Navigating the red tape

Working as a physiotherapist in the UK is a career dream for many physiotherapists who qualify from programmes in South Asian countries. As of 1 May, there were 6,222 physiotherapists registered in the UK, who had obtained their qualifications from overseas, including South Asia. 

Is this an easy dream to achieve? 

Not by any means. There are several steps and hurdles along the way and only those who persevere are able to achieve this feat.

The first step involves registration with the Health and Care Professions Council (HCPC) which can be a challenging process in itself as there isn’t a lot of support available. Prospective registrants are left to chase other past registrants seeking advice and

guidance on what and how much information to be provide on the form, what information their universities should provide and what details need to be included. We have at least eight to 10 prospective registrants reach out to us every month seeking support for their HCPC application process. In addition to guiding them to some resources available on the HCPC and NHS England websites, we end up spending a significant amount of time calling/chatting and providing pro bono advice. 

Equivalent standard 

The HCPC will decide if the education and training is equivalent to that of a UK physiotherapy qualification. The outcome of the application could be an acceptance to the register, recommendation of a period of adaptation, or rejection. So some dreams end right there.

For those who receive registration, this is just the beginning. Applying for jobs and securing an interview while living in another country is a huge challenge. 

If selected, other challenges include meeting Home Office visa regulations and the eventual journey to the UK which can be a one to two-year process. 

Working in the UK can be equally difficult for foreign trained physiotherapists as they are exposed to a new healthcare system and work culture. The level of support provided by employers and NHS trusts varies and whilst most are able to integrate and thrive, several experience complaints from colleagues, other members of the multidisciplinary team or patients which lead to dissatisfaction, stress and mental trauma. Overseas trained physiotherapists form a disproportionately large number of professionals reported for fitness to practice hearings and 44 foreign trained physiotherapists have been struck off the HCPC register in the last decade - 20 of them were from South Asian countries. There were also 450 physiotherapists who were referred to fitness to practice hearings during this period. 

Progression in work itself will be limited in the sense that one cannot change employers frequently due to sponsorship regulations and this limits exploring promotions and broadening one’s work experience portfolio. NHS England Workforce Race Equality Standard data is heavily stacked against Black, Asian and minority ethnic healthcare workers. This is reflected across the recruitment journey from short listing to appointment. Only 40 per cent of BAME staff report that their organisation provides equal opportunities for career progression or promotion.

Devdeep recalls: Don’t be surprised if you get only 40-45 marks in your assignments, we usually don’t expect Indian students to get much more.’ This was what my course leader said to me on the first day of my induction in an MSc course.

Not only had I travelled 5,000 miles to undertake it but also paid nearly £10,000 only to be told that I shouldn’t expect to be given more than barely passing marks. This was not only shocking, but also humiliating and right away made me question my decision to come to the UK. 

Building a career in the UK has required immense dedication, effort and support from peers, mentors and society at large.

But we persevere, we fight on and we excel. So here I am 15 years on, sharing my experiences of a journey that has been challenging and yet exhilarating at the same time.

Recent research exploring the experiences of post-graduate Indian students in the UK found focus on recent evidence, engagement, self-study and critical thinking were the differentiating factors in education here. 

However students don’t gain any exposure of work culture and practice in the UK which impacts on their ability to understand the different approach of managing patients, hurts their job prospects (the age old issue of ‘you can’t get a job as you don’t have experience and you can’t get experience as you don’t have a job’) and leads to further difficulties in establishing their career. Despite these challenges, overall these students rated this education as a positive influence on their professional thinking and approach towards the patients. 

Sri adds: I came to the UK in 2015 and applied for my HCPC registration and the procedure was straightforward. I was also successful with my first job application and have enjoyed every single aspect of my work as an inpatient physiotherapist in the major trauma wards of the John Radcliffe Hospital in Oxford. It was a part-time position that perfectly suited my childcare responsibilities as well.

My work experience has been very positive and the main reason for this is the brilliant support I have received from my managers and colleagues. With a complex social situation that I have, I would never have been able to pursue my career as a physiotherapist if not for the constant support and understanding I received from my colleagues and managers.

Whether it is time and funding for training to requests for flexible working being approved, my managers have supported me all along.

I only realise the value of this aspect to my job satisfaction and how lucky I have been when I hear about stories of other internationally trained physiotherapists not receiving adequate support at work and struggling as a result of this. This is critical because the education and training that internationally trained physiotherapists receive is slightly different because of cultural differences and it will take some time for us to understand the system in the UK. This highlights the need for a robust induction process that would include communication skills and understanding the cultural differences of health care in the UK and the countries that we come from.

To cite a small example, patient confidentiality and privacy is vital to the care we deliver in the UK, while in some instances in India, I have had to wade through multiple relatives to actually find my patient and everyone would want to know what is happening with the patient.

My leadership journey has been supported in a big way by the CSP, which sponsored me for the CSP Leadership Programme and also for the AHP future leader’s programme. A recent decision by the CSP to ringfence funds for education opportunities for BAME candidates will go a long way in improving our skills and training.

However, it is critical that we take the first step in sourcing these opportunities and applying for them. Managers and employers also need to encourage by providing time and mentorship. 

I am now exploring different aspects of how I can make a difference to the lives of patients and the sky’s the limit for a physiotherapist to achieve this in the UK. This journey continues.