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Independents' Day

There is racism in the NHS – and we need to address this

Dr Adwoa Danso on why general practice is not exempt from the Black Lives Matter campaign

‘Adwoa, what do you know about the negro population and the cultural association with smoking weed? Do your family do this? Why is it a cultural thing?’

These questions were posed to me by a senior GP partner during a morning tutorial with two GP registrars.

I was embarrassed and shocked. Most worryingly, I didn’t tell anyone. She was the most senior GP at the practice and I didn’t know who would listen, so I went home and cried. On securing a GP training job, I informed the foundation programme director. Their response? ‘She’s like that’.

This was my stark introduction into racism within the NHS. It is seen. it is heard. Brave individuals do speak up, but ultimately it is ignored.

Since then, this racism has become apparent to me all around. Whether that is having to make a petition for dermatological conditions on black and brown skin to be included in teaching material in medical school. Or finding out that more than one in four black African and Caribbean women experienced or witnessed racial harassment or bullying from managers in the last two years. Or the knowledge that black doctors are more likely to face disciplinary tribunals than white colleagues. Or that UK-educated black trainee CSA pass rates are 77% compared with 95% for white trainees We must do more.

And there are problems with representation. I am conscious of the ‘snowy peaks’ that tower over me. Like many other doctors, I know that the structures within the NHS have many barriers which hinder career progression.

This is evident within general practice - some may feel that the leadership is diverse, but it is not. Look at Pulse’s own Power 50 list. When I saw it for the first time, I was hoping to see a modern list that reflects the diversity within our specialty. It saddens me to think that only two of the 300 entries in the past six years have been black GPs, but this is unsurprising. How can a black, female, doctor like me really expect to be make any kind of list when we continue to be sidelined within the NHS?

I did manage to win one award. After three years of working as GP I was frustrated with the health inequalities that existed and how they negatively affected individuals’ health, particularly within marginalised groups. I set up a social media platform called ‘The Clinic Diaries’ to promote health and wellbeing mainly within these communities. In recognition of my work I was delighted to be awarded the ‘National BAME Health and Social Care Health and Wellbeing advocate of the year’.

But this award was unrelated to the NHS or the GP training programme – it is run by DiversityQ, a group that promotes diversity in all workplaces. As part of the award I am currently enrolled in a leadership programme and have an allocated mentor. But these awards are few and far between – how are other individuals in my situation going to get the same opportunities within the NHS?

Racism cannot go hand in hand with good leadership

There are a few voices speaking up. Professor Mayur Lakhani, the immediate past president and former chair of the RCGP, has long been aware of black GPs’ contribution to medicine and patient care. Last year he hosted a ‘President’s Listening Event’ black GPs with the aim to ‘better understand needs and promote opportunities for participation in the work of the RCGP’. With representatives from the GDDAUK (The Ghanaian Doctors Association UK), MANSAG (Medical Association of Nigerians Across Great Britain) and many more, it was well attended. Many spoke of similar challenges they faced, and it was strangely cathartic. I left feeling motivated and hopeful that change was on the horizon.

One way forward is to rethink the term ‘BAME’. This looks at categories as white and non-white. However, the differences between ethnicities is the key to understanding. BAME groups have been disproportionately affected by Covid-19, but black Africans were found to be the most at risk. The disparity between ethnic groups is proven but rarely highlighted. We saw similar with the MBRRACE-UK study; black women are five times more likely to die in child birth, Asian women twice as likely. Both very serious statistics – but there is a clear discrepancy between to the two groups. Genetics vary widely within the BAME group and even more so among black people. Grouping numerous ethnicities in to one group can be detrimental.

My local CCG is a prime example - its ‘Workforce Race Equality Standard 2018-2019’ stated that five people (33%) of their workforce were BME, which is ‘an overrepresentation of BME staff compared to the borough (12%)’. However, how many of those people were black? And would white doctors ever be described as an ‘overrepresentation’? The black and brown experience is different, we must be mindful and aware that representation should be representative of everyone.

The Black Lives Matter campaign, which has highlighted many unspeakable racist acts in the US and here, has seen many large brands stand in solidarity with black people, and expressed desires to be more transparent and diversify the workforce. I would relish the opportunity of positions of added responsibility. After many years of wanting a seat at the table, is it finally happening – or is it just tokenism? I can’t help but question this seemingly knee jerk response.

In the NHS, it is not the responsibility of black medics to make themselves heard, but for our colleagues to understand the unique hardships we face and be allies to dismantle the institutional racism that exists. Racism cannot go hand in hand with good leadership. There is evidence that a diverse workforce in which ALL members are valued is linked to patient care. Achieving this must be a priority.

Dr Adwoa Danso is a locum GP in Essex and east London, resident doctor on GN Radio UK and an executive at the Ghanaian Doctors and Dentists Association UK

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Readers' comments (22)

  • Flabbergasted by the question asked of a GP Registrar by a GP partner who should know better. In fact anyone with an ounce of common sense should know that the question is inappropriate. I was a GP in Edinburgh and have now been an emergency physician for many years in Edinburgh and latterly Leeds. The “culture” I have come across is most certainly not being black for want of a better phrase. Anyway who decided that being black was indeed a cultural matter or a choice? Ridiculous.

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  • Took Early Retirement

    The worst racism is actually at the GMC.

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  • Trying to understand who is responsible for racism and how it has come about I decided to read 'How to be an antiracist'by Ibram X Kendi. The concepts that this doctor talks about in this article are discussed. Its not for BAME doctors to fight racism, its all of us, all the time in whatever way we can.
    I would recomend the book and BTW, BAME is such an uncomnfortableacronym, if someone can think of anything better, that would be great!

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  • It is endemic...we all know it. All minorities. And in many scenarios 'they' are the majority. But, 'they' should be we and black should be us. History can fuse to indoctrination and the subconscious. The fabric of life and what it is to be human has not even been touched, even in our profession of 'medicine'. It is all tragedy. Do not look to the elite and well-set for answers...GMCs Dame Marx delivered an email this is often sweet, apathetic, generic wording backed by a mere 'document' or 'enquiry' that sits gathering dust and fills the 'powerful' with a sense of doing - money and ego sadly irons out the turmoil and discrimination globally of true life. The elite have set certain humans up to fail.

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  • Racism from blacks towards others occurs too.
    It is who you are inside, not your skin-colour that matters. Everyone should be taught that education, working hard and living with respect for all others is the important thing in this world. Britain is a very open and tolerant country compared to many countries. Blaming today's whites for black-slavery centuries ago
    is wrong, as slavery is too, of course. I think having separate BAME groups is a recipe for increasing division and non-integration in many cases. Do not make others feel like victims.
    Respect for all, hard work and education needs to be the recipe for living, for all races.

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  • I know it’s probably a futile thought but I just wish we could all treat each other equally with tolerance and respect as individual members of the species Homo Sapiens

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  • The writer could have enlightened the ignorant GP by informing her that cannabis reached the West Indies in the 1850s by indentured servants moving from the Indian sub-continent taken there by..... their British masters.

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  • its career 'suppression'for constantly hear statements like, 'it's how the system works'. During my GP training I did an audit and my clinical supervisor would not allow me to present it,even though I did all data collection and analysis. I had been paired with another Gp Trainee who was on annual leave
    this entire time.Clinical supervisor's reasons of refusal was; 'Not you, Jenny (not her real name) will present the audit, she has a better accent! I didn't fight because my appraisal was due in 2 weeks before the end of placement. Of course Jenny took the credit as the lead and l was left with a lump in the throat!!

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  • Let us just not get lost I tokenism. It is not only NHS that needs to change we as BAME Doctors need to look at attitudes and also GMC needs to change. GMC has spoken about racism for in excess of 10 years but I have yet to see significant change.

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  • I am still very perturbed that this issue exists on a more overt basis. At the beginning of my career it was very common to hear this kind of talk in the "canteen culture "of discourse between health professionals. I am talking about the 90s.

    I did quite a lot of work with respect to this back then. I am not sure of the timing of the horrifying comments that the author of this piece presents.

    However, there has been a much bigger challenge which is intrinsic to the institutions that represent and govern us.

    Given recent events at the GMC where a BAME doctor was thrown to the wolves, I practically soiled myself laughing when I received an email from the GMC talking about what actions they were going to take to address the issue of racism in the profession.

    The crude and unsophisticated overt racism, is disappearing probably because of new cultural norms. However, the bigger challenge will remain holding our institutions to account.

    To do this, however tedious colleagues think this might be, continued to fill out all those diversity questionnaires that appear after all sorts of interactions that they do.

    Whilst I appreciate that everybody seems to scratch their backside when the results of these kinds of analyses come out, they do offer a barometer of what is actually going on with respect to racism within the profession.

    The article above has in fact quoted some of this data.

    Only by having this can we challenge the perception that most of these issues of race and diversity have been expunged from our profession.

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