Just to be clear and not misinterpreted: I have worked with and researched refugee health professionals (RHPs) for nearly 20yrs. I have dedicated much of my 'free' time to advocating for them & working with colleagues to create programmes to support their transition into jobs 1/
And worked with the UK Government, NHS & local employers to create viable funding streams for these projects that continue today e.g. #buildingbridges refugeecouncil.org.uk/get-support/se… 2/
I have also worked to generate evidence on what works well for different RHPs based on their own experiences, country of training, language of training, age, gender etc for schemes across England & mainly in London & Manchester. Some of this dates back to the early 2000s 3/
The situation for RHPs & the support given to them is politicised. There are clear economic arguments to support refugees back into employment & they are a much needed resource at times of crisis. Many of those I have met over the yrs would do anything to return to medicine 4/
And I mean almost anything. They are passionate, highly skilled & dedicated individuals who experience (in some cases) horrific losses of family/friends, their communities, their income & their national identity & their identity as medical professionals 5/
As a result they will say 'Yes' more easily than perhaps they should or without considering the potential risk to themselves. I have argued for yrs that we should streamline accreditation & make things easier for refugee drs to return to practice 6/
However, my job as a researcher & medical educator also tells me that there are some things that all those seeking to work in the UK NHS need to have for their safety & that of their patients. I should say, my concern is for the former & less so for the latter 7/
The proposal to have refugee/migrant Drs working as Medical Support Workers is on the one hand a great opportunity for RHPs to demonstrate their worth but on the other is, in my opinion, fraught with risks for those RHPs. 8/
In order to protect RHPs & patients there needs to be: 1) a clear framework within which to work; 2) very close clinical supervision to ensure that the boundaries of that framework are adhered to. Given extreme pressures on frontline NHS staff my concern is for 2. 9/
At present refugee doctors mostly enter employment at FY2 level or as locums. There is evidence that some are asked to perform tasks that, given their extensive skills & experiences, they are capable of but which would not & should not be asked of others at that level. 10/
I fear that in these challenging times some refugee drs seeking to be helpful or demonstrate their skills, may overstep the boundaries of the MSW role. This could put them at risk & jeopardise any future full registration with the GMC. 11/
Equally, from day 1 of medical school, students start to learn about the NHS and absorb the cultural norms of their future working environment. The absence of PLAB or clinical placements meant that the subtleties of the NHS or the ethico-legal framework may be missed. 12/
It's important that we recognise that our NHS has long been supported by international medical graduates and, in some parts of the country or in some disciplines, would completely fall apart without them. /13
However, it's also important to remember that we also have a history of ambivalence towards IMGs. They are also seen as a disposable asset, something we can use to plug gaps, do jobs others don't want to do, & to shut the visa door on as we 'grow our own'. /14
The ever changing political rhetoric around migrants & refugees needs to be considered as too does the evidence about racism and/or discrimination within the NHS. /15
and finally... I am very supportive of current moves to employ RHPs or migrant drs in the NHS. But this should be if, and only if, they have sufficient training, support, supervision & access to PPE. They are not & should not be cannon fodder for the NHS at this time /16
