Migrant Architects of the NHS: South Asian Doctors and the Reinvention of British General Practice (1940s–1980s) by Julian M. Simpson (review)

Julian Simpson’s Migrant Architects of the NHS is a study of the migration of South Asian doctors into British general practice in the mid-twentieth century. The publication of this book is timely in the story of the British National Health Service (NHS), coinciding with the 70-year anniversary of the organization’s foundation. Simpson previously worked as a journalist and has an academic background in the social history of medicine. This ground-breaking book attempts to place the contribution of doctors from South Asia working in general practice into the context of Britain’s imperial past. The author offers an interesting new perspective on a previously under-researched area of NHS history.

Simpson’s book uses archival research and oral history, the latter distilled from 45 interviews (of which 40 were with medical practitioners). His approach provides a commentary on the accepted historiography, and allows both individual and collective observations of the South Asian doctors to be included. The reader is hence given an understanding of some of the fundamental reasons for medical migration in the context of the development of the NHS.

The doctors relate their experiences freely, and in some cases emotionally. Many of them travelled to Britain expecting to gain further qualifications before returning home or settling there as senior hospital practitioners. However, for a proportion these expectations were not fulfilled. A combination of manpower shortage and institutionalized racism meant that a significant number of these migrant doctors settled in Britain and became general practitioners in industrial areas, which were often socially deprived. General practice in these regions of Britain was regarded as unpopular, and frequently shunned by graduates from British medical schools.

The book is structured into three main parts: the first covers how the development of the NHS encouraged the migration of doctors; the second examines how Britain’s imperial legacy continued to exert professional discrimination, hence limiting career options for migrant doctors; and the third explores how medical migration has impacted on British society.

Simpson suggests that the support of South Asian doctors was not only essential to sustain general practice in Britain, but also fundamental to the survival of the NHS, especially in impoverished areas and in unpopular clinical specialties. He describes the history of general practice since the inception of the NHS, including its poor morale in the 1960s (exemplified by Lord Moran’s infamous statement that general practitioners were doctors who had fallen off the ladder). In addition, lack of confidence in the NHS led to an exodus of British-trained graduates, leaving general practice under-staffed and practitioners distributed unevenly around Britain, a situation recognized officially by the Chief Medical Officer as a reality that needed to be accommodated.

The influx of South Asian doctors provided part of the solution to the medical manpower shortage, but probably not in a centrally organized way. Simpson argues, however, that formal British immigration policy in the 1960s was adapted to allow the doctors to work in the UK, so that they were not necessarily managed as immigrants. Enoch Powell’s notorious ‘Rivers of Blood’ speech (1968) is used to demonstrate this, with Simpson pointing out that Powell “unequivocally excluded doctors from his apocalyptic warnings about the impact of immigration on the UK’s social fabric” (78).

Simpson moves on to discuss the British colonial legacy as it affected the health service, and how migrant doctors were often initially treated as no more than “pairs of hands” (124). He inter-weaves formal historiography with individual accounts, some of these encompassing other medical roles across the health service as well as general practice. Perhaps it is too great a leap, however, to conclude that a migrant doctor’s recall of her Indian professor’s lack of emotional response to a patient demonstrated “an absence of a revolution in medical care in newly independent India” (104).

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