Psychiatric Bulletin (2006) 30: 228-229. doi: 10.1192/pb.30.6.228
© 2006 The Royal College of Psychiatrists
Psychiatric Bulletin (2006) 30: 228-229
© 2006 The Royal College of Psychiatrists
Overseas consultant psychiatrists moving into the NHS: initial experience
Mitesh Shah, Consultant Psychiatrist,
Santanu Goswami, Consultant Psychiatrist and
Gagandeep Singh, Consultant Psychiatrist
Mersey Care NHS Trust, Liverpool
Robert Brown, Consultant Psychiatrist
Rehabilitation Services, Adult Mental Health Directorate, Rathbone
Hospital, Mill Lane, Liverpool L9 7JP, e-mail:
marie.jones{at}merseycare.nhs.uk
Declaration of interest
M.S., S.G. and G.S. moved to the UK from India under the International
Fellowship Scheme.
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Introduction
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Moving to a different country for work can be an interesting experience but
can be demanding for healthcare professionals as the systems across countries
are vastly different. At the same time, such an opportunity can enable
professionals to broaden their skills and experiences. The National Health
Service (NHS) provided such an opportunity by recruiting consultants from
overseas under the International Fellowship Scheme. In this paper three
psychiatrists (M.S., S.G. and G.S.) who moved to the UK under this scheme
describe their initial experiences.
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Initial experience
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In 2002, the Department of Health, UK launched a global campaign to recruit
psychiatrists from overseas to work as consultants in the NHS. We were among
the hundreds of aspirants who responded to advertisements in national
newspapers. Initial seminars organised across India were informative but
overwhelming. Being short-listed for the interviews was an exciting experience
in itself but the amount of paperwork needed for acquiring Specialist Training
Authority (STA) approval seemed to be an uphill task. Visiting the UK for the
interview was very exciting. For many of us it was our first visit abroad. The
interview week allowed us to visit our potential workplaces and attend
presentations about multidisciplinary teams and working systems. We visited
about ten sites across four different trusts and we found it quite difficult
to assimilate all the information.
Like many other trusts, Mersey Care NHS Trust provided us with the
opportunity to socialise with the consultants and leading staff and meet the
chief executive and other lead consultants of the trust. Our families also had
a glimpse of the life they were potentially going to experience. Perhaps the
best part of the interview week was being interviewed by a panel of experts.
The overall interview style, framing of questions and emphasis on putting the
candidate at ease was not only refreshing but also gave us an idea of the
system we were perhaps going to work in. However, waiting for the interview
results was somewhat nerve-racking although worth the wait.
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Selection
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Our selection of a post was based more on our impressions than empirical
data as we had difficulty in recalling all the information. Our final
decisions about taking the posts in the Mersey Care NHS Trust were made on the
basis of location and possible better future options for our families.
The time from being selected to joining our posts proved to be an ordeal.
We had to ‘crisscross’ various parts of our home country to
complete documentation for STA approval which required evidence of our
training in our home country. Fortunately, our medical institutes not only
provide rigorous training but also keep excellent records of training
activities, such as duration in post, skills gained, formal and informal
teaching programmes and academic and research activities. Postgraduate
training activities have to follow a prescribed pattern and all trainees have
to complete regular 6-monthly assessments and final examinations. Supporting
documents authenticated by our supervisors were provided to the STA. Despite
this efficient system, it took us about 6-8 weeks to complete the paperwork.
However, as our education and training were conducted in English, clearance
from the English Language Testing System was not difficult. While we waited
patiently for approval, feedback from colleagues who had already arrived in
the UK reinforced our decision to move here. Depending on the exact timing of
filing the application, it took about 10-16 weeks for STA approval and another
4-8 weeks for General Medical Council (GMC) registration.
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Relocation
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Once GMC registration was finalised, the major task of planning the
relocation began. The Department of Health provided an excellent relocation
programme, which included assistance in moving, help in finding suitable
accommodation and support for our families. Although one of us undertook a
‘preview’ trip to organise accommodation and children’s
schools, others were assisted by our relocation consultants.
As the departure date became imminent, we spent time with our relatives,
addressing their concerns and saying ‘goodbye’. Perhaps there was
too little time left to prepare us for the professional challenges ahead.
Overall, it was a long journey. We appeared at the interviews after about 8
months of filing initial applications. It took another 4-6 months for approval
and registration to come through. The final move from our home country took a
further 3-5 months.
When we arrived in the UK we were excited, but were apprehensive about a
totally different healthcare system, about which we had no experience. For the
first few months we shadowed senior consultants but found the information
overwhelming. There were difficulties in obtaining information from other team
members owing to their own busy schedules but we were helped by continual
input from our clinical and medical directors. Major professional challenges
included understanding the correct application of the Mental Health Act 1983,
the multidisciplinary team approach to patient management, after-care
programmes and the intricacies of the referral system. We had to rely on
others for the implementation of the Act. However, in addition to the initial
shadowing the Mersey Care NHS Trust provided further assistance by appointing
a mentor with whom we could discuss our professional difficulties. The trust
also provided assistance for the Section 12 course approval, which is
essential for application of the Mental Health Act 1983. For those of us who
are not yet Section 12 approved, we are constantly supervised and assisted by
another senior consultant.
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Conclusions
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Moving to the UK was not only a professional challenge for us but also a
testing time for our families. There were issues related to living in a new
country with the different lifestyle, food and educational system. For some of
us, it was a matter of supporting our children who experienced a culture
shock; for others, safety and security on the streets were major concerns.
One of the major factors that has helped us to settle down here has been
the support we have drawn from each other. Those who came here earlier
provided excellent assistance and guidance to the newcomers. We frequently
interact with each other, make suggestions and put others at ease. The fact
that few of us knew each other before arriving in the UK only helped the
situation further. Our colleagues in our home countries have reacted variably
to our move. Although there was some concern at the potential loss of trained
practitioners (especially those who were in government jobs), we met with a
general feeling of acceptance of our move. We have often discussed with our
colleagues back home the similarities and differences in health systems and
the challenges of working in the NHS.
Overall moving has been a challenging experience. We still feel anxious,
nervous and lonely at times, and miss our families. At other times we feel at
ease.
It would be immensely helpful if future programmes included a more
comprehensive induction programme focusing on the structure of the NHS, the
Mental Health Act 1983 and the city where recruits would work. Some knowledge
by existing staff about the culture of overseas doctors and their expectations
would also be helpful in allowing a smoother transition.
Top
Introduction
Initial experience