Making it to the Registers: Documenting Migrant Carers' Experiences of Registration and Fitness to Practise

Who gets to become and remain a professionalised healthcare worker in the UK? This question has become particularly salient given the endemic shortage of qualified healthcare workers in high-income countries with ageing populations. The current international make-up of the UK healthcare workforce is the result of several factors, one of which is the struggle over the gate-keeping functions of the health professions. More specifically, the regulatory tools of registration and fitness to practise (FtP), which relate to the skills, knowledge, health, and character that professionals must satisfy, play a key function in the construction of the modern, professionalised, diverse healthcare workforce. 'Making it to the Registers' zooms in to interrogating in-depth the lived dimensions of these two tools for global, migrant carers. The recent pandemic highlighted the reliance of UK healthcare on an international workforce, but the use of overseas-trained carers as flexible sources to adjust to the UK's spasmodic health workforce challenges is neither new nor exceptional. 'Making it to the Registers' will therefore focus on the evolution of these two requirements (registration and FtP) and build on historical literature by comparing the differentiated responses of statutory regulators to three 'crisis' situations: WWII, the 'oversupply' of foreign medical graduates in the 1960-70s, and the coronavirus pandemic. In some instances, regulators made it easier to expand the statutory registers to increase the availability of healthcare personnel while in other instances, regulators tightened requirements to make it more difficult to get onto the registers. Regulatory choices during periods of crisis have long lasting effects on the structure of the healthcare workforce; studying them in depth can therefore provide insights for the reform of professional regulation more broadly.
'Making it to the Registers' was conceived with BAPIO (British Association of Physicians of Indian Origin) an organisation with 25 years of experience in lobbying for and supporting migrant doctors and nurses from Asia and Europe to work professionally in the UK. BAPIO's work has been understandably reactive to regulatory policy changes and to the individual pressing needs of professionals, and this collaboration with 'Making it to the Registers' will enable reflecting back on its institutional history and assessing its impact on migrant workers to plan its future work.
This project will deploy together the disciplines and methods of history, legal studies, anthropology, sociology of diversity in health, and user-engagement activities, as well as the experience and expertise of our partner and other organisations. In Phase 1, we will use archival research methods to generate original knowledge about how the tools of registration and FtP for overseas-trained healthcare workers historically came to be promoted, enacted, modified, used, and documented by professional regulators and other institutional bodies. In Phase 2, the project will take stock of the themes emerging from the Phase 1 findings to investigate current experiences of migrant workers with regulatory systems. This will be done in conjunction with BAPIO via interviews and user-engagement activities. In Phase 3, we will show the project's wider applicability with the support of cultural institutions (Brotherton Special Collections, Leeds Playhouse, YARN, and Refugee Council). We will produce, share, and preserve, in a variety of accessible formats, original insights to enlarge academic, policy and public understandings of how regulatory tools of the professions get experienced by migrant healthcare workers and the activists that support them. This will be supported with a sharing event bringing together migrant healthcare workers, professional regulators and policymakers and media, a co-curated open access digital archive, and a political theatre project on the theme of UK's migrant healthcare workforce