Doctors from India, South Africa and other Commonwealth countries are to be barred from the NHS in an attempt to preserve health service jobs for British graduates.
For generations the health service has been sustained by immigration but yesterday the Home Office moved to end a crisis that has prevented thousands of highly trained British doctors from advancing their careers. Last year the system for selecting doctors for higher training collapsed in what was described as the greatest disaster for medical training in a generation.
The change will end a long tradition of importing doctors to the NHS. Among the 277,000 now registered with the General Medical Council, almost half got their first medical qualifications abroad — the majority from India, Pakistan, South Africa and Australia. Without them the NHS could not have run a service since the 1960s.
Since 1997, however, the number of medical school places in Britain has almost doubled. There are now enough home-grown graduates to fill training posts, reducing or eliminating the need to import doctors.
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Last year many UK-trained doctors were denied initial posts, or won only short-term positions, as 10,000 overseas doctors joined the queue for 20,000 posts. The chairman of the British Medical Association had to resign after writing to The Times to defend the system of applying for training posts, in the face of widespread fury.
The Home Office announced yesterday that, from next month, doctors living outside the European Union will not be eligible to apply for posts through the Highly Skilled Migrants Programme — hitherto an open door to migrants with the right qualifications.
From April 1, the door will also be closed to migrants from India who are applying under a new points system. So-called Tier 1 migrants — those with the highest qualifications — will be barred from applying for higher medical training posts. Non-EU doctors already in Britain as Highly Skilled Migrants, or those seeking leave to remain as Tier 1 migrants, will still be free to apply.
The new rules are expected to cut the pool of potential applicants by between 3,000 and 5,000 by 2009. But the Government has admitted that this will still not be enough to ensure that all British graduates who are good enough will get posts. Between 700 and 1,100 young doctors will be denied jobs in 2009 and beyond.
So the Department of Health yesterday announced that it would consult over proposals to impose additional limits on foreign applications.
Its preferred option is to tell NHS trusts that international medical graduates should be eligible for posts only if there are no suitable applicants from Britain or the EU. That would exclude almost all of them.
An earlier attempt to implement such guidance was challenged in the courts by the British Association of Physicians of Indian Origin (BAPIO), which won a Court of Appeal ruling that it was unlawful. The department appealed to the House of Lords, which is expected to reach a decision in May.
If the Government wins, it could exclude all graduates from medical schools outside the EU from training posts with immediate effect. If it loses, it will have to find a way of implementing such guidance within the law.
The new immigration rules gained approval yesterday. Dr Ramesh Mehta, a consultant paediatrician and President of BAPIO, said: “This should have happened four years ago. We don’t have enough training posts and our UK doctors should have opportunities.”
The British Medical Association was less impressed, however. Dr Hamish Meldrum, chairman of the BMA Council, said: “This is a confusing move, which seems to achieve little apart from adding to the uncertainty for overseas doctors in the NHS.”
Matthew Jamieson-Evans, a spokesman for RemedyUK, a pressure group set up by young doctors last year, said: “They should have done this years ago. If they had done it sooner, it would have avoided a lot of trouble.”
The changes will have no effect this year, when there are expected to be at least three applicants for each training post, with as many as 20 per post for the more favoured specialities such as surgery.