International Doctors: Visas

Margaret Ferrier Excerpts

Wednesday 2nd November 2022 Westminster Hall

[Matt Warman (Boston and Skegness) (Con)]

I beg to move,

That this House has considered visas for international doctors.

It is a pleasure to serve under your chairmanship, Mr Stringer.

This is a debate about doctors, but I want to begin with the story of a hypothetical patient. Let us call her Marjorie and say that she lives in Skegness. She is in her 80s or thereabouts. She is registered with a local GP practice, and she has a trainee doctor as her GP. They have a really good relationship and know each other well. They have the continuity of care that means that Marjorie’s needs are looked after. For a couple of years, Marjorie has gone back and forth to her doctor with little ailments, as people often do. In her final consultation, her doctor mentions that she will be moving on relatively soon.

Thereafter, Marjorie finds herself with another GP, and the continuity of care is broken. Marjorie struggles to get the type of relationship that she built up over the past few years, and she finds herself bouncing in and out of hospital. She is fine, but not as well as she would be if her care had been provided by a doctor who was able to make sure that they knew each other well. The reason for the break in continuity of care is that the doctor she had in training was an international medical graduate who was being trained at the surgery in Skegness. Unfortunately, for a whole host of reasons, the surgery was not registered to take international medical graduates once they had qualified, and it was not what is called a sponsoring practice—it was not able to say that it would sponsor the visa for that doctor.

The reason I make that point in such a way is because the people who are suffering as a result of the approach we currently take to visas—on one level, they are doctors who are dealing with the immensely stressful visa process—are ultimately patients, who should be our priority. The doctor I mentioned is one of 40% of trainee GPs who come from abroad. While they are training, their visas are sponsored by Health Education England.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

A result of the difficulties around trainee GP visas is that many IMGs feel that they have no choice but to take on other roles within the NHS, or they leave the NHS altogether. Many may even return home. Does the hon. Member agree that this is yet another area where the Home Office must look at the bigger picture, rather than trying to plug gaps on an ad hoc basis?

[Matt Warman]

Ultimately, this is where we need joined-up government, whereby the Home Office and the Department of Health and Social Care deliver on the same priorities, and I really do think that they can.

As I say, 40% of trainee GPs come from abroad. In the final months before they qualify as GPs, the last thing they should be doing is dealing with the stress of a potential visa application and considering whether the practice where they might want to apply for a job is registered on the programme, and whether they can reasonably jump through the Home Office hoops at that precise moment. We are increasing stress for doctors, and we are increasing the risks for patients at the same time.

The hon. Lady alluded to figures from the Royal College of General Practitioners which show that some 30% of GP trainees are considering not working as GPs when they qualify for these visa-related reasons, and some 17% think they might have to leave the UK either temporarily or, at worst, permanently. That is some 1,200 doctors who are considering not working in the health service as a result of this system. In Lincolnshire alone, a third of practices have thought about registering as a visa-sponsoring practice, but just one in 10 have actually done it. We are really limiting the options for GP trainees and for the health service.

This is a political choice, and it reveals an inequality between different sorts of doctors. It will probably take a hospital doctor five years to qualify. After those five years, they will qualify for indefinite leave to remain in a much easier way. Because GP trainees take just three years to complete their programme, they need to go through this visa process, because three years is not five years, and the Home Office has decided that five years is what is required.

There are other associated problems. When it comes to applying for a visa, the GP practice that needs to register will consider whether that process is worth while. It may, in theory, be worth while in advance, and some practices do register in advance, but many do not. They then find themselves confronted with a brilliant candidate, and they try to register, but with the best will in the world, the timescales are very tight for doctors to apply for visas when they have a job offer from a practice that is already registered. There are lots of things to line up, and it is stressful for practices and for doctors. Even if there were no backlog in the Home Office, it would be a very tight timescale.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I thank you for allowing me to participate in the debate, Mr Stringer. I thank the hon. Member for Boston and Skegness (Matt Warman) for bringing this matter to light. It is good to see the Minister in his place—a return to duty in his ministerial role—and I am confident that, like the rest of us, he will be keen to address the key issues of the debate and why this issue is so important. I wish him well in this new role and look forward to his response to our questions.

The issue of visas is always a difficult one. I am incredibly aware of the need to protect our country and ensure that only those who have a desire to enjoy British life and to enhance it should be given visas. I understand the system of immigration and agree that it should be rigorously implemented. However, within that, we very much need to have the appropriate systems for the appropriate types of visa. That is why I believe that changes need to be made, as outlined by the hon. Member. Talented and skilled doctors want to come here and contribute to our society but unfortunately, due to the visa system, they are not always able to do so. For me, the issue is: how can we help them to help us in the United Kingdom of Great Britain and Northern Ireland?

[Margaret Ferrier]

As the hon. Member for Boston and Skegness (Matt Warman) said, a difficulty that many international medical graduates face is that many GP practices do not have a visa sponsorship licence in place, making it harder to meet the requirements before the student’s studies end. Does the hon. Member share my concerns about the general level of the Home Office backlog and the associated impact on IMGs?

[Jim Shannon]

I agree with the hon. Lady. I hope that through today’s debate and contributions, this issue can be addressed. Again, we look to the Minister to give us some help, direction or support in how we can go through the vigorous bureaucracy that is clearly there. People with talent and skills want to come here; it is about how we can make that happen.

I have raised immigration on multiple occasions with Home Office Ministers—in particular, with regard to visas for those working on fishing boats in my constituency and the skilled work done by Filipino fishermen. The previous Minister was most helpful. That work is undoubtedly skilled, but it is under the pay threshold, so visa requirements sometimes restrict that opportunity.

Junior doctors, nurses and others do work that is not highly paid but highly skilled and necessary. That is why there must be time-sensitive application systems for those vital jobs and staff members. We need flexibility in the system. I say this again because it is important: those highly skilled and highly talented people who wish to come here will add to society and enable us to fill some of the vacancies.

I cannot speak for the United Kingdom mainland, but I can certainly speak with some knowledge of Northern Ireland. I am my party’s health spokesperson, and the research we did for this debate shows that 6,613 vacancies are listed for the five trusts in Northern Ireland. I know that they are not entirely for medical staff, but it is clear that we are desperately in need of staff, and there are many opportunities for doctors.

In my constituency and neighbouring constituencies, we are having problems in relation to GPs. I absolutely agree that there is a need for restrictive immigration, but we must not cut off our nose to spite our face. I am sure those numbers are replicated throughout the entire UK; perhaps the Minister will give us some figures for GP vacancies. I know that the Government have set out a strategy for employing and recruiting more GPs—that is good news.

During the Brexit discussions, we were told that there would be distinct differences between the visa systems. That is as it should be. The hon. Member for Boston and Skegness said that the system needs to be altered to meet the need, and that is what we need to do today.

The hon. Gentleman mentioned GPs, and we are of the same mindset. In a neighbouring constituency, a GP surgery, which is 10 minutes from my office, is set to close down because there are not enough GPs. In response, the GPs in my area have issued a moratorium on joining or leaving local practices. In other words, they will not take any more patients, and in some cases they are directing patients who live outside the area—that was okay a few years ago—to go elsewhere.

The trust is hopeful that it will get more GPs to take over the practice, but the fact is that we simply do not have enough GPs. That puts more pressure on the existing ones, which leads to more burnout, and the vicious cycle continues. GPs are under incredible pressure. Patients want to meet their GP; they want face-to-face appointments. That has been lost to them over the past two and a half years due to covid, but they are trying hard to get back in the queue.

The hon. Gentleman said that 40% of all GP trainees are international medical graduates—the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to that—but they have difficulties obtaining visas. I do not have the exact numbers for Northern Ireland, but I do know that we cannot afford the loss of any more GPs. I therefore add my voice to those of others in the Chamber requesting that a special dispensation be granted not simply to allow those trainees to stay but to enable us to recruit further.

If there a block of trainee GPs who have almost completed their degrees and courses and are ready to come here, let us encourage them to do so. The question is not why it cannot happen, but how we can make it happen. The thought of training GPs to understand how we do medicine and run our practices, only for them to leave—not because they want to but because the system is not working for them—is madness. That needs to be addressed through this debate.

Recently, medical professionals outlined to me that the mental health and self- esteem of our medical community are at an all-time low because the staff are simply burned out. I have met many nurses, GPs and surgeons who are absolutely exhausted with the work they do. For those who are on call and have a duty rota to complete, being sent an SOS text to cover shifts is no longer exceptional; it is standard. That tells us that the GPs need to be employed and some of the pressure taken off.

We need to change the way that things are done, by giving GPs more admin support and funding for on-site nutritionists, physios and mental health teams, which we need within all health clinics. In my constituency, they are trying to do that regularly, and it should help to diagnose early, whether the problem is diabetes, arthritis or dementia. Whatever the issue, doing that correctly in GP surgeries is the way forward.

It is impossible to imagine that things can go on much longer the way they have for the past two and a half to three years throughout the United Kingdom of Great Britain and Northern Ireland. We need change, flexibility and help, Minister. We do not want to put all the pressure on the Minister, but in this case there are ways forward. The hon. Member for Boston and Skegness has outlined them, as have I and others. We look forward to a successful conclusion to this debate, with a way forward from which we can all benefit across this great United Kingdom of Great Britain and Northern Ireland.