South Asian doctors and the reinvention of British general practice (1940s– 1980s)

The NHS is traditionally viewed as a typically British institution; a symbol of national identity. It has however always been dependent on a migrant workforce whose role has until recently received little attention from historians. Migrant Architects draws on 45 oral history interviews (40 with South Asian GPs who worked through this period) and extensive archival research to offer a radical reappraisal of how the National Health Service was made.

This book is the first history of the first generation of South Asian doctors who became GPs in the National Health Service. Their story is key to understanding the post-war history of British general practice and therefore the development of a British healthcare system where GPs play essential roles in controlling access to hospitals and providing care in community settings.

Imperial legacies, professional discrimination and an exodus of British-trained doctors combined to direct a large proportion of migrant doctors towards work as GPs in industrial areas. In some parts of Britain they made up more than half of the GP workforce. This book documents the structural dependency of British general practice on South Asian doctors. It also focuses on the agency of migrant practitioners and their transformative roles in British society and medicine.

60 2 Empire, migration and the NHS The establishment and development of the NHS in the post-​war period coincided with the dismantling of the British Empire. Colonial-​era language or parallels have been used at times to describe the relationship between the NHS and the migrant labour it has relied on.1 However, the development of the British healthcare system and the impact and legacy of the Empire are two closely linked phenomena that historians have rarely considered together.2 The same can be said of the history of post-​war migration to the UK and the

in Migrant architects of the NHS

31 1 The making of a cornerstone Before exploring in detail the way in which migrant South Asian doctors shaped general practice and the NHS, I first want to situate their story within the broader context of the history of British healthcare, empire and of post-​war migration to the UK. The role of migrant doctors in the NHS is not confined to general practice. They were disproportionately represented in junior positions, less prestigious types of medicine and in geographical areas that were unpopular with local medical graduates. I will say more about the

in Migrant architects of the NHS

of thousands of South Asian GPs. Nor did most South Asian doctors initially set out to enter general practice. None of the forty South Asian GPs interviewed for this project migrated to take up posts in primary care. Only one had any ambition to become a general practitioner (on his planned return to India) and he stressed that as a result, he was wholly unrepresentative of migrant South Asian doctors in general.1 His contemporaries mostly entered general practice reluctantly. Participants in this research report spending years working in the NHS before eventually

in Migrant architects of the NHS

entry of a significant number of South Asian doctors into the profession of general practice was not officially orchestrated or even explicitly encouraged by the Department of Health. It was at times resisted by the British medical profession. This chapter describes what was in effect the accidental acquisition by the NHS of a substantial workforce of South Asian GPs. The individual choices made by thousands of South Asian doctors had a major structural impact on the development of British primary care. 151 From ‘pairs of hands’ to family doctors151 ‘What can you

in Migrant architects of the NHS
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Historicising a ‘revolution’

history of migrant South Asian doctors in the NHS a decade ago, I was struck by the contrast between their numerical importance and the lack of historical interest in their roles. When they were mentioned in historical accounts, it was mainly in the form of statistics concerning their numbers. In the context of the NHS, avoiding a reflection around the impact of medical migration is tantamount to missing a revolution in post-​war Britain. By focusing on one group of migrants, I have shown how the history of the NHS cannot be disentangled from Britain’s imperial past

in Migrant architects of the NHS
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Writing the history of the ‘International’ Health Service

1 Introduction: writing the history of the ‘International’ Health Service The histories of the National Health Service (NHS) and of British general practice are profoundly intertwined with the history of the imperial legacy and of medical migration. This book shows that the NHS, which was established in 1948, would not have been what it had become by the 1980s without being able to draw on the labour of migrant South Asian1 doctors. When it comes to the history of the NHS, the migration of South Asian doctors cannot be treated as a side issue. An appreciation

in Migrant architects of the NHS

defined set of practices was implemented by practitioners. GPs working during this era retained a great deal of professional autonomy at a time when their profession was undergoing a profound transformation. During this period, general practice as a discipline consolidated its status as the cornerstone of the NHS. The provision of treatment in primary care settings became increasingly important to governments keen to contain costs. It was at this time that general practice became recognised as a medical specialty and that the College of General Practitioners (later the

in Migrant architects of the NHS

93 3 The empire of the mind and medical migration It is important, in order to understand how the NHS and British general practice were able to draw on the labour of South Asian doctors, to appreciate, as was shown in the previous chapter, how British immigration and medical registration policies remained defined by imperial legacies for much of this period. It is also crucial to appreciate that these legacies continued to shape medicine in the Indian subcontinent and the thought processes of doctors—​as is apparent in their oral history interviews and in

in Migrant architects of the NHS
Memories of practice on the periphery

181 6 ‘The more you did, the more they depended on you’: memories of practice on the periphery Having described how doctors came to be in Britain, the discrimination that they faced and the processes leading to their geographical clustering, I will now turn my attention to their interactions with their environment and the influence they had on British society and medicine. The present chapter draws on doctors’ accounts to explore the nature of general practice in the first forty years of the NHS in the peripheral areas where many medical migrants built careers

in Migrant architects of the NHS