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Is the NHS institutionally racist?

Organisations such as the police and local authorities have found themselves rocked in the past by allegations of institutionalised racism. But for a profession where so many of those on the front line are from ethnic minority backgrounds, the issue could be even more explosive when it comes to doctors.

By Gareth Iacobucci

Organisations such as the police and local authorities have found themselves rocked in the past by allegations of institutionalised racism. But for a profession where so many of those on the front line are from ethnic minority backgrounds, the issue could be even more explosive when it comes to doctors.

It probably explains why the GMC is treading so carefully with the launch of a major survey of ethnicity in the ranks of UK doctors, incredibly the first of its kind.

The issue of why so many foreign-trained GPs are the subject of complaints from institutional sources, such as PCTs and other NHS employers or the police – the very complaints that tend to be the most career-threatening – remains an unsolved mystery.

Of 54 doctors struck off last year, nearly two-thirds had trained outside the UK. Nearly a third of complaints against them came from other health professionals, a far higher percentage than those made by such bodies against UK-trained doctors.

The GMC says it wants to find out why international medical graduates and doctors from black and minority ethnic backgrounds are subject to complaints, and how these complaints are being handled by public bodies.

That mission statement potentially makes it of enormous consequence not only to those who qualified abroad but also to the thousands of ethnic minority GPs trained in the UK.

As Dr Edwin Borman, chair of GMC's committee on diversity and equality and chair of the BMA's international committee, puts it: ‘Clearly something is going on there that we need to know more about.'

Disproportionate

He adds: ‘Disproportionate numbers of doctors who qualified from abroad and come from an ethnic minority are appearing before the GMC.

‘Now, it may well be that they have very good reasons for that, and obviously the GMC has to take seriously any complaint in terms of a referral, but we do know in some situations there is evidence that shows unfair and inappropriate discrimination can occur.'

Dr Borman admits it is ‘extraordinary' that the GMC does not already possess comprehensive ethnicity data, although it has been collecting details from those on its register since 2004.

Dr Shiv Pande, a former treasurer of the GMC who sits on its fitness-to-practise panel, says racism is present ‘in every society' and that more accurate data will allow it to be investigated as a possible reason for the overrepresentation at disciplinary hearings.

‘If there's any clinical incompetency then no doctor should ever be able to practise, but you should not be stopped because you are white or brown,' he says.

Dr Prasad Rao, chair of the British International Doctors Association, says he fears some ethnic minority doctors have become ‘scapegoats' for PCTs.

‘Whenever I go to any town as BIDA chair, a lot of times the phrase they use is "they're all ganging up" against international doctors.

‘Whether "they" means PCTs or clinical directors, and a few others in the hospital sector, there is a perception that as international graduates, the institutions are mostly made up of British qualified white doctors. We're not sure but we feel the system is against us sometimes.'

He adds: ‘The GMC doesn't have the data to tell us. I have two sons, brought up as British. I would find it totally unacceptable if the research would find out even they are being discriminated against. This research certainly needs to look at it and wipe out any potential institutional racism in the GMC or NHS bodies.'

Dr Ravi Mene, a GP in Manchester and secretary of Salford LMC, believes ‘misunderstanding of cultural differences' and communication difficulties could explain the number of overseas-trained doctors at GMC hearings.

‘I'm not saying they need to protect bad doctors but we need to find out why this was happening in the past and how it can be avoided in the future. Then hopefully it will disappear in the next 10-15 years,' he says.

Yet collecting ethnicity data alone will not conquer racism, or eliminate bad doctors. Dr Chaand Nagpaul, a GP in Stanmore, Middlesex, and GPC negotiator, says it is what is done after the statistics have been collected that matters.

‘We know that disciplinary proceedings decisions seem to be weighted against doctors from certain ethnic groups. It is important to first be armed with information, but I think it's important that the GMC take the time to explain how this data will be used in the next step.'

The GMC has all the potential to open a massive can of worms with its study, which is not only overdue but unpredictable in terms of where it will lead.

Which perhaps explains why the GMC is being so careful over its use of the ‘r' word.

giacobucci@cmpmedica.com

Do the facts back up racism claims?

• Of more than 5,000 cases to go before the GMC in 2006, more than 300 culminated in fitness-to-practise hearings
• Of the total number of cases, 15% were made from
so-called People Acting in Public Capacity (PAPC) – a group that includes PCTs and other NHS sources and the police – with 85% coming from members of the public
• However, almost 30% of referrals of international medical graduates came from PAPCs
• Of 54 doctors struck off last year, nearly two-thirds trained outside the UK

‘You should not be stopped from practising because you are white or brown'

Dr Shiv Pande quote

Dr Shiv Pande

Dr Prasad Rao: GMC needs to wipe out potential institutionalised racism Dr Prasad Rao: GMC needs to wipe out potential institutionalised racism

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