Migrant architects of the NHS: South Asian doctors and the reinvention of British general practice (1940s-1980s) says that 16% of GPs working in England and Wales by the 1980s were from India, Pakistan, Bangladesh or Sri Lanka - and highlights the crucial role they played in making the British primary care system what it is today.
The book's author Julian M. Simpson says: 'The NHS evolved during its first four decades into a system based around general practice and primary care. By becoming family doctors, South Asian doctors prevented a GP recruitment crisis. Through their work, they shaped the field as it transformed itself into the cornerstone of the British healthcare system.’
Predominantly based in inner cities and industrial areas, South Asian doctors were the first point of contact in the healthcare system for around 9m people, the book reveals, making up more than 50% of the GP workforce in parts of the UK at a time when many of their British counterparts were choosing to work abroad.
The exhibition comes as today's NHS is seeking to recruit GPs from overseas to meet a recruitment target set by health secretary Jeremy Hunt in 2015. Mr Hunt pledged to increase the full-time equivalent GP workforce by 5,000 by 2020/21, but official data show the workforce remains in decline.
Mr Simpson’s book has inspired an eight-month exhibition at RCGP headquarters in Euston, London. Migrants who made the NHS draws on archival research, photographs and oral history interviews with 40 GPs who moved to Britain from South Asia over 40 years – including some who are still practising today.
Not only were many South Asian doctors supporting the continued existence of the NHS by helping to maintain staffing levels, but they also played an innovative role in the development of general practice. Speaking to GPonline Dr Shiv Pande, one of the 40 GPs whose stories the exhibition is based on, explained how he became the first single-handed doctor in Liverpool to employ a practice nurse.
‘There was a lot of ingenuity, lateral thinking [and] experimentation that came with the job… We were looking after patients 24/7, 365 days a year. It was hard work. The locum service was there, and they could cover, but it was costly.
‘It became clear to me that a practice nurse was needed. I was a male doctor, and many of the ladies coming to my surgery - especially from the Asian community - did not want to talk to me about their issues. So, because I was able to appoint and had the freedom to make these decisions, I appointed a nurse to take blood pressure, weight and urine samples.’
Many South Asian GPs took on additional responsibilities beyond their clinical roles. Many became involved in local politics as councillors, or campaigned for racial equality within the healthcare sector. Dr Pande was no exception. He proposed and co-presented Aap Kaa Hak - a Granada TV programme based on the English-language show This is Your Right - where he would answer questions about health and welfare in Urdu and Hindi.
‘I was thinking: "What about those people who, like me, were not born here, not brought up here, who may find the language difficult but are nevertheless working here?" So I went to the studio and they started doing the programme in Hindi.’
Although it was widely recognised at the time that the NHS could not function without migrant doctors, they still faced systematic discrimination when applying for posts.
‘They used to shortlist people into three piles - Asians on one side, women on the other and white male doctors in the third pile and usually it was white male doctors who got appointed into general practice,’ says Dr Has Joshi, a GP in Wales who became RCGP vice-chair in 2007.
Female South Asian doctors faced both gender and race discrimination. Speaking about her experiences of looking for a job as a GP in Manchester in the 1970s, Dr P. L. Pathak says that, despite having the right qualifications, she was often overlooked by potential employers.
‘They looked at me and they said to me: "You are very young and you could still have a family." They said: "You are the right candidate" but unfortunately they didn’t give me the job and I was so disappointed… I said, oh my God, wherever I go they’ll be saying "you look so young, you’re still going to have a family" and there was no way of convincing them.’
RCGP president Professor Mayur Lakhani says: 'General practice in the UK would not be what it is today without the hard work, innovation, and courage of our predecessors, and their dedication to delivering high-quality patient care. Indeed, without them, our profession and the NHS might not even exist at all.
'Not only were they doctors, but they became highly-valued members of the communities in which they practised. While many faced incredible challenges, our exhibition also documents the overwhelmingly positive and lifelong relationships they forged with their patients.
'We are hugely privileged to be hosting this exhibition at the headquarters of the RCGP to honour the work of this often-overlooked but incredibly important group of doctors. In the year that the NHS celebrates its 70th anniversary, it is especially fitting that we pay tribute to them.'