The Learning Process

The consistent feedback from projects elsewhere, in England, Wales and Scotland, is that all Refugee Doctors who come to the UK require more support and training than they expect, and usually take time to understand the NHS and how it works. The UK healthcare system is significantly different to any other country, and presents challenges for anyone coming from abroad to work. Added to that, most Refugee Doctors have not initially chosen to leave their home environment, but have had to move for their own and their family’s safety. It is also noted elsewhere that people progress at very different rates through an educational pathway, and outcomes are difficult to predict at an individual level.

Students recruited to the scheme would need to start with English language training, while receiving community integration support [below]. IELTS is said to be the biggest hurdle to Refugee Doctors working here. They would initially be assessed using ESOL/PLAN frameworks, before moving on into Advanced and Clinical English language skills. We will look at outsourcing this as part of the options appraisal.

Once skilled in Clinical English they would sit IELTS, and commence some clinical volunteering in the hospital. We would encourage adoption and volunteering within the same units for familiarity, such that a Refugee Doctor becomes attached to a team all the way through their training [introduction  volunteering  observer  HCA skills  clinical placement  service job or training].

Once IELTS is passed [other programmes have the expectation this may take up to 2 years], clinical teaching will begin, using existing facilities within ULHT. Because of our links with REACHE Northwest in Salford, we may be able to use audio-visual linkage, through Facetime or similar, to some of the activities in Manchester.

Once PLAB 1 is passed, the doctor will be able to undertake clinical work to a level of Health Care Assistant.

Once PLAB 2 is passed, the doctor will then become eligible to undertake a CAPS Clinical Placement. In both of these roles, there is an expectation that clinical supervision and oversight will be provided by the units in which the Doctor is working.

The Clinical Placement will be unpaid work, for a duration of three months. Agreement will need to be reached with local Benefits Agency Offices for the continuance of benefits payments.

Placements will be arranged both in Primary and Secondary Care in Lincolnshire, across ULHT sites, and using the CEPNs for Primary Care placements. We expect that the Doctor will be functioning at FY1 [or FY2 level at best] during this placement.

Clarification will need to be sought on how the indemnity requirements will be met, during both the “HCA” stage of volunteering [where clinical supervision will be expected].

Outcome Measures

We need openly to acknowledge that it is unlikely that there will be many refugee doctors passing through the entire scheme in a single year. Experience from REACHE Northwest suggests that, with a cohort of 84 refugee doctors, there are 6-8 doctors each year going onto find a service or training job in the NHS locally.

More visibly in the first year, we expect to see progress through IELTS and PLAB 1 examinations, toward PLAB 2 readiness. Tutors elsewhere develop skills and experience to assess readiness to sit the exams, and we would hope that, at each review, we would use benchmarking as follows:

  1. IELTS passed
  2. PLAB 1 passed
  3. PLAB 2 passed
  4. GMC registration
  5. Clinical placement
  6. Entered training or service
  7. Left scheme [other]

Leaving the Scheme

Sadly, it will not always be possible for refugee doctors to complete the scheme. Reasons such as poor attendance, family crises, financial hardship, illness, may all create situations in which it is difficult for the doctors to continue. REACHE Northwest find that 1 in every 3 students drops off the course. We will expect an 80% attendance rate at sessions.

Support

As mentioned above, Refugee Doctors will need support in a number of different areas.

  • Community

    • Housing

      • Finding accommodation

      • Tenancy agreements

      • Stigmatisation

    • Claiming Benefits

    • Services

      • Dealing with Utilities

      • Transport

      • Finding schools

    • Health

      • Registering with a doctor

      • Using a Pharmacy

      • Registering with a Dentist

      • Attending Hospital as a patient

  • Personal

    • Coaching & mentoring

    • CV writing

    • Emotional support

    • Partner support

  • Professional

    • Register BMA Refugee Doctor Initiative [see below]

    • Understanding colleagues

      • Workplace language

      • NHS culture/expectations

      • Different roles

      • Practising skills

    • Knowledge/Technology/Learning

      • Library Access

      • PLAB Study Group

      • Internet access

    • Volunteering within:

      • Acute Trust

      • Third Sector [Red Cross, SJA]

In particular, it is worth establishing as an over-reaching principle that we are looking to attract these doctors, and their families, to the community of Lincolnshire long-term, not just for the duration of this project. It will be important to share this understanding with partner agencies, such as housing and education, so that accommodation or schooling will not be linked to participation in the project: the possibility that a doctor would accept a place simply to gain accommodation, or children’s education, can be challenged at interview.

Faith Community

Refugee Doctors may belong to any of the world faiths, or to none, Facilities are available in both Lincoln and Boston for worshippers in many faiths, including Islamic Centres in both towns.

The Islamic Association of Lincoln is currently fundraising and constructing a new mosque at a site in Lincoln.

Faith Communities in the Christian tradition are widespread, including Sanctuary groups in Lincoln and Louth, who are recruiting members of their communities to provide accommodation for refugees.