cite as; Mehta R, Singhal P. Editorial. Francis Report. The Physician 2013 vol2; issue 1: 

The Francis report is frank, bold and challenging to the medical profession. Dr Makani Purva in this issue analyses the outcomes. The report highlights the need for changing the current culture of fear to a culture “where the only fear is the failure to uphold the fundamental standards and the caring culture.” The General Medical Council has recently launched a new version of Good Medical Practice which requires all doctors to “act without delay if you have good reason to believe that you or a colleague may be putting patients at risk”. BAPIO has experience of fear of establishment amongst the members. We have several examples where member tried to blow the whistle and faced severe reprimand.

Recently BAPIO supported a meeting at the Houses of Parliament on “Gandhian Values in the Modern NHS”. Lord Bhikhu Parekh in his inaugural speech recollected the story of when Gandhi was trying to fight the establishment in South Africa and cajoling the Indians to stand up against injustice. He had said, “If you behave like worms don’t complain of being trampled upon”. Gandhi had always stood up for truth and honesty and he was constantly seeking fairness and justice. Francis says, “We need to be courageous to speak up and stand up for the patients that we serve”. Good Medical Practice is keen on professionalism in action: “Patients need good doctors. Good doctors make the care of their patient the first concern: they are honest and trustworthy and act with integrity and within the law”.

BAPIO’s vision, “Empowering doctors and dentists of Indian heritage to be beacons of leadership and professional excellence,” is consistent with these principles. However, who looks after the doctors? There are professional bodies that should be doing this job, but we know that most of the doctors feel unsupported at times of crisis. BAPIO has tried to stand up for fairness and justice. The HSMP case is an example. International medical graduates (IMGs) face an unfair uphill struggle in most Royal College examinations.

However we were shocked to note that the exit examination of the Royal College of General Practioners (MRCGP, CSA part) has a pass rate of 36.8% for IMGs in comparison to 90.6% for UK graduates. The college is not willing to accept

that there is any flaw in the examination. BAPIO has thus decided to stand up for fairness and justice, and is filing a case in the High Court for judicial review. Francis, Gandhi and we all should have the satisfaction of standing up for principles.

This issue has raised some important topics, such as the Francis report and its implications, the importance of sound clinical medicine, and the benefits of Indo-British collaboration. Interestingly, all of these issues are interlinked. It is clear that there is a need for enough doctors to provide safe and quality care, but the resources are finite. In fact it is unlikely that the NHS will ever see the degree of investment seen of the last few years. Therefore the needs of the hour are innovation and creativity. Some specialities are facing severe medical staff shortages, thus impacting on patient care. It was unfortunate that the Department of Health, under pressure from various organisations, took a retrograde decision in 2006 which resulted in the mass exodus of non-EU international medical graduates. The Department of Health took no account of the impact of such a decision on the NHS, which has a long history of reliance on overseas health workers. The story of overseas recruitment is not new. Since the 1930s, successive governments have resolved staffing crises through recruiting workers from overseas.

Through the experience highlighted in the report by the management team of Weston General Hospital, the value of international medical graduates (most of them well trained and qualified) to the National Health Service (NHS) has once again been emphasised, especially the usefulness of resilience in the system. It is extremely important in the current financial climate that the resource available is well utilised and not wasted on locum agencies, and perhaps the GMC and Department of Health could draw some lessons, making it easier for international medical graduates to gain entry to the UK. This would benefit both the NHS and the international graduates.

The Francis report clearly mentions the importance of providing quality care within the current financial resource. If ever there was the time to consider the concept of good clinical medicine, it is now. Professor Bannister's article makes good reading, as it articulates a case for regulatory bodies to change the structure of undergraduate teaching to enable future doctors to practise good clinical medicine, which would help to bring sustainability to its rightful place at the centre stage of healthcare policy, e.g. avoiding unnecessary investigations means that the resource could fund other more useful activities.

Innovation and creativity are born not during abundance, but during extreme conditions. I draw satisfaction from authors highlighting the need to explore new ways of working which will go a long way in sustaining the NHS.