Training refugee doctors could ease UK's NHS staffing crisis

Even before the Covid-19 pandemic pushed health workers out in droves, the UK's National Health Service faced shortages of nearly 100,000 staff — a recurring crisis with no long-term solution.

Earlier this year Britain's Royal College of Physicians warned that staff shortages and an exhausted workforce constituted the “greatest challenge” to the recovery of the NHS.

That's on top of the problem of the record six million patients waiting for non-urgent operations and procedures. A wide-ranging plan by NHS England to get down the backlog is yet to be published, amid suggestions of wrangling between the Treasury and health department.

Meanwhile, the UK has been grappling with a backlog of asylum-seeker claims, record numbers of people crossing the English Channel in search of refuge and an overall crumbling migration system, prompting “crackdowns” on asylum claims and legislative reforms by the Home Office, including its controversial Nationality and Borders Bill.

At the crossover of these two national issues lies a practical solution that one UK charity has been working on for over a decade. Since 2009, the Refugee Council, in partnership with the NHS, has run a programme that supports refugee health professionals who live in London to enter the workforce.

The help offered is practical and ranges from preparing for the Occupation English Test and getting registered with the General Medical Council (GMC) to help with exam preparation, free access to the Skills Lab and assistance in job searches, interviews and CV writing.

Not only does this support give medical professionals who happen to be refugees a route to use their skills and experience, which benefits the NHS, the cost makes it “really good value for money”, says the project manager of the programme.

“The NHS struggles to recruit enough medical professionals to fill some roles. We help refugee doctors to requalify to UK standards and find jobs in the NHS, where they can contribute their valuable skills by helping treat patients,” says Fahira Mulamehic, project manager for the refugee healthcare professionals programme at Building Bridges.

It costs an estimated £290,000 ($393,720) to train a UK doctor from scratch, whereas providing refugee doctors with the support and training needed to enter the NHS workforce comes at a fraction of that cost — about £25,000 per doctor.

Saffron Cordery, deputy chief executive of NHS Providers, said the parts of the plan designed to tackle the waiting list backlog included measures to free up clinician time and work with the independent sector.

Refugee health professionals come with skills, experience and specialisms that could benefit the NHS workforce, says the charity, but only a small percentage of the hundreds that are in the UK are actually practising medicine.

Since starting the programme, the charity has helped 155 doctors to enter the NHS workforce, 23 of them between March 2020 and April 2021, during a time of unprecedented demand for health care caused by the Covid-19 outbreak.

One of the programme’s beneficiaries is obstetrics and gynaecology specialist Dr Saad Maida from Syria, who has been working flat out in a hospital in the West Midlands during the past two years of the pandemic.

After studying medicine at the University of Aleppo, Dr Maida travelled to the UK in 2010 to do a Master's in maternal and reproductive sciences at the University of Glasgow. By the time he graduated with a distinction in 2011, however, his home country was at the start of what would turn into a decades-long bloody conflict.

Making use of his post-study work visa, he stayed in England and tried to secure a permanent research position — the visa specifically prohibited him from working as a clinical doctor — but he lacked the necessary experience and network to do so.

By the time his visa ran out in 2013, Syria's brutal conflict was at its apex, having gone from a civil combat to an all-out proxy war with ISIS emerging as the notoriously gruesome combatant on the scene. In a bid to create a quasi-state, the militant Islamist group laid siege to parts of the country, particularly in the north-eastern region where Dr Maida is from. Anyone who did not adhere to ISIS ideology was in danger. But as a Christian, Dr Maida was especially on a “knife edge”, he says. This ended up “cornering” him into applying for asylum.

“I did not seek asylum because my visa was running out, more like because I could not go back. I would have had to enter the military and I had the conscientious objection to being involved in armed conflict. At that point also my home town was surrounded by ISIS,” he tells The National.

The moment he had his refugee status, which gave him an unfettered and immediate right to work, including as a clinician, he “hit the ground running”. Nevertheless, even though he had his General Medical Council licence by then, Dr Maida still didn’t know how to navigate the NHS system to get a job, which is when he turned to the Refugee Council for help.

“They provided me with interview training, they found me a job through the [Clinical Apprenticeship Placement Scheme] and ever since then everything I applied for in the NHS has been successful. So quite the opposite to my situation before I became a refugee,” he says.

Dr Maida, 37, is now in his fifth year of a seven-year training programme in obstetrics and gynaecology at University Hospital Coventry in Warwickshire, a working environment which he describes as very supportive and understanding.

Not only did the Refugee Council get him on track to fulfilling his life’s purpose, it has also helped ease a chronic problem facing the healthcare system.

“There are hundreds of refugee doctors but only a small proportion are licensed and there is an acute shortage in the UK so every little helps — we need everyone on board,” he says.

He has referred a few refugee doctors he has met to the programme.

“It's not like we're competing with local doctors, it’s the opposite, there is a massive shortage and there is over-reliance on the recruitment agencies and the NHS is in deficit every year and every year they say the same thing.”

By offering specialist careers guidance as well as financial and pastoral support to transition into working in the NHS, Building Bridges gives refugee medical professionals the critical help they need to become valuable members of the profession.

A retired GP and volunteer with the programme, Dr Stephen Nickless is one of these medical “pastors” lending his expertise to refugee medics, who can often be overwhelmed by the disorientating and unfamiliar medical system. He does it to “stay involved” and to help them “integrate into the UK and rebuild their professional lives”.

“It is the most enjoyable and creative thing that I have done since I left medical school — meeting new people from different countries and cultures, establishing a trusting relationship and helping them to progress their personal lives and their medical careers,” he says.

Even after spending more than 30 years practising as a GP in some of the most culturally diverse and deprived communities in London, Dr Nickless says working with refugees in the programme opened his eyes to important social and political issues.

“I have learnt to look at the UK — our culture and our politics — through the eyes of others. There are many good things about the UK that I took for granted — and some big negatives of which I was only vaguely aware.”

Many of Dr Nickless’s words of wisdom still ring in Dr Maida’s ears today, particularly on busy days on the ward. “I asked him once what his one piece of advice would be and he said: ‘always under promise and over deliver,’ so now even if I’m perfectly competent at something I always watch out not to over promise, because you never know what happens,” he says with a laugh.

How to have the right bedside manner and critically review scientific papers were other important skills he learnt from the facilitators on the programme, he says, since cultural differences left a lot of “room for improvement”.

“Having anyone with the feel of the NHS impart that kind of insight and wisdom to people who are about to embark on a new journey in the NHS is priceless,” says Dr Maida.

He’s still in touch with his former mentor, sending him a message or email “every time I feel like I've achieved a milestone or something”.

Dr Nickless’s inbox will have pinged a fair few times recently, given what Dr Maida has accomplished. Last year he became a British citizen, bought a house and got engaged. Professionally, he is nearing the end of his training and final exams for membership to the Royal College of Obstetricians and Gynaecologists.

“I’m in a good place,” he says, grateful for the support the Refugee Council provided when the doors to his career kept closing around him.

That recognition that it is a door that opens both ways, for the host country and the refugees it takes in, is what the organisation has capitalised on successfully.