Three years after the Merrison Committee submitted its final report, Parliament passed the 1978 Medical Act. In reference to the registration of overseas doctors, the provisions of the act reflected more continuity than change. The GMC's oversight of the register remained intact. The Medical Act's scheduled termination of reciprocity on December 1, 1980, came as no real surprise. The retraction of reciprocity from Pakistan in 1972 and the subsequent withdrawal of recognition of Indian medical qualifications a year later anticipated this provision of the legislation while underscoring the politically conditional relationship of overseas doctors to British medicine. The terms of access to the medical market were no more surprising. Overseas doctors were now required to pass the Professional and Linguistic Assessment Board (PLAB) examination, which replaced the TRAB examination. For those who passed the PLAB, the right to practice medicine was still subject to restrictions regarding length and place even after the category of temporary registration was replaced by the category of limited registration.

The act enhanced the authority of the GMC over registration even as the relationship of overseas doctors to British medicine became more contingent. After years of lobbying, the council now enjoyed discretionary power to specify the duration and clinical assignment for doctors who were admitted under limited registration. It was also empowered to grant full registration to those overseas doctors who satisfied the necessary medical qualifications and clinical experience. In sum, the act formalized what postwar British medicine had become: a globalized medical profession that was stratified between domestic and overseas graduates, one largely white and permanent and the other largely nonwhite and transient.

As I have argued in this book, the inequitable treatment of overseas doctors of color was not so much a historical accident of the postwar period but rather a result of the careful political management of the national and imperial boundaries that historically circumscribed British medicine. Since 1858, the medical register had fortified these boundaries, creating a space for the growth and consolidation of British medicine as a social institution. Admission to the register—a crucial step toward success in the British medical occupation—was tied to the possession of a medical qualification from designated university and nonuniversity licensing bodies in the United Kingdom.