Uncomfortable was just the beginning.

Blimey.

4 Months after the decision of the majority of Welsh and English voters outside London to leave the EU, life in the UK has become unsurprisingly uncertain for the average EU citizen. It’s not what I was made for: I am German, and as such political and existential uncertainty is genetic anathema for me. Never in my life I woke up and had to find out by a Radio 4 radio presenter that the majority of my fellow inhabitants of this sceptered isle had not only decided to turn their back on the most successful economic bloc but also to make life for people like me mighty uncomfortable. Which something I don’t really understand, because:

I am not taking anybody’s job. Just like my fellow 27,000 EU doctors in the UK, we were hired in to work in posts that did not attract British graduates. According to that postillon of Brexit, the Daily Mail, the vacancy rate for posts for doctors in the NHS is 7%. Filling these posts will now even be trickier, as recruitment from the EU has just become virtually impossible, with European colleagues now rethinking their decision to work in a country that might ask them to leave in two years.

I came to the UK not for need, but for want. It will soon be 20 years since I started my first job as a Junior House Officer in Dudley’s Russels Hall Hospital. Not the most glamorous or attractive post, you will agree. But that’s the point: I didn’t come to the UK because I was unemployed in Germany, au contraire. I just wanted to work in the UK, full stop. Like so many other Germans of my generation, anglophilia is in my genes. We grew up with Freddie Frinton, Monty Python, Dave Allen (ok, so he was Irish), British pop, language excursions to England’s beachside towns (I was exiled to Brightlingsea for 6 weeks. Best language trip ever!), so moving to the UK was a dream that was harboured for many years. Graduation just made it finally possible.

I am not living in an ethnic ghetto. Ask any European academic working in the UK, and you’ll find a group of people who have assimilated completely into British life. Okay, so we can’t get rid of our accents (and boy, do you remind us), but apart from that you will find us being immersed in British culture, whether it’s on a local or national level. And why? Because we love it. That’s what why we came over here for. British culture is so much more vibrant and varied compared to other nations and sports the best public broadcasting service in the world (apart from Radio New Zealand National). The BBC alone makes it worth living here.

I am not leeching of the state : Like my fellow EU citizens me and my darling partner are net contributors to the British state: we are paying a considerable amount of taxes, rarely use the NHS or council services, buy local and/or British and don’t send our wages (which, by the way, would be considerably higher back in Deutschland) to our relatives. An UCL paper from the centre for research and analysis of migration reported that European migrants made a net contribution of £20bn to UK public finances between 2000 and 2011. Those from the 15 countries which made up the EU before 2004, including France, Germany, Italy and Spain, contributed 64% – £15bn more in taxes than they received in welfare – while east European migrants contributed 12%, equivalent to £5bn more.

So, why do Amber Rudd and Jeremy Hunt (and probably a few people more) want to get rid of me and my colleagues? For the last twenty years, the UK has been my home, so I wouldn’t have a clue where to move to. If someone would tell me to go home, I’d probably ask why he wants me in Essex this very minute.

It’s all rather baffling. Or, actually, it’s more than that.

It’s scary.

It has created existential uncertainty for a group of people propping up public services of the country they love. And it doesn’t look like it’s going to get better.

 

 

It’s getting uncomfortable

A few months ago the BBC reported that “The poll of more than 900,000 patients found that, in the last two years, the proportion saying it was not easy to get through on the phone rose from 18% to 24%.”  The Telegraph, not a particularly pro public sector paper started an article under the headline “GP services are imploding as surgeries ‘at risk of closure'” with the paragraph

Two-week waits for GP appointments have become ‘common’, doctors have warned, while thousands could be left without a family doctor entirely due to financial cutbacks.

Then there is this interesting poll suggesting that one in ten GPs is planning to emigrate.

The Guardian rounds up our little press review with the news of falling GP numbers due to a recruitment crisis.

Since then there has been the confirmation via survey that overloaded GPs cannot cope any more and risk burnout.

I am not surprised that patients are getting upset with their GPs. For 8 years I saw a daily battle for appointments being fought  all over the East End, with long queues in front of practices at 07:30 in the morning (I recently saw a lady who brought a camping chair and her breakfast).

Over the last few years there has been a relentless onslaught on my profession from politicians and  – undoubtedly synchronised – from the usual corners of the press. The reason for this is beyond me. Primary care – as it is practiced in the UK – is the most cost effective way to deliver health care and so I naively presumed a government that has austerity as the main driver for its policy decisions would embrace and foster such a system. It’s widely recognised that ever pound invested in primary care saves 5 pounds in secondary and tertiary care, so investment into general practice is a financial no-brainer.  GPs were initially reassured that things would get better before the 2010 election after David Cameron promised  “With the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures that have dominated the last decade of the NHS“. What the nation got was the 2012 Health and Social Care Act, reducing general practice’s core funding and introducing a seven day GP service on a smaller budget.

It is getting uncomfortable in primary care, both for patients and providers. A+E is struggling like never before. If Brexit would really become a reality, then I would predict a considerable amount of EU doctors starting to think about their future in the country and the health system they love, risking another 20,000 doctors leaving (often serving areas that are struggling to attract graduates). There are about 3,000 GPs from the EU working in primary care, arriving every morning in their practice to do what they without doubt feel is the best job in the world, for patients they have been looking after for decades, in cities, towns and villages they have made their homes.

With another sudden, significant loss of doctors, the current crisis in the NHS would feel a gentle breeze, compared with the storm that’s coming, so better wrap up warm and batten down the hatches.

 

International General Practitioners In The UK: Do They Attract Qualitative Research ?

I am currently working towards a BSc in Psychology at the Open University and to pass this year’s module I have to come up with a piece of qualitative research, so I thought I venture into the exciting world of discourse analysis. But what to do?

Being a German native, I am one of ca 3,396 German doctors practicing in the UK, one of 24,031 doctors hailing from the European Economic Area (EEA) and therefor a member of the 90,639 strong workforce of international  medical graduates (IMGs) working in the four nations (GMC, 2012). While I don’t have the number of registered GPs from outside the UK, there is a good chance that there are 15,000+ family doctors who gained their medical degree outside the UK. I know quite a few, as the GP workforce in the East End is a pretty international bunch, which in my view is a good thing. But then, that’s me. In most of my postgraduate training jobs, the majority of junior doctors consisted of IMGs with often senior posts in their country of origin, and the clinical pearls I learned from these colleagues I still use to this day. So why not do some qualitative work on IMGs working as general practitioners in the NHS? I started my literature search and soon drew a blank. There is almost next to nothing out there on either patients’ or doctors’ views on the thousands of IMGs providing primary care in the NHS. There are a few qualitative studies by Ahmad, Kernohan and Baker from the nineties and some quantitative work on patient’s preference for doctors but that seems to be it.

I wonder whether this is a mainly ethical problem, do researchers prefer to stay away from  a potentially hot political potato or whether the actual topic is just not of interest? Furnham et al already established that patients prefer seeing doctors from their own cultural background, so it is quite possible that qualitative work asking patients about their perceptions on consultations with IMGs (or asking GPs about their international colleagues) would discover some problematic issues, but should I as an IMG myself shy away from finding out what our patients think of me and my fellow IMGs?

This makes my OU assignment trickier than I thought: not only do I have to negotiate some potentially protracted areas in the ethics section, I am also denied a big bunch of literature to fall back on.

Oh well. Loads to do then.

General Medial Council: The state of medical education and practice in the UK report: 2012; http://www.gmc-uk.org/publications/somep2012.asp

Adrian Furnham, K. V. Petrides and Joanna Temple: Patient preferences for medical doctors;  British Journal of Health Psychology (2006), 11, 439–449