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Independents' Day

Whitewash in the ivory towers

Editor’s blog

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When I mention to white GPs that Pulse is doing an article on race in general practice, almost without fail they recount a tale of a black or minority ethnic colleague who has had patients tell them they want to be seen by the ‘English’ doctor or racially insult them.

This can be a daily occurrence – almost one in 10 BME GPs say it is. As ugly as this is, it is a societal issue; practices can remove patients but there is only so much the profession can do about the ingrained prejudice of the population.

But the problems faced by BME GPs run deeper. While the profession can’t change society, it can look at itself – and the inconvenient truth is that this might reveal a more subtle, but potentially more damaging, form of discrimination. At every stage of their career, BME doctors – even those born in the UK – face tougher hurdles than their white counterparts.

The reasons behind this are complex, and Pulse’s coverage here can only scratch the surface. But one issue many BME GPs have cited is the prevailing notion of ‘good’ general practice, often defined by people in so-called ivory towers.

We can start with more BME GPs at the top levels of regulatory bodies

Good general practice is, we are told, working in bigger groupings; yet BME groups say their members are more likely to be singlehanders.

Good general practice is supposedly about shared decision making with patients – yet BME leaders say they often practise in communities that prefer a ‘doctor knows best’ approach.

Good general practice is, in the CQC’s view at least, judged on caring for older people, those with long-term conditions or poor mental health and other vulnerable groups. But not populations who have English as a second language at best – which can be just as challenging.

Good general practice is, according to critics of the RCGP’s clinical skills assessment, measured by how well you care for well-educated, middle-class, mostly white actors. Yet BME doctors can struggle to get positions in the type of areas where such people live.

Clearly, these are not insurmountable hurdles for BME GPs, but they do exacerbate the differences. There are no easy answers. But there are two actions that, I believe, could bring an improvement.

First, let’s get more BME leaders at the top level of the bodies that set standards and regulate the profession. One GP told me of a ‘middle England insiders’ club’ atmosphere that made her feel she ‘didn’t belong’. This is just not on and no review will work while such situations persist.

The second solution is more radical but could benefit the whole profession: let’s broaden our definition of ‘good’ general practice to take into account the differing needs and expectations of our multicultural – and multifaceted – population.

Let’s acknowledge that sometimes bigger isn’t better, sometimes doctor does know best, and sometimes you don’t need to judge practices on a matrix of 30-odd ratings. Such moves could begin to erode institutional racism and other forms of discrimination, and allow GPs to work in the best interests of their own patients.

But failure to address these disparities will lead to accusations of a whitewash within the ivory towers.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at



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Readers' comments (3)

  • Vinci Ho

    Jaimie , you have my respect for your audacity and wisdom to spend so much article space for this subject on racial issues
    It is also an interesting time in history of this country .Brexit was a distraction and had generated all kinds of political uncertainties with a main theme of immigration. But more importantly, it also exposed the longexisting equivocation on defining the common cultural and ethical values of our country.
    If Grenfell Tower fiasco was about not treating ordinary people with dignity and respect , Windrush scandal was adding more weight with discrimination of ethnic minorities.
    The latter triggered the memory (at least , from historians) of Enoch Powell’s infamous ‘Rivers of Blood’ speech in 1968 when he quoted a middle-aged working man ;’a decent , ordinary fellow Englishman in his constituency’ ,that this country would not be worth living for his children because ,
    ‘’In this country in 15 or 20 years' time the black man will have the whip hand over the white man."
    Powell was probably proven wrong if he was trying to be prophetic about what this country would turn out to be . But the controversial issues he raised have not been responsibly dealt by politicians . They now become even more prominent as the reality is , according to the 2011 UK censuses:
    In 2011 the majority of the UK population described themselves as belonging to the White ethnic group (87 per cent or 55 million). The remaining 13 per cent (8.1 million) belonged to a minority ethnic group.
    So UK did not become a completely white country, nor being stormed and occupied by all ‘aliens’ , the reality requires an opening society for multiculturalism instead.But what had successive governments done?
    The current story of poor Amber is most extraordinary. The net consequence is we have now the first Home Secretary ,born from a Pakistan family , with a bus driver father . The irony for the far right elements in the Tory party is : he is perhaps a Neo-conservative but also from a Muslim family background. The Windrush stories undoubtedly would have an impact on him at personal level. Question is which way will he swing politically being the Home Secretary ? And remember he is a strong Remainer for EU and Brexit. This ‘hostile environment’ for immigrants will have to be ‘amended’. I think Sajid knows how crucial his role is, historically . Will he stick to his soul and conscience or else , be conquered by reality politics ? Very interesting time .
    Of course , the racial issues are not monopoly of one political party . The collapse of UKIP in the local elections this week was well predicted but Labour could have gained more councils if it was not for its own scandal on anti-semitism . The problem is clearly deep-seated and I cannot see any plausible way Uncle Corbyn could get himself and his party ‘out of jail’(at least , politically). As I wrote in the past , the demeanour of the political machinery behind him i.e. Momentum , had reminded me of Third International in the 1920s and 30s. Well , the history was there to read about how the Bolsheviks treated Jewish people. With the final results of the local elections , neither Tory or Labour could say they had a better upper hand of this current political deadlock.

    May be , Brexit after all , is a bit like the latest Avengers movie (highly recommended for fans,9.5/10!): finding the six ‘infinity stones’ : Power , Space , Time , Reality ,(but also), Mind and Soul.
    It is never about colour and race........

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  • you have opened a can of worms! well done Jamie, let us turn our organisations into true meritocracies and let us aim for excellence. there is no place for any form of discrimination and let General Practice in 2018 in the UK, lead the way.

    'O mankind! We created you from a single (pair) of a male and a female, and made you into nations and tribes, that ye may know each other (not that ye may despise (each other). Verily the most honoured of you in the sight of Allah is (he who is) the most righteous of you. And Allah has full knowledge and is well acquainted (with all things).'

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  • painfully true.. time we get it once and for all 29 march 2019 is right here and uk will no longer have flexibility of employing international doctors.. canada, nz, au all promising.

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