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