated in the Refugee Doctors’ Programme Evaluation Network, which is a pilot evaluation exercise designed to collect data about the routes refugee doctors have taken towards registration in the UK and the projects/programmes in which they have participated. The data are being used to assess the success of the services provided to refugee doctors. The network has published three reports since March 2005, More than you think, Climbing the ladder and Ready and waiting. Copies of these reports are available from the BMA International Department.

Refugee Doctors’ Database
The BMA holds and maintains the Refugee Doctors’ Database. This is a voluntary database which currently holds the details of 1171 refugee and asylum seeking doctors. All information provided is strictly confidential. This is an invaluable resource, which has enabled help for refugee doctors to be more accurately targeted. We regularly contact doctors on behalf of refugee doctor programmes to ensure that they are aware of the services available in their area. The BMA produces bi-monthly statistics on numbers, nationalities, progress towards UK registration and needs, and we send all the doctors on the database a regular newsletter informing them of recent developments and the availability of assistance through local projects. The newsletter is also available from the BMA website at www.bma.org.uk/ap.nsf/Content/refdrnews

Regional networks
There are a number of major projects located throughout the UK and contacts building up in others. The ROSE website, aimed at supporting refugees and overseas qualified health professionals into employment in health and social care, has a comprehensive list of local resources as well as other useful information – www.rose.nhs.uk Each Postgraduate Deanery has an associate dean who is responsible for international doctors, including refugee doctors. Whilst the form of help offered differs between deaneries it is making a real difference and needs to continue until all areas of the UK are covered. Contact details for the various postgraduate deaneries are available from www.copmed.org.uk/contacts/

Unfortunately a considerable number of programmes throughout the UK have had to close for lack of sustained funding leaving refugee doctors facing problems accessing language teaching and IELTS/PLAB preparation courses. Furthermore, asylum seekers are regularly dispersed to areas of the UK where no support exists and on occasions some individuals have had to leave programmes they are participating in because they have been dispersed.

Information pack
In January 2004 the fifth edition of the Jewish Council for Racial Equality’s (JCORE) A Guide for Refugee Doctors was published. This is a comprehensive resource available to refugee doctors and service providers free of charge. Copies are available from the BMA International Department, which is distributing them on behalf of JCORE. We are awaiting publication of the sixth edition.

Clinical attachments
Clinical attachments are very important for refugee doctors, as they provide first hand experience of the NHS and may also enable doctors to obtain a reference from a UK consultant. Finding an attachment has grown increasingly difficult, and doctors often have to wait for some time before they can secure one because Trusts can have lengthy waiting lists. Some projects have included attachments as part of their packages but this is not the case nationwide. The BMA believes that refugee doctors must have access to well-planned and appropriate clinical attachments, preferably free of charge. The BMA has published a set of clinical attachment guidelines, which are available on the International pages of the BMA website at www.bma.org.uk/ap.nsf/Content/clinicalattachmentguidelines

Refugee doctors and employment
The Refugee Doctors’ Database shows that 131 doctors are practicing medicine in the UK. Furthermore, 252 are job-ready. This means that they are eligible for GMC registration upon the offer of employment. However, the BMA is aware that this does not give the full picture. The latest statistics available from the Refugee Doctor Programme Evaluation Network in July 2006 show that of the 863 London-based doctors on whom information is held, 188 (22%) are working. Due to a lack of funding the RDPEN has not been able to analyse data collected since then.

Unfortunately, there are still a large number of refugee doctors who are experiencing great difficulties in finding employment and this has become a growing priority for the Refugee Doctor Liaison Group as more reach the job ready stage. Refugee doctors need help with CV writing, job-search and interview skills. Many are frustrated at having to complete hundreds of applications and to still not be short listed. They also report difficulties when trying to explain gaps in their CV. Individuals from the BMA have assisted at job-search courses and the BMA and RDLG are committed to doing everything they can to help resolve these problems.

Given that most refugee doctors will have not practiced medicine for some time the preferred entry point for them into the UK medical workforce would be the start of the Foundation Programme. Despite persistent lobbying by the BMA and members of the Refugee Doctor Liaison Group, doctors who have undertaken a pre-registration year before they came to the UK are still not eligible to be considered during the first round of the Foundation Programme application process. They will, however, be considered for any unfilled posts which are available when all eligible applicants have been placed.

We have been able to establish a good working relationship with the Foundation Programme Director, Professor Derek Gallen and colleagues at the UK Foundation Programme Office. This was established following correspondence during last years application round for the Foundation Programme, which led to the BMA meeting Prof Gallen in February. Whilst he was unable to meet all of our concerns he committed to highlighting to NHS Employers that refugee doctors should not be disadvantaged on account of their immigration status and drawing the attention of all postgraduate deaneries to the number of job ready refugee doctors and the need to notify the BMA/projects working with refugee doctors of any employment opportunities.

BMA assistance
BMA Charities, through the Hastings Benevolent Fund, can provide grants to refugee doctors for PLAB exam fees, PLAB course fees, book grants, the cost of travel to courses and exams and interest free loans for GMC registration fees. Applications are assessed on an individual basis. BMA Charities can be contacted by emailing info.bmacharities@bma.org.uk or calling Marian Flint, Clerk to the Trustees on 020 7383 6142.

The BMA offers a free package of benefits to refugee and asylum-seeking doctors who are working towards GMC registration. This package includes the BMJ, BMA news, access to the BMA library, access to guidance notes and reports, BMA Counselling Service and some local BMA support. Following a resolution passed at the 2000 ARM, the BMA waives membership fees for eligible refugee doctors who are suffering financial hardship. Application forms are available from the International or Membership Departments or from the BMA website at:
www.bma.org.uk/ap.nsf/Content/refugeedrinitiative2006

Royal College assistance
The Royal College of Physicians (RCP) and Royal College of Surgeons of England (RCS) have both introduced a range of benefits for refugee doctors falling within the remit of their colleges. The BMA has written to the Presidents of the other Royal Colleges encouraging them to consider what assistance they could offer refugee doctors. We are pleased to report that a number have identified ways in which they can help refugee doctors – the Royal College of Anaesthetists, Royal College of Obstetricians and Gynaecologists, Royal College of Ophthalmologists, and the Royal College of Surgeons of Edinburgh.

GMC
The GMC has waived fees for refugee doctors’ first two attempts at Part 1 of the PLAB test, halved the fees for the first two attempts at Part 2 and reduced the fees for the initial grant of limited registration. Asylum seekers are not included in these concessions, although the BMA has taken this up with the GMC.

Dialogue with government departments
The BMA has corresponded with a number of government departments on the subject of refugee doctors and the difficulties they face and this has led to some Ministerial meetings. In October 2005 the previous Chairman of the International Committee met with Tony McNulty, the then Immigration Minister, and Lord Warner, former Health Minister, to address sustainable funding for refugee health professional projects. Also present were the Royal College of Physicians and NHS Confederation. At the meeting there was general agreement to work together to identify a good practice model of assistance for refugee health professionals.

This work has led to the BMA working in partnership with a number of organisations to put together a proposal, Building Bridges: developing refugee health professionals to support social cohesion and integration. This is a national initiative to develop an England-wide strategy to help more refugee health professionals find work. It aims to be pan health professional, focus on regional delivery and build on the current expertise and experience of existing service providers to refugee health professionals.

A Building Bridges Steering Group, of which the BMA is a member, has been established to drive this work forwards. The steering group has been working with key service providers in London to address how to take Building Bridges forward. At present one of the key discussions taking place is on an integrated service delivery model and a consultation paper was launched in October seeking views on future training and guidance services in London. The consultation paper is available from the NHS Employers website at www.nhsemployers.org/workforce/workforce-3030.cfm

The BMA has lobbied the government in the past to re-introduce employment concessions for asylum seekers and has raised this issue on a number of occasions with the Home Office. The BMA believes that asylum-seeking doctors who have been offered posts in the NHS should be granted time-limited permission to work, with the possibility of extensions, while they await decisions on their applications. A similar arrangement should apply to failed asylum-seekers who are unable to return to their home countries because it is considered unsafe for them to be repatriated. This would prevent them from being de-skilled thus ensuring their ability to contribute to the healthcare system when they are repatriated.

There has been considerable media coverage about the barriers to employment being faced by international medical graduates seeking employment within the NHS. That asylum seeking doctors are being offered jobs is testimony in itself to their skills and abilities. Preventing asylum seeking doctors from working is a waste of valuable skills from which the NHS can certainly benefit.

Offers of support
The procedures that refugee doctors need to follow in order to resume their medical careers in the UK are extremely complicated, and most refugee doctors need support at all stages if they are to succeed. Many BMA members have contacted the International Department to offer to help refugee doctors in any way they can.

There are several ways our members can help:

Contact a local study group, journal club or course for refugee doctors: Study groups, journal clubs and English/PLAB courses are keen to involve local doctors: either as a regular arrangement, for example in helping to organise meetings, or as guest speakers on subjects such as ‘A career in general practice/opthalmology/public health’, ‘Writing a CV’ or assistance with revising a particular clinical issue for the PLAB test.

Offer a clinical attachment: Clinical attachments, in hospital medicine, public health or general practice, are extremely important for refugee doctors, but can be difficult to find in the right specialty and the right location.

Become a mentor: There are informal mentoring schemes running in several regions, through local refugee doctors’ schemes. Time Together, run by Timebank has established mentoring schemes for refugee professionals including doctors - www.timetogether.org.uk/

The BMA believes that refugees can make valuable contributions to the cultural and economic life of a country and fully supports all efforts to integrate them into the professional workforce. It is vital that the potential contribution of refugee doctors is acknowledged, and that all efforts are made to ensure that their talents and enthusiasm are nurtured and developed, for the benefit of the refugee doctor, for the NHS, patients and for the community as a whole.

For further information on the BMA’s work with refugee doctors, and how you can get involved, please contact the BMA International Department: Tel: 020 7383 6491 Email: jwaterfield@bma.org.uk

© British Medical Association 2008

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