Scrap the Cap: The NHS doctor unable to train as a GP due to visa caps

The Doctors' Association UK is supporting Dr Iqra Akhtar, an NHS doctor, who may not be able to take up a GP training post due to visa caps. Dr Akhtar has been in the UK working in the NHS for year, and has successfully applied for GP training. To take up her post Dr Akhtar resigned her post as a non-training staff grade to move to Preston and was required to switch to unrestricted Tier 2 visa. This has now been refused. 

Dr Akhtar is now residing in the UK on a spousal visa, and is waiting to hear from the Home Office after her Trust re-applied for a tier 2 visa. If her visa continues to be refused Dr Akhtar will be unable to take up her post to start training as a GP. Speaking to DAUK she expressed frustration that visa caps were designed to reduce immigration, yet she is already resident. 

Dr Akhtar told DAUK "the visa caps are affecting my career. I planned to start my GP training; having worked in the NHS and being a resident in the UK I did not anticipate this was going to affect me. This is very discouraging for doctors, especially those aspiring to work in the NHS."

Dr Akhtar also added that visa caps will adversely impact rota gaps.

The Doctors' Association UK has written to Dr Akhtar's MP Sir Mark Kendrick and asked him to take up Dr Akhtar's case with the Home Office. 

This week, DAUK wrote to Sajid Javid warning of the impact of visa caps on general practice. The letter was published in The Independent. Speaking to Sky News, DAUK Chair Dr Samantha Batt-Rawden said:

"What we've been hearing about at The Doctor's Association UK are cases of doctors currently working in the UK, who have been training the UK, in specialities such as General Practice which is short across the frontlines...and because of visa issues they are being asked to leave.

Which is terrible for the NHS when we are so short of doctors but there is a real human cost for these doctors who have invested so much in training, in service to the NHS, who have made their homes here and are now being asked to leave"


Scrap the Cap: DAUK writes to Sajid Javid expressing concern for General Practice

In a letter to Sajid Javid dated 3rd June, The Doctors' Association UK express concern that Theresa May's caps on Tier 2 visas are now affecting general practice. The letter, timed for release with the RCGP, states doctors "are feeling the strain of working in departments, wards and general practices, which are severely understaffed" and note that "several specialties are under-filled".

DAUK to goes on highlight how General Practice is being affected by Tier 2 visa caps. 

"In particular, we are concerned by hearing a number of cases affecting those wishing to train as GPs in the UK, those currently in GP training and even fully qualified GPs who have completed their training in the UK and now are being refused tier 2 visas".

DAUK goes on to cite a cases of doctor currently in GP training who has been forced to leave the country, and a further two cases of doctors unable to take up GP training posts that they had successfully applied for, one of whom is already working in the NHS.

The Doctors' Association UK are supporting many other doctors who have approached them with their own stories regarding visas. Dr Samantha Batt-Rawden, Chair of DAUK said "These cases are just the tip of the iceberg. We have been approached by many others in the same situation, many of whom are devastated they cannot pursue their chosen career of General Practice. The government's promise of an extra 5000 GPs by 2020 seems unlikely to be delivered, yet we are turning potential GPs away from the UK".

DAUK has learnt that visa issues are also affecting fully qualified GPs, who are struggling to find a practice to sponsor them for a visa. Today, Professor Helen Stokes-Lampard called for NHS England to sponsor visa for GPs, to spare small practices the cost and bureaucracy of applications. 

This morning, The Doctors' Association UK told the BBC Radio 4 Today programme, that in respect to boosting the NHS workforce with overseas GPs "getting them here, means changing the rules".


DAUK responds to comments that GPs have become a “council of despair"

The DAUK have written to Steven Brine, a junior health minister, who at a House of Commons Library Debate on GP retention and recruitment said there is “little wonder” that medical students don’t want to follow GPs into the profession as GPs have become a “council of despair”.  

The full letter can be found below: 

 GPs are not responsible for the recruitment crisis

Dear Mr Brine,

We are writing to you to express our dismay at recent comments made at a House of Commons Library Debate on GP retention and recruitment. It is our understanding that you stated there is “little wonder” that medical students do not wish to follow GPs into the profession as GPs have become a “council of despair”. We are shocked and appalled that given the incredibly difficult circumstances in which GPs continue to work, you would blame the recruitment and retention crisis on the very same dedicated professionals who continue to prop up a failing service. Given these conditions, it can hardly come as a surprise that we are struggling to recruit medical students into General Practice; yet the more pressing problem is in retaining the talented ones we already have. If you are ignorant to the working pressures currently faced by General Practice, I hope you will allow us to advise you.

The GP Forward View published in 2016 promised us 5000 more GPs by 2020. Perhaps you might care to enlighten us as to the whereabouts of these promised GPs? The number of GPs has continued to fall; from 34,592 in 2015 to 33, 872 in 2017. Workforce shortages are dire. Many practices have been forced to close altogether. Two in every five GPs are planning to quit, citing perilously low morale. GPs feel forced into early retirement, often citing an unmanageable workload; indeed 34% of GPs are planning to retire from General Practice in the next 5 years, following the 4000 GPs that have retired early in the past five years. Changes to GPs’ pensions has created a disincentive to continue working once the lifetime allowance for pensions has been reached. Many of those doctors that continue to work in the NHS have been forced to reduce their hours and work “less than full time” due to the incredible workload and intensity of General Practice.

Why is the NHS losing so many dedicated GPs? Put simply, the workload is increasing to unsustainable levels, whilst funding and remuneration is falling. A recent poll by the BMA showed that 84% of GPs find their workload unmanageable. The average GP now carries out 41.5 consultations a day, far beyond the 25 maximum limit that is considered ‘safe’. There is more administrative work than ever before, and the burden of care is increasingly shifting from secondary to primary care. There is “little wonder” that medical students are not choosing to work in such a pressurised environment.

The work is becoming more complex and intense due to a combination of an ageing population, patient demand and rising bureaucracy. With a lack of funding, reduced time for patient care and widespread staff shortages it is simply impossible to meet rising patient expectations. GPs simply cannot deliver the care that they desperately want to. Patients are more dissatisfied with General Practice than ever before and often direct their frustration at the doctors that work so hard to care for them. This is not helped by government rhetoric and a refusal to manage the public’s expectation of what General Practice can deliver given current budgetary restraints and staff shortages. This, and a near constant denigration of GPs in the media, has meant that GPs are blamed for what is essentially a funding crisis that is entirely the responsibility of this government. Comments such as yours only add to this rhetoric and are potentially damaging to General Practice. There is “little wonder” that medical students are not choosing to work in a profession that are disparaged for working tirelessly to prop up a failing service.

In the current blame culture of the NHS, GPs are increasing facing an onslaught of complaints and litigation and now, following the case of Dr Hadiza Bawa-Garba, could face criminal proceedings for making an honest error. GPs must see, diagnose and treat complex patients all in less than 10 minutes, and live in fear of making a mistake. With increasing workload and exhaustion that risk becomes ever greater. There is “little wonder” that medical students are choosing specialties that carry less risk.

Perhaps you would prefer that we simply paint a rosy picture for our medical students, who chose to enter General Practice expecting a good lifestyle, and then leave when they find the reality of General Practice to be somewhat different. This may help recruitment but it certainly would only fuel the retention crisis. You cannot blame those still trying to deliver an underfunded and overstretched service for simply being honest. It is bizarre that you appear to be berating a profession with low morale for having low morale.

Our profession is despairing, but we have good reason to do so. Your comments were not only unprofessional, but detrimental to a profession already suffering from low morale.

We hope on receipt of this letter that you might acknowledge the injury you have caused General Practice, retract your comments and make a public apology to GPs.

We look forward to your timely response.

Yours Sincerely,

 Dr Samantha Batt-Rawden MBChB MRCEM