An evaluation of the CAPS refugee doctor scheme in London - a survey of outcomes.

The NHS faces challenges in recruiting and retaining clinicians. The NHS Long-Term Plan aims to increase NHS staffing levels as one of its objectives. With adequate support, refugee doctors can help fill gaps in staffing and deliver high-quality patient care. There is a moral imperative to support this group: to promote inclusion and equality. London is the only region in England to offer refugee doctors the opportunity of a funded six-month supernumerary F2 role with access to a bespoke education programme and to the resources offered by the Professional Support Unit (PSU). Our aim was to evaluate retention rates of refugee doctors in the NHS following this six-month placement.Between October 2009 (at the inception of CAPS) to March 2020, 85 refugee doctors entered the CAPS programme. Of the 48 doctors who responded to our questionnaire, 45 are still working in the NHS (93.8%). Most are working as Locally Employed Doctors across a range of hospital specialities (47%) but general practice was the single most popular career choice (29%).The CAPS scheme is successful in integrating refugee doctors into the NHS at a relatively low cost. More support should be offered to this group in terms of career progression, and the scheme should be rolled out to other regions of the UK, particularly those in which there is a shortage of doctors.

Supporting disengaged children and young people living with diabetes to self-care: a qualitative study in a socially disadvantaged and ethnically diverse urban area.

OBJECTIVE: To explore how to enhance services to support the self-care of children and young people (CYP) clinically considered 'disengaged' by diabetes services. DESIGN: Qualitative study. SETTING: Two diabetes clinics in an ethnically diverse and socially disadvantaged urban area in the UK. Eligible participants were CYP living with type 1 or type 2 diabetes aged between 10 and 25 years who did not attend their last annual hospital appointment. PARTICIPANTS: 22 CYP (14 female and 8 male) aged between 10 and 19 years old took part. The sample was diverse in terms of ethnicity, age at diagnosis, family composition and presence of diabetes among other family members. DATA COLLECTION: Semistructured interviews. DATA ANALYSIS: Data were analysed thematically. RESULTS: Analysis of participant accounts confirmed the crucial importance of non-medicalised care in CYP diabetes care. A life plan was considered as important to participants as a health plan. Participants valued the holistic support provided by friends, family members and school teachers. However, they found structural barriers in their health and educational pathways as well as disparities in the quality of support at critical moments along the life course. They actively tried to maximise their well-being by balancing life priorities against diabetes priorities. Combined, these features could undermine participants engagement with health services where personal strategies were often held back or edited out of clinical appointments in fear of condemnation. CONCLUSION: We demonstrate why diabetes health teams need to appreciate the conflicting pressures experienced by CYP and to coproduce more nuanced health plans for addressing their concerns regarding identity and risk taking behaviours in the context of their life-worlds. Exploring these issues and identifying ways to better support CYP to address them more proactively should reduce disengagement and set realistic health outcomes that make best use of medical resources.

Integrating Refugee Healthcare Professionals In The UK National Health Service: Experience From A Multi-Agency Collaboration.

PURPOSE: Refugee healthcare professionals (RHPs) may encounter several barriers to employment upon moving to the UK, such as conversion of professional qualifications and a lack of familiarity with the recruitment process. The Building Bridges Programme (BBP) is a London-based multi-agency collaboration which helps refugee healthcare professionals seek employment in the UK National Health Service (NHS). METHODS: We have kept an electronic database of all RHPs who have participated in the BBP from October 2009 to March 2018. Data collected include gender, language spoken, country of initial medical qualification, immigration status, religion, ethnicity and professional work experience. In this paper, we focus on employment outcomes and determine the proportion (%) of RHPs joining the BBP who enter employment in the NHS. RESULTS: Between October 2009 and March 2018, the BBP supported 372 refugee doctors, 42 refugee pharmacists, 69 refugee dentists, 25 refugee biomedical scientists, 4 refugee physiotherapists and 83 refugee nurses. The following are the results for the RHPs who settled into a registered NHS position appropriate to their (home country) professional qualifications: 98/372 (26%) doctors, 4/42 (10%), pharmacists, 17/69 (25%) dentists, 1/25 (9%) biomedical scientists, 1/4 (25%) physiotherapists and 2/83 (2%) nurses. The following are the results for the RHPs who settled in associated healthcare profession positions: 109/372 (29%) doctors, 16/42 (38%) pharmacists, 12/69 (17%) dentists, 10/25 (40%) biomedical scientists, 3/4 (75%) physiotherapists and 34/83 (41%) nurses. CONCLUSION: The BBP provides a useful model that is transferable to other countries. Future studies assessing the utility of such programmes should ensure that the long-term employment outcomes of RHPs are more closely tracked. A key limitation of this paper is the absence of a control group of participants who did not join the BPP, which would help to conclusively demonstrate whether participants who joined our programme had a statistically significant improvement in employment outcomes.

Severe hypercalcaemia in a child secondary to use of alternative therapies.

We describe a case of a 4-year-old boy who presented with acute vomiting, weight loss, loss of appetite, polyuria and polydipsia. Initial investigations revealed a very elevated corrected calcium level which peaked at 4.46 mmol/L. He had a prior diagnosis of autism and his mother had consulted an alternative therapist who had recommended many supplements, including calcium and vitamin D. He required treatment with hyperhydration, calcitonin, furosemide and several doses of pamindronate before his calcium level returned to the normal range 2 weeks later.