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Independents' Day

Does the NHS have a problem with BME doctors?

Editor's blog

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I thought long and hard before writing this editorial. As a white man, I didn’t feel adequately qualified to comment. But as a journalist, I saw it as my duty to address the subtext of a lot of the discussions around the case of Dr Hadiza Bawa-Garba.

Because sadly in today’s Britain, race still matters.

Ethnic minorities are under-represented at senior levels across the public sector in the UK; they are more likely to be excluded at school and subsequently unemployed. Race hate crimes are rising. But how does this affect the health service?

Well, BME staff working in the NHS are more likely than their white colleagues to report being bullied or harassed and to experience discrimination. In 86% of acute trusts a higher percentage of BME staff do not believe their organisation offers them equal opportunities for career progression.

Among BME doctors I speak to the perception persists of a system blind to – or unwilling to address – its own prejudices

BME doctors make up 18% of UK-trained consultants and 31% of UK-trained GPs. But of the nine doctors who have been convicted for gross negligence manslaughter since 2004, seven have been BME. No white doctor has been convicted for more than a decade.

UK-trained BME GPs are nearly twice as likely to face a GMC sanction or warning, compared with their white counterparts – and then there are the well-publicised differential pass rates for the GP entrance exam. These are wider than ever recorded and, as with GMC sanction rates, perplexingly still exist between white and BME trainees qualifying in the UK.

Of course, all these discrepancies can be explained away. The GMC says BME doctors are more likely to attract complaints in the first place and more likely to face a complaint from their employer (and so be investigated).

And the RCGP has a High Court ruling to back up its assertion that its exam is fair. But the judge also told the college to redouble efforts to address the differential pass rates; it is adamant that it is doing so, but four years on shouldn’t we be seeing evidence that those efforts are working?

Among BME doctors I speak to the perception persists of a system blind to – or unwilling to address – its own prejudices. Indeed, the international doctors’ group BAPIO believes the ‘pursuit’ of Dr Bawa-Garba ‘reflects the inherent bias’ within the GMC – although chief executive Charlie Massey said the accusation was ‘troubling and without merit’.

But you have to wonder if the constant references to Dr Bawa-Garba’s ‘native Nigeria’ and tabloid images of her in a headscarf – often contrasted with the small white boy who died under her care – influenced the GMC’s decision to crack down on her so hard.

We have to be careful not to seek convenient answers to such a complicated set of events. Jack Adcock’s family and the wider health service deserve answers about how such tragedies can be averted in future. But equally, we should not be afraid to ask whether the doctor’s ethnicity was a factor. Would the GMC and the courts have acted as they did if she were white?

I once read that ‘to be human is to be prejudiced’ and the main thing is to accept it and seek to act fairly. As well as asking this of ourselves, we should demand our institutions do the same, and be seen to do so.

Nigel Praities is editor of Pulse. Follow him on Twitter @nigelpraities. Thanks to Professor Aneez Esmail for his help with this editorial.

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Readers' comments (29)

  • Very brave and fair Nigel.

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  • Macaque

    Cheers Nigel!

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  • Very good article. Good journalism.

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  • medicine tastes awful

    Brave and focused.

    There is evidence of racial bias in this sector as much as in other public services such as education. The NHS has a well over representation of BME staffing that is under represented in the hierarchy of regulatory bodies, senior influential key levels and top managerial levels. The public and service users do have racial bias or distorted belief of the BME healthcare personnel. I am sure a lot of BME healthcare professionals has experienced this in their careers and the evidence is clear.
    This is a wake up call for all BME staff without whom the NHS would be dead.

    This is wake up call for you Mr Hunt, (We know He loves his sleep!)

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  • Racial discrimination is a strange phenomenon. ‘Race’ is a novel concept originating from the slavery era which is actually an ethnic issue as the gene pool in the caucasians and Africans are virtually the same (Ha!).

    It’s the stories that come with the varying levels of melanin pigment and how that is interpreted in different parts of the world that influences the bias coming into play. This has and will transcend generations and exist in Britain due to its imperial past and the genetic arrogance that sadly exudes in its ‘collective tribal behaviour’ (football hooliganism prime example) despite thousands existing still within it who have become educated, enlightened and rendered virtually colour blind.

    However, infuriatingly the current trend to legally back this bias by various statutory bodies through court is a mode of establishing sanctity to practice it as an endemic disorder.

    Sadly, much talent, power, ability, leadership and opportunity goes wasted unnoticed, marginalised and wilfully ignored.. (tell us about it!)

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  • Thank you Nigel for the article.

    Specific to HBG case, there is striking omission from GMC'S part. GMC allowed the consultant on that day to go scot free. The consultant who chose teaching over patients. A consultant who threw his registrar under the bus when s**t appeared to hit the fan.

    What happened to traditional - "buck stops with the consultant".

    GMC's justification is - he is Irish whereas funnily they just punished an Irish doctor in a different case very recently.

    GMC suggests doctors to acknowledge their mistake and apologise but when it comes to itself, it is using every possible excuse in the book.

    I am sure if GMC was facing their own panel, it would have got the most severe punishment got "lack of insight"

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  • doctordog.

    Are we sure this is about amount of skin melanin, and not culture and ideology?

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  • Excellent article

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  • Nigel, this article needed to be written. An emotive subject best addressed by providing the evidence and asking questions which is what you did.

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  • Vinci Ho

    I wrote this in the past and will stand by this:
    If our society allows our difference and dispute to ferment into division and prejudice, arrogance and bigotry will act as catalysts for taking adverserial actions(or inactions) against each other.
    Nigel , good work.

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