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GMC named as defendant in judicial review over MRCGP exam

The GMC has been dragged into the legal row over the MRCGP exam after a High Court judge ruled it was ‘arguable’ that the regulator had failed in its duties with regards to equality legislation.

Mrs Justice Patterson said that no equality assessment of the exam had been carried out by the GMC and - despite the regulator commissioning a major independent review by racism expert Professor Esmail - there was’ uncertainty in my mind’ about whether it had done enough since finding out about the differential rates.

The judge dismissed the argument that the GMC’s decision to approve the exam was taken in December 2010 – and therefore too long ago to be subject to a judicial review – and agreed that it was arguable that the GMC had an ongoing role in approving the exam.

However, Mrs Justice Patterson said that the GMC would not have to face allegations of direct or indirect discrimination. If it was guilty of this, she argued, then the correct forum to hear such cases would be employment appeals tribunals.

It was revealed in court that there are around 50 employment appeals on the issue ready to be heard. However, it is believed that these will not be heard until after the judicial review has concluded.

A previous hearing ruled that the GMC should be not a defendant in the judicial review being brought against the RCGP by the British Association of Physicians of Indian Origin.

But this ruling means that the GMC will have to defend its actions over the differential pass rates between UK and international medical graduates in a judicial review likely to be heard early in the new year.

The judicial review will look charges that the clinical skills examination component of the MRCGP directly or indirectly discriminates against international medical graduates. The date for the full judicial hearing has not yet been confirmed, but it will last three days.

Paul Philip, acting chief executive of the GMC, said: ‘We accept today’s decision by Mrs Justice Patterson to give limited permission to include the General Medical Council within the scope of the Judicial Review. This permission relates solely to public sector equality duty. We will look carefully at the Judge’s Order.

‘We will not be commenting further on this ahead of the hearing

‘We accept today’s decision by Mrs Justice Patterson to give limited permission to include the General Medical Council within the scope of the Judicial Review.

‘This permission relates solely to public sector equality duty. We will look carefully at the Judge’s Order. We will not be commenting further on this ahead of the hearing.’

Readers' comments (29)

  • Vinci Ho

    Please do not comment .
    There is a potential risk of contempt of court

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  • We hope that JR is before new year.

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  • This is perhaps overdue, but ultimately we are paying for all sides of this through membership fees. Since the GMC is now largely a lay-panel with medical representation in a minority, why do we have to pay fees? This isn't self regulation in any way or form - the funding for this should come out of general taxation.

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  • RCGP not responsible for the actors, GMC not accountable to the RCGP... finally accepting some decisions taken by the court. There should be a complete revamp of the exam system. Let this be the first nail in the CSA coffin.

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  • RCGP wrote today:

    "There are indeed differences in the pass rates between doctors who are from white ethnic backgrounds and those who are from minority ethnic backgrounds, particularly international medical graduates. These are differences that exist across many medical specialities and in higher education more generally."

    I wonder why are we (IMGs) are so successful in US? 99.9% IMGs trained in US are flourishing and very well respected. IMGs in UK and US are very much alike. So, is there something wrong in the chilly air of UK. Does it freeze the brains of ethnic minorities making them unintelligent. Or is there something systematically wrong elsewhere.

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  • RCGP also writes:
    "Our examination is in place because as a medical royal college, our principle responsibility is to the nation’s patients.
    It is our job to ensure that, through a fair process, all of the doctors who qualify as GPs meet the requisite standards for ensuring safe patient care. That is what the public expects of us, and that is what we deliver."

    Is there anyone who do not believe that patient safety is paramount. No one. But the context in which RCGP release these statements is certainly disappointing. In other words RCGP believes 70% doctors of a particular group are unsafe.

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  • I also wonder why so many doctors of ethnic background are referred to GMC. I will give the pulse readers a comparison to consider:

    Foreign born doctors represent 25 to 30 % of the state's practicing physicians in California. Following page mention the names of doctors disciplined by the state medical board -

    http://www.dir.ca.gov/dwc/medicalunit/DisciplineList.htm

    Look at the names and than look at the names of the disciplined doctors in the GMC website. For comparison, you can also look at the data of any of the 50 US states. Data speaks for itself.

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  • Agree. Ethnic minority doctors are much more likely to be referred to and be punished by GMC than any state in US. This issue also need a thorough review. I encourage GMC to seek an independent review on this matter also.

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  • GMC knew about the differential pass rate since 2010 which was affecting the IMGs but seem to have chosen to TURN THE BLIND EYE. Legitimate question is WHY?
    Would the GMC had raised concerned if the affected trainees were local graduates? We all can confidently predict the answer for the latter, can’t we? IS IT DISCRIMINATION?
    YOU WONDER THE REGULATOR IS TRULY INDEPENDENT AND FAIR IN IT'S ACTIONS ON WHO THEY REGULATE.IN OTHER WORDS, ARE THEY FIT FOR THE PURPOSE?
    If they had got it wrong, do they have the courage, integrity and openness to learn from the experience and put things right for the ones who are being affected?

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  • Why is the college so reluctant to record the exams ---- because it will be so blatantly obvious where the problem lies....the whole system favouring the local graduates in the name of patient safety. This country will
    never improve until it addresses it delusional equality views.

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  • Dr Gerada, in her interview this morning on BBC said that CSA is a "cultural exam"!!! which is contrary to the scoring sheet - as the marks are given for being able to gather info ex: patients reason for attendance/ideas to the nature of their complaint/ concerns/expectations/ and requirement to develop rapport/ to arrive at a joint management plan. Although there is a standard consultation model, which we are encouraged to follow- we are also encouraged to make it our own..
    Surely this is not a "cultural awareness exam" or did I train on a different planet? Missed it altogether.

    If it is a" cultural exam" then I wonder why the pass rate is not equal for British born/trained ethnic minority to white british! Although practices at home may vary, exposure in communal area/ education would presumably be same…hmmm thats food for thought.

    I welcome the judicial review..which is long awaited and reflects on institutional discrimination. If "comprehensive steps have been taken to ensure the exam is equitable and fair to all candidates" I don't understand the persistent difference in pass rates!!!!

    And sorry Dr Gerada but eventually many IMG's do not pass.

    I am sure we will hear all about it in the near future!

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  • This comment has been moderated.

  • Clare clean bowled!!

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  • Low morale and bleak future.. ..

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  • If the judicial review declares CSA illegal, will everyone have to re do it again?

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  • Everywhere you hear people saying we want " the best " I feel that they are implying the IMGs are unsafe. We should wait for the judicial review and if RCGP's view is upheld DOH should stop bringing any more IMGS or be highly highly selective.
    IMGs should not be let to Rot in the country waiting for a job for many months , tnagled in visa problems , financial difficulties. home office telling IMGs that you can be on VIsa but can not apply for training post ( stamp on their visa) come on this is not 1940's stop modern slavery.

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  • If you only replay Prof Esmail's interview in the High Court which he has given to BBC this morning, RCGP and GMC will both be clean bowled, let alone Clare Gerada.

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  • I agree with anonymous at 12.32 pm…
    Dr Gerada's opinion of "cultural exam" made me wonder as to reasons for recruiting an IMG into a profession meant for Doctors who are aware of local culture meaning white candidates! Coz Coloured Doctors, irrespective of their background and training will never learn the local culture!
    Question's which Dr Gerada and RCGP should be answering:
    1) Why do they think it's worth spending public fund in training IMG doctors when they have clear statistical data to support poor performance by an IMG, only to fail at the end of 3 to 4 years?
    2) Why do the RCGP claim to practice equality and diversity while contradicting this statement with their belief of an IMG ( or even coloured doctor of British origin) will not be culturally prepared for the exam!?

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  • It is worth knowing the information gathered by equality monitoring form of examiners by RCGP. RCGP should publish it to increase the confidence of people taking the CSA examination. Publishing such data does not mean RCGP is being accused of any bias. Please confirm our belief in British honesty. We still do not understand the reason of 1 examiner in each case. We know that triangulation decreases the bias.

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  • As I posted before:

    Once this is all over, we should all try to negate the negative stereotypes associated with many immigrant groups. Hidden bias and unconscious bias is the result of prejudice which is formed as early as childhood. There are studies which have shown that as early as age 3, children pick up racial prejudice without really understanding their significance. Bias is sustained by in-group attitudes and socialization by the culture at large. Everybody know this. Unfortunately UK is lagging far behind countries like US in this regard. In a hypothetical scenario: white examiner and white examinee: 1 extra mark per station. White examiner but Non white examinee: 1 less mark per station. Net result: big difference between pass rates. A small difference in each station's marks due to hidden bias and prejudice among the examiners can result in the oucome which we are unfortunately witnessing. The fact that white culture is dominant in UK may explain why non whites often do not show a strong bias favoring their own ethnic group.

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  • This institutional bias / discrimination is very disappointing - when i left my country to seek a better future to escape the same , it never crossed my mind it happens in this country.
    Now my life is in disarray being affected by csa.
    It appears next JR would be many months from now.
    Fask track JR should be done here as lives and livelihoods are being destroyed.

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