Project Phases

In this phase, we will examine published minutes of meetings and annual reports of statutory regulators as well as the following archival materials:

• Ministry of Health (The National Archives);
• Trade unions - BMA (BMA Archives, Wellcome Library) and Medical Practitioners’ Union, and professional associations (RCP and RCN);
• Scholars working on healthcare regulators (Margaret Stacey);
• Advocates helping to find work/placement for refugees - Esther Simpson, Yvonne Kapp (Trades Union Congress);
• Campaigning organisations (Socialist Medical Association) and organisations assisting refugees to find work (Society for the Protection of Science and Learning and British Federation of University Women);
• Jewish refugee medical professionals (Wiener Holocaust Library, RCP’s Voices of Medicine project, and Medical Sciences Video Archive, Oxford Brookes); and
• Refugee and immigrant physicians (RCP Archives) and nurses (RCN Archives).

In this phase, we will use the historical insights gained from the archival research in Phase One to frame interview questions for understanding the contemporary fitness to practice (FtP) landscape. In order to get a deeper understanding of how statutory regulators adapt registration and FtP requirements during ‘crisis’ situations, we will conduct interviews with:

• Regulators (NMC, HCPC, PSA), on setting registration requirements, principles behind and challenges posed by emergency registration, risk assessment when registers are expanded, rationales behind FtP procedures, and ways in which these proceedings have worked;
• Professional associations (BMA, RCN), on lobbying activities around shaping regulation of the professions;
• Activist (BAPIO, RefuAid, Refugee Council) and training (Reache) organisations, on activities in training migrant/refugee healthcare workers and assisting them in navigating the registration system, and lobbying for reforms of registration and FtP procedures; and
• Health education experts (HEE), on choices made to create initiatives that aim to widen the healthcare workforce.

Tabita Tariq, qualified nurse with refugee status in the U.K.

The team will also focus on the contemporary experiences of migrant and refugee healthcare workers in navigating regulatory requirements. We will conduct 25-30 interviews with refugee health professionals who wish to share their experiences, as well as staff and managers at St James Leeds and St George’s University Hospital, London, focusing on perspectives on and experiences with registration requirements and FtP procedures.

These interviews will form the backbone of a digital archive of community stories. We will work with our partners to co-create an oral history archive of BAPIO as an institution and of the UK’s international healthcare workforce community more generally. By community, we do not mean local community, but a historical community of individuals from different national locations, with vocational professional training and who faced similar regulatory mechanisms in the UK.

We will also work with the Brotherton Gallery to digitise 20 meaningful objects (e.g. diplomas, name badges, uniforms) that signify registration or the anticipation of or hope for registration for the participants. The audio recordings and digitised objects will be available via open access platform YARN. The digital archive will be hosted by the University of Leeds for five years before being transferred to BAPIO.

This phase will focus on analysis of the interview data.

The team will also use the data as starting points to reach outside the realm of professional registration requirements and fitness to practice (FtP) procedures. Using comparative analysis (Riles 1994) and legal critique of governance (Gersen and Suk 2016, Halley, Kotiswaran, Rebouché and Shamir 2019), we will draw analogies with other mechanisms that do upstream evaluation of the conduct of future professionals. We will ask what sort of comparator or examplar they could offer to FtP.

To gain insight into perspectives on the upstream regulation of entry to the healthcare professions, we will do conceptual work and conduct interviews with:

• Members of Student Health and Conduct Committee, University of Leeds (handling FtP concerns);
• Representative of the Medical School Council; and
• Representative of HEE, including LETBs, about work including past work by deaneries.