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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.

Julian M. Simpson

150 5 From ‘pairs of hands’ to family doctors The professional options of South Asian doctors who decided to stay in Britain were limited, notably as a result of racism and heterophobia. Discrimination operated both in hospital medicine, resulting in migrant doctors being directed towards general practice, and within general practice itself resulting in outsiders being at a disadvantage when it came to obtaining posts in the more desirable areas. The presence of South Asian doctors in general practice in industrial and inner-​city areas is nevertheless partly

in Migrant architects of the NHS
Julian M. Simpson

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
Julian M. Simpson

124 4 Discrimination and the development of general practice The presence of migrant South Asian doctors in the British healthcare system can be linked to the existence of a post-​imperial recruitment system in post-​war Britain and the lingering effects of the empire of the mind in South Asia. Their movement into general practice, however, requires to be understood in a different way. This chapter and Chapter 5 will show how a discriminatory professional environment limited these doctors’ options and how their responses to this context contributed to defining

in Migrant architects of the NHS
Julian M. Simpson

movement of doctors.3 In this chapter, I  argue that seeing the development of the NHS through the prism of empire and its legacies is key to understanding how it came to be so reliant on migrant South Asian doctors. This reflection draws on the work of historians who have argued that closer attention should be paid to the ways in which Britain’s imperial past have shaped its present. It also builds on the insights of post-​colonial theorists who argue that the impact of imperialism is an essential dimension of the modern world that cannot be ignored.4 Adopting such an

in Migrant architects of the NHS
Julian M. Simpson

Royal College of General Practitioners or RCGP) was founded. This chapter explores the relationship between South Asian doctors and what has been termed the ‘renaissance’1 of general practice in the post-​war years. Changes in British General practice from the 1960s onwards coincided with the entry into the field of substantial numbers of South Asian doctors. These two historical processes should be seen as interconnected. This ‘renaissance’ was not a linear process; it was contested, took on different forms and at times practitioners chose to ignore some of its

in Migrant architects of the NHS
Doctors’ organisations and activist medics
Julian M. Simpson

evidence of their agency at a local level. At times, this social and political engagement extended beyond local contexts and resulted in them taking on national roles. South Asian doctors set up voluntary organisations which had an impact on policy and more generally provided a setting in which migrant practitioners could access training and socialise. They also acted to change British medicine in a number of ways. This chapter describes how migrant doctors became involved in medical politics and in addressing social questions. They added new dimensions to British

in Migrant architects of the NHS
Memories of practice on the periphery
Julian M. Simpson

offers an examination of the nature of the relationship between South Asian doctors and ethnic minority patients. I conclude by outlining the problematic nature of the disengagement of the mainstream of British medicine from large parts of Britain and the resulting dependency 182 182 Shaping British medicine and society of particular populations on migrant doctors who were themselves frequently professionally marginalised. Embracing ‘dirty work’; finding common ground If entering general practice was a logical option to pursue for practitioners who found

in Migrant architects of the NHS
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Historicising a ‘revolution’
Julian M. Simpson

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
Julian M. Simpson

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