Identity, Migration, Community Cohesion and Healthcare:A Study of Overseas-trained South Asian Doctors in England and Wales

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Abstract

Community cohesion in Britain has been an issue of policy concern in recent years in which the role of migrants in the UK has been scrutinised in terms of their sense of belonging, integration and their economic and social contribution to society. However, much of the existing literature, in this area relates to the experiences of low/unskilled labour migrants. This thesis redresses this imbalance and examines the experiences of overseas-trained South Asian doctors. It provides unique insights into the debates about integration, cultural identity and community cohesion based on an empirical study of overseas-trained South Asian General Practitioners who are elite migrants.A mixed method approach was employed that included secondary data analysis of the GP Workforce Statistics and in-depth interviews with 27 overseas-trained South Asian doctors in three different geographical locales in England with varying ethnic populations.The quantitative analysis shows that a significant and increasing proportion of NHS doctors continue to be overseas-trained South Asian doctors. It also provides evidence of geographical clustering with South Asian doctors being over represented in deprived areas with high and low ethnic minority concentrations. The case studies and interviews with the GPs reveal a complex intertwining of macro-, micro- and meso- structures in the migratory process, related, in part, to the legacy of empire and also to the inner workings and opportunities provided by an organisation such as the NHS. In order to overcome blocked social mobility within the NHS hospital structure, entry into General Practice appears to be an entrepreneurial step for overseas-trained South Asian doctors, also facilitated by regional NHS institutional structures like Primary Care Trusts. Evidence shows that doctors have integrated their cultural/religious values creatively in their adaptation to Britain importing innovation into their everyday experiences.The findings show that there are parallels to be drawn with the experiences of low/unskilled South Asians, in particular, in the area of structural integration. However, there is variation as to how these elite professionals approach issues related to socio-cultural integration thus adding a new dimension to our existing understanding of community cohesion in the UK.

Layman's Abstract

Community cohesion in Britain has been an issue of policy concern in recent years in which the role of migrants in the UK has been scrutinised in terms of their sense of belonging, integration and their economic and social contribution to society. However, much of the existing literature, in this area relates to the experiences of low/unskilled labour migrants. This thesis redresses this imbalance and examines the experiences of overseas-trained South Asian doctors. It provides unique insights into the debates about integration, cultural identity and community cohesion based on an empirical study of overseas-trained South Asian General Practitioners who are elite migrants.A mixed method approach was employed that included secondary data analysis of the GP Workforce Statistics and in-depth interviews with 27 overseas-trained South Asian doctors in three different geographical locales in England with varying ethnic populations.The quantitative analysis shows that a significant and increasing proportion of NHS doctors continue to be overseas-trained South Asian doctors. It also provides evidence of geographical clustering with South Asian doctors being over represented in deprived areas with high and low ethnic minority concentrations. The case studies and interviews with the GPs reveal a complex intertwining of macro-, micro- and meso- structures in the migratory process, related, in part, to the legacy of empire and also to the inner workings and opportunities provided by an organisation such as the NHS. In order to overcome blocked social mobility within the NHS hospital structure, entry into General Practice appears to be an entrepreneurial step for overseas-trained South Asian doctors, also facilitated by regional NHS institutional structures like Primary Care Trusts. Evidence shows that doctors have integrated their cultural/religious values creatively in their adaptation to Britain importing innovation into their everyday experiences.The findings show that there are parallels to be drawn with the experiences of low/unskilled South Asians, in particular, in the area of structural integration. However, there is variation as to how these elite professionals approach issues related to socio-cultural integration thus adding a new dimension to our existing understanding of community cohesion in the UK.

Keyword(s)

Overseas-trained South Asian doctors, identity, migration, entrepreneurship, General Practitioners, geographical contexts, ; racism, coping strategies

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