UK immigration route for Indian doctors: How to work in NHS without taking PLAB test

NHS UK is facing a shortage of medical practitioners in areas like paediatrics, emergency medicine, and respiratory medicine. (Photo by Nicolas J Leclercq via Unsplash)

The issue of immigration and visas seems to be a constant irritant between India and the UK. Discussions on the Free Trade Agreement (FTA) between the two countries have included talks on easing and simplifying the visa regime facilitating intra-company transfer for Indian and UK conglomerates. While it seems like the UK home office does not want to yield any ground on migration, the UK has occasionally given way to relaxation of rules, especially to fill vacancies in its health sector.

In the last three years, around 80 doctors from India have started work in the UK’s National Health Service (NHS) without giving the mandatory Professional and Linguistic Assessments Board test commonly known as PLAB. These tests, which cost a minimum of Rs 5-6 lakh, are required to be passed by medical professionals with overseas qualification to be able to work in the UK. But such is the shortage of doctors in the UK that the General Medical Council (GMC), the body which regulates doctors in the United Kingdom, has validated two schemes run by a voluntary organization for doctors of Indian origin to get medical professionals from India to the UK.

The British Association of Physicians of Indian Origin (BAPIO), which was established in 1996, has developed two pathways through which it has sought to cater to the requirements of the health sectors in India and the UK, harnessing the structural strengths and imbalances. “Every year around 100,000 candidates qualify for MBBS in India. However, not all get post-graduate opportunities due to paucity of seats. Thus, India has doctors, but not enough training opportunities, while the UK has capacity but less workforce,” said Prof Parag Singhal, consultant endocrinologist, and chair of the BAPIO Training Academy.

Collaborating with select hospitals across India, BAPIO facilitates newly qualified MBBS candidates to enroll them for a two-year training on a curriculum that aligns them with UK work requirements. What this means is that the chosen candidates are provided training and employment in hospitals in India for two years after which they achieve PLAB exemption. “During these two years, qualified professionals from the UK travel to India to provide training and support to these candidates. During the two years while they undergo training, they also have a stable employment in the hospital,” said Prof Singhal.

After the two-year period, the candidate travels to the UK where they undergo further training in an NHS Trust partnered by BAPIO to complete all the milestones. “Even in the UK they are aligned with a hospital where they are paid UK salaries. After two years they get relevant degrees from Royal Colleges UK which are recognized all over the world,” explains Prof Singhal. So after four years of employment and training, candidates end up with a world-class postgraduate qualification and experience of working in the UK.

The other pathway which has been developed by BAPIO is for medical professionals who already have a post-graduate qualification in India and are desirous of gaining UK experience. Such professionals are inducted for a three-month training in India after which they come to the UK and work at registrar grade for at least two years. “Under this scheme the professionals again do not have to give the PLAB test, and get GMC registration upon arrival to the UK. After the lock-in period of two years, they can go back to India or continue to work in the UK if they wish.”

According to Singhal, the NHS is particularly short of doctors in the fields of medicine, paediatrics, emergency medicine, and respiratory medicine. Given the demands of pay rise and better working conditions, medical professionals from the UK have been moving away to places like Australia and continental Europe, further crippling the NHS. After Brexit, the number of nurses coming from Europe has gone down which has put a strain on the existing health force. The NHS thus is desperate to employ professionals from around the world, which is where India can play an important role.

The schemes were launched by BAPIO in May 2020 and have been growing in strength. Around 80 Indian doctors are already in the UK, and a further 20 are undergoing training in India. “There is tremendous potential for these schemes because they have been tailored to provide the best to both the countries which also fosters close relationships,” said Prof Singhal. The GMC was impressed by BAPIO’s scheme and the training rigour that allowed the exemption from PLAB.

To be sure, for Indian MBBS graduates, the PLAB exam is a more straightforward pathway to join the medical profession in the UK, but these schemes by BAPIO help gain postgraduate qualification, and also the hand-holding that it provides helps in negotiating the new territory of the UK. “We have been very mindful of the fact that as medical professionals the candidates must get paid, so our schemes provide for stable employment along with training,” Prof Singhal said.

The case of dependent parents

The paucity of doctors has also occasionally led the UK home office to relent in allowing aged parents of medical professionals to live in the UK. An ophthalmologist working in a hospital in Bolton wanted his 81-year-old father to have the right to stay in the UK especially after his mother passed away, which would have left his father alone in India. The UK home office refused the application citing immigration rules that prohibit such applications and the need to preserve assets of the national health service.

When the case reached the immigration tribunal, the NHS trust employing the ophthalmologist provided letters describing him as “genuinely irreplaceable” and that they would struggle to replace him if he left the job. The NHS trust also said that losing him would “put patients at risk from potentially treatable, sight threatening retinal disorders.” Although the judge concluded that the father did not satisfy the rules, he allowed the appeal on human rights grounds after the home office, too, during the hearing did not oppose the case.

The father thus won the right to stay in the UK, but it is important to note what the judge said in his ruling. “The son has a significant job in the health service that would be hard to replace. The evidence is plain that his medical speciality is undersupplied and he could not be replaced. No doubt arrangements would be made. Advertisements would be placed and work would be shuffled but it is quite plain that there would be significant disruption to important healthcare to a large number of people if the appellant’s son left the country.”

But not every professional desirous of getting their parents to join them in the UK has been successful. The case of the Indian-origin ophthalmologist working in Bolton has been an exception. Organizations like the BAPIO have aligned with other associations to petition the UK government to change visa rules for adult dependent relatives. But while the UK government is desirous of filling empty positions in the NHS and other sectors, it has not shown any inclination to change the rules facilitating the migration of dependent parents.