Is the NHS institutionally racist?
The explanation for the disproportionate number of black and minority ethnic (BAME) doctors being referred to the General Medical Council (GMC) for fitness to practise concerns may be the result of poor induction, inadequate support, and unhelpful feedback, according to a recent GMC report.
Between 2012 and 2017, 1.1% of BAME doctors were referred to the GMC compared with 0.5% of white doctors. Doctors who qualified outside the UK are 2.5 times more likely to be referred to the GMC compared with UK graduates (1.2% compared with 0.5%).
The ‘Fair to Refer’ report is based on interviews and focus groups, with 262 people including GPs, locums, specialty and associate specialist doctors, and consultants from different ethnic backgrounds – including a mixture of those from overseas and the UK.
The report, commissioned by the GMC, found a combination of factors could explain the disproportionate referrals of BAME doctors. Some doctors who are new to the UK or the NHS have inadequate induction or lack support when they first arrive. Another problem is that BAME doctors – whether new to the NHS or not – do not always get effective, honest, or timely feedback which could have helped to prevent subsequent problems. The report says some clinical and non-clinical managers avoid or defer difficult conversations, particularly if they are of a different ethnic group to the doctor.
The report also says that some working and contractual patterns leave doctors isolated, meaning they lack exposure to learning experiences and resources. In addition, some groups of doctors are treated as ‘outsiders’, which creates barriers to opportunities and makes them less favoured than ‘insiders’ who experience greater privileges and support.
The report also says that some organisations have a culture that looks to find an individual to blame when something goes wrong, rather than investigating the system in which he or she works, or trying to learn from the mistake so it doesn’t happen again.
Charlie Massey, Chief Executive of the GMC, said: ‘We want to avoid doctors being referred to us for problems that can be resolved earlier locally. We want patients to get the best possible care, which is best delivered by doctors working in supportive and inclusive surroundings.’
The report makes four key recommendations:
- Improve support for doctors new to the UK or the NHS, or whose role is likely to isolate them;
- Ensure engaged and positive leadership more consistently across the NHS;
- Create working environments that focus on learning, rather than blame, when something goes wrong;
- Develop UK-wide mechanisms to ensure delivery of these recommendations.
What are your views? Do you believe that there are significant elements of institutional racism embedded within the NHS? If so then what should be done?