HE may have stepped down as the chair of the British Medical Association [BMA], but Dr Chaand Nagpaul has never been busier. In fact, when he spoke to the GG2 Power List, you wonder how he manages to be a senior partner in his GP surgery. We can only give a flavour of what he does day-to-day and what drives him.
“I’m the chair of the BMA’s Racial & Ethnic Equality Forum,” he explained. “This forum that I created when I was BMA chair is important because ethnic minority doctors suffer far greater levels of employment related difficulties, career progression issues, contractual issues, where terms are not met. They need to know they’re being represented by their national body. We’ve engaged in providing advocacy to thousands of minority doctors.”
In September 2022, his vision to help international medical graduates [IMGs] came to fruition. For £44 pounds per year, they become affiliate members of the BMA and have access to information about the UK NHS, including modules on how to pass the GMC’s Professional and Linguistic Assessments Board [PLAB] exam.
“In any one year, doctors who come from abroad, make up more than 50 per cent of new registrations on the GMC register. So, we have more overseas doctors who come here in any one year than the newly qualified doctors from the UK. But we also know that the IMGs suffer even more greatly than the UK trained doctors in terms of workplace issues. For example, they are three times more likely to be referred to the GMC than those trained in the UK.”
Last year, he also oversaw the publication of three reports into racism faced by doctors in the NHS. Nagpaul also continues his role as a board member of the NHS Race and Health Observatory, an independent body of experts, established by the NHS to examine the health inequalities experienced by people of colour.
“One of my proposals to them is to commission research because what you don't know you don't know. But I know in my day-to-day how inequitable care is to certain communities, right down to the fact that I noticed that when I offered 10 minutes appointments, I knew that my patients who are non-English speaking, refugees, asylum seekers, they're all getting a rotten deal, compared to my well-spoken, articulate white patients.”
It is clear Nagpaul brings a different perspective from most people. This July the doctors’ union will celebrate its 191st anniversary. When he was elected as chair in July 2017, Nagpaul was the first person of colour in the BMA’s history to lead what is regarded as the doctors’ union. This was a three-year term. Members voted him in for a further 12-months, not once but twice, and he could only serve as chair of council for a maximum five years. But what five years they were. Nagpaul was at the helm when the global pandemic struck. It was he who noticed how doctors of colour were dying disproportionately on the front line.
“When you come across the first 10 doctors who died all coming from an ethnic minority background, that flies in the face of any sort of statistical variation. It is a statistic that it demands action, not just to protect doctors and healthcare workers from Covid, as it was then, but also the underlying factors that would lead to such a statistic, so it could not be ignored. I remember it was mid-April, and I just called it out. I said the government had to act – it needs to have an independent inquiry. It should never have come to this, that it needed a pandemic with its disparities to wake up the government and wake up people about these gross inequalities.”
Nagpaul’s parents emigrated from Kenya. His grandparents had left India and settled, like tens of thousands, in east Africa. Many south Asians set up lucrative business, and they lived luxurious lives with big houses and employing Africans as their servants. Nagpaul’s father, Lalit, was an entrepreneur who ran a successful photography business and garage. But by 1968 that comparatively wealthy lifestyle would be over. His parents realised that east African heads of state would soon expel Asians, and his father made his way to Britain. Like thousands of other south Asians, Nagpaul’s father would work to save money to bring his wife and two children to Clapham in London.
They were not only the only non-white family on their street, but when he went to school, Nagpaul was the only person of colour. Growing up in a Britain which was hostile to non-white immigrants, the young Nagpaul faced racism and P*** bashing.
“There was the National Front that wanted Britain to be white. I remember one occasion where I was being chased by two skinheads and I remember just getting to the home, opening the door quickly with my key and banging it shut, and then panting with relief, that somehow, I had escaped, being attacked. That was the reality of the day.”
Nagpaul sees himself as a British-Indian, but he loves London, and after ‘A’ levels he won a place at the prestigious St Bartholomew's Hospital. Armed with a medical degree, Nagpaul decided he wanted to be a family doctor or GP. Yet, nine times he faced rejection without interview.
“I went to my GP tutor, and I said this is what's happened. He said, you know, it's your name, that's the problem. It hadn't even dawned on me that there could be a selection process that disadvantaged me because of my name.”
Once again, Nagpaul inability to accept defeat led him to do something few others in his position would do.
“What I did for the 10th application is I went to Charing Cross Hospital for the training scheme. I knocked on the door of the consultant who was the postgraduate tutor and responsible for shortlisting and I said you don't know me. I'm Dr. Chaand Nagpaul. I'm a junior doctor, but I want to be GP and train in your medical school. I want you to know who I am. Here's my CV. Please open the envelope, read it, because I really want to be a GP. And I was shortlisted, and I'm convinced that it was because he saw the face behind the name.”
Nagpaul remains passionate about the NHS, and he reminded the Power List that he could easily have left and set up in practice in America. Now that he is no longer chair of the BMA, he has returned to his GP practice of 33 years.
“I joined my practice the day I qualified as a GP, and I’ve been in the same practice since. I’ve overseen its expansion to over three times its original size, now serving nearly 17,000 patients, over three-quarters of whom come from ethnic minorities, mostly south Asian. It is a bespoke modern-day centre. We have a range of multi professional staff from pharmacists, physiotherapists, physician associate, dietician, mental health worker to advance nurse practitioners. We also have lots of culturally competent initiatives to support the multi-ethnic population including group consultations, such as for diabetics.”
Nagpaul and his wife, Meena, are now the senior partners at his centre. He told the Power List that the most difficult part of being BMA chair was being away from his practice, and he missed being a frontline GP. He has treated some of his patients for more than 30 years. As always, this level of responsibility is not enough, and this family doctor is involved in representing GPs in influencing the integrated care board to deliver positive change. Nagpaul, though, has never forgotten that he is here today because of others, and he paid tribute to those Asian doctors from overseas who mentored and helped him as he was training to be a doctor.
“I learned in my council chair the scale of suffering of ethnic minority doctors. Being the first ethnic minority council chair, suddenly for many ethnic minority doctors, they felt they had an avenue to communicate. So, even to the current day, I get communications from doctors, who say I know you're no longer chair of the BMA, but I need to tell you about what's going on in my hospital trust. My inbox was flooded from the day that I became BMA council chair from doctors telling me just what their experiences were and wanting me to help, which was one of the real drivers for why I did what I did as the BMA chair.”
