Torn apart: visa rules and dependent relatives

Health secretary Wes Streeting spoke enthusiastically of his Government’s desire to bring NHS staff, including doctors, ‘back to work and working at the top of their game’, at his party’s annual conference in Liverpool last month.

The speech, which otherwise made no reference to the issue of chronic understaffing in the NHS, came barely a week after The Guardian reported on the harrowing experience of one overseas doctor working at a GP surgery in the Parliamentary constituency neighbouring that of Mr Streeting’s Ilford North.

The paper’s report told how Pakistan-born Tajwer Siddiqui had arrived in the UK in July this year with the intention of gaining the qualifications needed to become a GP and be joined in the UK by his wife, also a physician, and daughter.

These plans were thrown into jeopardy, however, by the Home Office’s initial refusal to grant a visa to Dr Siddiqui’s 19-year-old autistic daughter, a stance which reportedly led Dr Siddiqui to consider quitting the UK barely two months after arriving here.

While this decision was fortunately reversed, the episode speaks to a broader set of experiences concerning the challenges faced by IMG (international medical graduate) doctors attempting to forge new careers and lives in this country, not least when it comes to their families and visa arrangements.

Most infamous perhaps is the ADR (adult dependent relatives) visa process, which requires applicants to prove their relatives’ health requires long-term care unavailable in their home country and has left scores of IMG doctors and their families emotionally and literally torn apart.

Even for those who opt not to go down the ADR route, however, the experience of securing even a visitor visa for their relatives is one fraught with difficulties and uncertainty and, in some cases, has forced doctors to reconsider their futures in the UK.

Ipswich-based GP partner Pinak Roy is just one of an undetermined number of IMG doctors who now find themselves in such a position, following the death of his father earlier this year.

Having arrived from Bangladesh a decade ago, Dr Roy wholeheartedly embraced the UK and general practice, becoming a partner at his practice as well as a GP trainer and taking up an out-of-hours care role. 

As he continued to become ever more established in his career, Dr Roy took the step of becoming a British citizen and, despite the huge pressures on those working in primary care, maintains he still loves his job and the system it serves.

‘I’m one of those GPs who, despite all the pressures, financial challenges and work-related stresses, I still like working in the NHS,’ he says.

‘It’s an egalitarian system, and I love the fact that I don’t have to ask a patient if they can pay or not before treating them.’

After many years battling ill-health and dementia, Dr Roy’s father passed away in July of this year, leaving his wife, Dr Roy’s 60-year-old mother, widowed and alone.

To look after his mum during her time in need, Dr Roy applied for a visitor visa so he could bring her to the UK temporarily. 

He was stunned when his application was rejected by the Home Office, a decision he says left him feeling like a second-class citizen. 

‘It makes me feel deprived,’ he says. 

‘When my dad died in July, I immediately applied for a visitor visa for my mum. She has had to look after a demented person for 10 years and this has impacted her so much [and] I knew that we need to kind of get her life together and to get her life back.

‘Being a British citizen, being a passport holder of this country, I don’t feel that I’m actually being treated equally to other people in this country.’

A survey into the effects of immigration rules and visas on IMG doctors was conducted by the BMA earlier this year and makes for alarming reading.

Ninety-four per cent of the more than 3,300 respondents to the survey said immigration rules made it less likely they would remain in the UK in the long term, with 84 per cent saying that they knew of at least one colleague who had left the NHS to care for a relative.

When BMA council chair Philip Banfield wrote to the Home Office warning of the risks restrictive immigration rules pose to NHS staffing, these concerns were dismissed by the then Conservative Home Office minister Tom Pursglove, who said there was no evidence they were deterring overseas doctors from coming to the country.  

It’s an argument Dr Roy considers as frustrating as it is short-sighted.

‘I just don’t understand why they’re being so thick-headed and not trying to think it through,’ he says.

‘When I first came, I wasn’t worried about my parents because I was younger, and they were healthier. As doctors, we only start to think about these things once we are older and when we are, by then, giving much more to the NHS. 

‘How do I prove that my mum, while she is physically okay, mentally she needs my support? This is not something that anyone can prove, so it feels that the ADR visa rule has been made in a deliberate way so that no one can come in.

‘I can’t get her even a visitor visa when I want to, because of how unpredictable the visa decision-making process is.’

Dr Roy’s concern extends beyond just his personal circumstances to what his situation and experience of the immigration system might mean for other IMG doctors and the health service.

He says that, other than being separated from his mum, he is happy in the UK but that other doctors have further incentives to leave beyond escaping inhospitable immigration rules. 

‘I know a lot of GPs and they’re just thinking the solution is to go to Canada, Australia or New Zealand, places where you can not only take your parents with you, but where they know they can make more money and have a better work/life balance,’ he says.

‘I wasn’t bothered about any of those things at all, but if I’m thinking about going to a different country because I cannot look after my mum, then there are so many other doctors who have other incentives to leave.

‘[If I leave] it’s going to cost the NHS much more than just losing a doctor, I’m a GP partner with 10 years’ experience, I’m a trainer and I cover emergency care as well. I’ve written to my local MP [about this issue] because I’m genuinely worried that there are a lot of doctors who are going to leave, and that includes myself as well. I’ll leave if this is not sorted.’