International Doctors: Visas

[Graham Stringer in the Chair]

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.

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?

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.

I thank my hon. Friend for giving way and congratulate him on securing this important debate. I have recently returned from an International Development Committee visit to Jordan, where I spoke to a number of highly educated Jordanians, as well as Syrian refugees. Some of the Jordanians were already doctors and nurses, and the Syrian refugees in the camps in Jordan cannot get an education beyond the age of 18 but wish to become doctors, engineers and so on. They speak amazing English and would love to train here in the UK.

At the moment, Germany is hoovering up a huge number of these doctors and people who would like to study to become doctors, to satisfy the demands of its health service. Does my hon. Friend agree that it would be helpful for the Minister to consider opening up more visa routes for brilliant young medical students from countries such as Jordan that have long been strong international partners of the UK, in order to ease some of the workforce pressures on our NHS? It is important that we increase the numbers, and that would be one way of doing it.

I absolutely agree with my hon. Friend that increasing all those routes is hugely important. Of course, we would all like to see more doctors trained in this country, and the Government have gone some way towards doing that, but where people want to work abroad, Britain should be as attractive a place as we can be. That is why, on the GP point specifically, the Government should be removing every single barrier in that visa process.

The most straightforward thing we could do, which would remove the need for a practice to register as a visa-sponsoring practice, is simply to say that when a GP qualifies in this country, they get the indefinite leave to remain that other doctors get. These are people in whom the UK has already invested. They are already here; they already have a visa. The extension of that visa into another form seems simply to be a bureaucratic hoop that we are putting in their way as doctors and in the way of GP practices. We are putting extra bureaucracy into a system, while on the other hand the Government say, “We desperately need people to come to this country to work in the NHS, and we will try to do everything we can.” The health service does hugely good work to try to recruit such people and specifically encourages them to train as GPs, but then we put an additional barrier in their way.

The response from the Government in the past has been, “Actually, the visa process registration is not terribly onerous and GP practices can do it.” They point to the numbers that have and do, which is fine as far as it goes, but it does not answer the question of why we put a barrier in the way in the first place. It should not be a cost of doing business when we say that we really want to make it as easy as possible.

Equally, it should not be a reasonable thing to put different sorts of doctors on different sorts of levels. It is not reasonable to say to people that, just as they have gone through the most stressful part of qualifying with exams, they should also be thinking about their immigration status. That calls into question their probity when we have things such as the General Medical Council making sure that they are upstanding members of our communities, and many of them have tens of thousands of patients to testify to that.

It is great to hear my hon. Friend making such an eloquent case, as always—more so than I can. The issue matters for all the reasons he has set out, but would he agree that because of the retention challenge in the health service, the more we pour in at the top is sometimes, in part at least, offset by those who go out at the bottom? There is a wider picture here to do with pension pots—the whole retention piece is part of the wider jigsaw, which I appreciate is not the remit of this Minister, but perhaps was in his previous job.

I thank my hon. Friend for that intervention. It is always tempting to ask the Minister to go and have a word with his former self, but we cannot do that. I think he has read the last couple of points that I want to make.

There are a number of relatively low-hanging pieces of fruit that the NHS has repeatedly asked for. I want to thank the RCGP, the British Medical Association, the radiologists, the British Dental Association, and also groups such as EveryDoctor, which have helped me with this debate and have identified the fact, as my hon. Friend implied, that there are a small number of things that could and should be sorted as quickly as possible. Busting the barriers around pensions and the bureaucracy around visas are things that would make a real difference to recruitment and retention across the health service. There are plenty of things that are difficult when it comes to addressing the NHS’s challenges, particularly as we approach winter. On the narrow point of GP provision, we have a visa process that puts pressure on, in particular, small GP practices, where the added burden of registering as a visa sponsoring practice is even greater now as they are under such huge pressure. It is also a burden on GPs at what is a particularly stressful point in their careers.

I know the Minister will make entirely legitimate points around putting a process in place, but the reality is that there is a political choice to be made to ease some of those burdens. There is a powerful, compelling case to be made for doing a small number of easy things that could address the GP crisis in particular, which, as my hon. Friend the Member for Winchester (Steve Brine) alluded to, is acute.

I appeal to the Minister and the Government to work as closely as they can with the Department of Health and Social Care to understand these challenges and see what can be done, and I urge my right hon. Friend to take seriously the suggestion that if someone qualifies as a medical doctor in this country, and in particular as a GP, they should have indefinite leave to remain. At the moment, it effectively comes with that if they qualify in a hospital but not in general practice. That is an inequality that the Minister can look to fix, and I hope he will do so as soon as is practicable.

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?

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?

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.

It is good to see you in the Chair, Mr Stringer. I also start by welcoming the Minister to his place. I wish him good luck; he probably needs it, as much as any Minister in Government, because his is an incredibly challenging post. We will, of course, have significant political differences on this topic, but it is an important issue, so if there is an opportunity for constructive and positive engagement, I am up for that, wherever possible. I thank the hon. Member for Boston and Skegness (Matt Warman) not just for securing the debate but, as ever, for his expert introduction to the topic and advocacy.

Moving to the subject at hand, like other Members I will start by recognising the extraordinary contribution of non-UK nationals to all parts of our NHS. I suspect everybody in the room has benefited from that, never more so than in recent times. GP practice is no different, and nationals of other countries will continue to play an important part, both now and in the future. As the hon. Member for Boston and Skegness alluded to, figures suggest that 47% of new GP trainees in England in 2020-21 were international medical graduates.

Another important context for this debate is the extraordinary pressure that our NHS is under, particularly in the light of covid, but also for all sorts of other reasons, which we could perhaps touch on in another debate. High vacancy rates are among them. As has been mentioned, challenges in recruitment and retention affect GP practices as well as everywhere else.

Against that background, the hon. Member identified what at first seems to be a technical problem in the operation of the immigration system, but one which, when examined, is significant. A failure to solve it leads to some absurd and harmful consequences. As he pointed out, the pain will ultimately be felt by patients. He explained that the three-year GP training regime for IMGs leaves them, on completion, two years short of being able to apply for settlement. That is unlike other specialisms, which have longer training periods.

I have a suggestion, at least for England: the primary care networks or the new integrated care boards could quite easily act as an umbrella sponsor, thereby taking the bureaucracy away from the practices, which is part of their purpose.

That is a valid proposition, and we could do the same with health boards in Scotland. If we knock our heads together, we can come up with a way to fix this. It just requires a little bit of pragmatism.

There is a second issue I wanted to raise—when I saw the motion for this debate, I wondered if the hon. Member for Boston and Skegness would raise it. That issue relates to recent reports from the BBC flagging complaints of poor treatment and conditions for international doctors in private hospitals, as well as highly questionable recruitment practices. I will touch upon it briefly because it has not been raised, although it is important to draw it to the House’s attention and to see if the Minister will investigate and respond. There were reports from 11 October suggesting that doctors from some of the world’s poorest countries were being recruited, by Nuffield Health in particular, to work in private hospitals under conditions prohibited in the NHS. There are reports of doctors being on call 24 hours a day for a week at a time, not being able to leave the hospital grounds and, unsurprisingly, suffering from extreme tiredness, putting both patients and doctors at risk.

Nuffield Health denies those allegations, but a British Medical Association and Doctors’ Association UK questionnaire of 188 resident medical officers adds some credence to the claims. It shows that 81% of respondents were recruited from Nigeria, and most complained of extreme working hours and unfair salary deductions. The conclusion of the Doctors’ Association UK was that we now have a two-tier system: one for the NHS and one for other international recruits in the private sector. I ask the Minister to look into that.

That issue highlighted to me another fundamental problem with how the immigration system operates. We have all sorts of checks and regulations that focus on ensuring that people who come to work here abide by their visa conditions, and they include the doctors we have been talking about—the IMGs—where the Home Office is on their case as soon as they have qualified to see what they are doing next. However, little or no checks are done to protect people who come here. That is not just in the NHS and with doctors; I have been firing off parliamentary questions and freedom of information requests in relation to the agricultural sector. That is a sector wide open to exploitation, but as far as I can see there is no concerted effort to protect people from that exploitation.

Does the hon. Member agree that, when it comes to the criteria used, one thing we should perhaps be seeking from the Minister is an assurance that greater weight will be given to the skills that people have, as opposed to the money they could earn?

That is absolutely fair. The point I am making is that we should also consider—and in fairness, we do—where it is that we are recruiting from. We do not want to leave some of the poorer countries in the world without the skills they need.

Nigeria is a red-list country, but the report highlighted that both the General Medical Council and the British Council are involved in establishing and overseeing a professional and linguistic assessment board test in Lagos. I encourage the Minister to look into those reports. I appreciate that he might not be able to tell us about them today.

Various broader issues have been raised, including visa fees, pensions and so on. We could talk about the impact of free movement and how that has mired certain services, including GP practices, in red tape and bureaucracy, but we will keep that discussion for another day.

I again congratulate the hon. Member for Boston and Skegness on securing the debate. Throwing out skilled and desperately needed GPs in whom we have invested tens of thousands of pounds in training is utterly absurd. The hon. Member for Strangford (Jim Shannon) put it very nicely, as he always does. The question is how we can help them to help us. There are pragmatic solutions available. This is an early test for the Minister on whether he will be a pragmatist or take what I would characterise as the more dogmatic approach of the previous Home Office regime. I very much hope it is the former and that he is a pragmatist.