Dr Chaand Nagpaul (CBE), is the first non-white Chairman of the British Medical Association (BMA). He is also a prominent GP, specialising in Family Medicine, and known nationally. He has spoken extensively on the NHS and represented doctors across various high-profile media and with frequent television appearances and lobbied government policy to ensure the highest healthcare standards.
Appointed to the most prestigious of representative healthcare posts in 2017 – speaking on behalf of 160,000 doctors across Britain, from junior positions to GPs, hospital doctors, academics and those in highly qualified senior roles– Chaand has already created a noteworthy impact. Earlier this year, his campaigning resulted in the lifting of then Home Secretary Amber Rudd’s immigration cap on overseas doctors from outside of the EU. “This was absurd,” he commented, “not least because at a time when the NHS is struggling with severe doctor shortages it is illogical to prevent overseas doctors who had been offered jobs, “proving themselves best for the position”, from working in the UK. The government must make it easier for overseas doctors to work in the UK, not simply because the NHS needs them but also to attract high calibre doctors for training and research. If these skilled individuals perceive feeling unwelcome, they will likely choose to work in other parts of the world, including America, Australasia, and Canada. I want the BMA to influence the government to strengthen the NHS’s global reputation to attract the best doctors. The BMA is working to ensure overseas doctors coming to the UK receive a wide-ranging package of support, supporting them through processes such as induction, the logistics of finance and registering, and getting settled into employment. We are also looking to introduce mentoring programmes.”
Chaand demonstrates his core humanitarian value for the NHS to deliver safe healthcare. Indeed, the role of the BMA is not just to represent doctors, but “to allow them to do their jobs properly to maximise care for patients and the public’s health”. We must speak out if that vital service is being undermined.” Here, Chaand states another one of his accomplishments: the successful challenge to May’s austerity measures. “I was relieved to hear that the PM plans to end cuts to funding, promising a future 3.4% annual increase. However, this is still less than the 4% quoted by independent think tanks” as the bare minimum required for the NHS. “The truth is that doctors are struggling to provide the level of care that the population needs. Hospital beds, staff and medical equipment and facilities are being gutted by austerity. Other nations such as Germany and France spend £20-30 billion more than the UK – and have tens of thousands more doctors and hospital beds compared to the NHS. Every doctor wants to go into work believing they can do their best, but the system is being stretched. For example, GPs are being forced into 10 min appointments for each patient with 9 in 10 GPs feeling they don’t have the time to care.”
Chaand went on to emphasise that the impending Brexit will severely aggravate matters: “It is highly likely to worsen our current medical workforce pressures, with the probability of current EU doctors leaving the UK, and fewer European doctors filling their posts. This will add pressure to all current NHS staff.” When asked about the emerging hypocrisy of a government that claims that the NHS is failing while touting privatisation as an alternative, Chaand stated: “This is politically disingenuous, and dissolving the NHS would be a disaster. The Commonwealth Fund named the NHS the most cost-effective and fairest health service globally because money is not wasted on administration nor diverted into private profits, and crucially it provides free care at the point of access, regardless of ability to pay.” The proposed introduction of privatisation could also undermine trust between patient and doctor: “the patient would not know whether actions were based on financial motives - trust is fundamental to the doctor-patient relationship and a central value of the NHS.” Chaand also talked of the “blame culture in the NHS rather than a learning culture” when it comes to improving quality and safety. “Doctors and NHS staff are often targeted for making mistakes rather than also focussing on the system that is adding unfair pressures from being understaffed and underfunded. This was brought into sharp focus in the charge of manslaughter against Dr Hadiza Bawa-Garba, who worked on a day when her hospital was severely short-staffed and with IT failures. Excessive target driven and financial performance management are also counterproductive when it comes to caring for the population and fostering a thriving workforce.” Chaand has received numerous national awards for his sensitive and expert approach. In 2013 he was voted as the most powerful GP in the UK by Pulse Magazine, he is named in the Sunday Times top 500 list of most influential people in the UK, and in 2015 he received the Queens honour of CBE for his services to primary care.
You are one of the biggest spokespeople for reforming the NHS. What more are you planning to do regarding the tackling of unhealthy culture?
A priority is addressing racial inequality. We’ve come a long way, obviously by example of my own position, but BME doctors are still significantly underrepresented. The problems we’ve uncovered start in medical school. It’s the phenomenon of differential attainment. UK medical students and junior doctors who are Asian are achieving lower exam pass rates than their white counterparts though this is not linked to ability. We know that Asians are culturally hard-working, highly capable and industrious. Rather, as backed by a study from Dr Catherine Wolf at UCL, lack of attainment amongst BME doctors is due to bias in the environment, however unconscious. This continues in the acquirement of senior posts and interferes with career progression. A larger proportion of Asian doctors are not awarded hospital consultant positions. I plan to target this effectively in the coming year.
What drew you to medicine and social healthcare?
I was always drawn to the sciences; I wanted to apply that academic knowledge to help alleviate the pain and suffering of people. Initially, I wanted to become a hospital doctor - a physician – but what really changed my stance was when as part of my training as a medical student I spent time in an inner-city London GP practice. I was in awe of the spectrum of medical conditions a GP l could diagnose and treat- from new-born babies or children with asthma to older patients with heart failure to those who had a mental health condition. There is a special trust between patient and doctor – with people divulging secrets they wouldn’t even tell their loved ones. As a GP myself in the same practice for 29 years, I have had the pleasure of continuity of care: seeing whole families over decades and watching babies grow into adults who then have children themselves. You are not just treating a patient, but a whole person, their family and a local community.
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A larger proportion of Asian doctors are not awarded hospital consultant positions.
I plan to target this effectively in the coming year.