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Nerys Hairon asked GPs why more male, Asian and older GPs are being investigated for poor performance

Arrogant men, prejudiced patients and institutional racism. These are just three of the reasons given by GPs to explain why male, Asian and older doctors are much more likely to be referred for poor performance.

Whoever is right, the National Clinical Assessment Authority's breakdown of the cases it has handled since it was set up in 2001 has certainly stirred up a hornet's nest.

Some 86 per cent of GPs referred by PCTs were male, but men account for 61 per cent of all GPs. When Pulse revealed the figures last week they provoked strong responses from both sexes.

GPC member Dr Gillian Braunold says arrogance 'ten-ded to be more of a personality trait of male doctors' and this landed some in hot water when dealing with complaints.

Male GPs, not surprisingly, argue the reasons are far more complex.

Dr Gordon Baird, a GP in Sandhead, Wigtownshire, says Dr Braunold's views are 'a form of sexual stereotyping that is arrogance in itself'.

He adds: 'I think it's wrong to stereotype people's temperament on the basis of gender. There is no place for arrogance in medicine.'

Dr David Bevan, a GP in Upwell, Cambridgeshire, argues arrogance 'is a disease of the profession, not of each individual sex' and male and female doctors 'cloak' their arrogance in different ways.

Women GPs, he adds, may be better at smoothing over misunderstandings. 'There are both real and imagined differences in style between male and female doctors,' he says. 'That can lead to understandings being much more readily dissipated by women.'

His view is supported by Dr Aneez Esmail, who has carried out research on sex and race bias in the NHS. Dr Esmail, senior lecturer in general practice at the University of Manchester and a GP in the city, says there is evidence that women 'are better team players and more empathic'.

However, Dr Fay Wilson, a GP in Birmingham and chair of one of the GMC's fitness to practise committees, suggests women may be the beneficiaries of some 'institutional sexism' both within the NHS and from patients.

'People think of the nice

lady doctor,' she says, 'so they don't think of them as having performance problems.'

Although the NCAA's statistics provide a comprehensive breakdown of the gender, age and ethnicity of the doctors it has been asked to assess, it has not linked the three factors. Only by doing so, some GPs say, will a clear picture emerge.

Dr Sue Allan, professional executive committee chair of Ealing PCT and a GP in west London, points out that older GPs account for a high proportion of the referrals and a far higher proportion of older doctors are men.

'Younger doctors are better trained to deal with people. Older doctors are just trained to do the medical bit but not to address people's concerns. I was not trained so much in consultation techniques and interpersonal skills,' she says.

What about the proportion of Asian doctors referred? Some 38 per cent of cases since April 2003 have involved Asian or Asian British GPs, whereas all ethnic minority groups account for 25 per cent of GPs.

The British International Doctors Association says this is 'blatant institutional racism'.

Chair of the association Dr Shiv Pande, a GP in Liverpool, says: 'From anecdotal evidence the public does not treat ethnic minority doctors any differently. The racism is within the NHS.'

However, others feel the causes may be different.

Dr Esmail feels many Asian GPs work in poorly-resourced, inner-city practices and get 'scapegoated'. He adds: 'They are the poor partners of general practice.'

GPC negotiator Dr Peter Holden goes further. He says neither ethnicity or gender plays a part in referral levels. Workload is the key, he insists.

'It's down to how many hours a week you work in general practice. By and large males tend to be full-time and Asians tend to have bigger lists. The groups that are referred more work longer hours in the week,' he adds.

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