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Independents' Day

GMC not to blame for greater likelihood of sanctions among UK ethnic minority GPs, says report

The GMC’s fitness-to-practise process does not discriminate against ethnic minorities, an independent report has concluded.

The study by Plymouth University researchers found no evidence of ‘unfairness or inconsistency’ towards characteristics – including age, health and ethnicity – in the GMC’s processes.

The review was commissioned by the GMC after figures – revealed by Pulse – showed black and minority ethnic doctors were twice as likely to face GMC sanctions, compared with white UK medical graduates.

However, the researchers were not able to pinpoint the direct cause for why BME doctors are 30% more likely to be referred for FTP proceedings in the first place.

The Review of decision-making in the General Medical Council’s Fitness to Practise procedures, which looked at the wording and criteria of GMC decision-making guidance, interviewed staff involved in the fitness-to-practise process and reviewed 187 randomly sampled cases, said: ‘No evidence of bias or discriminatory practices was identified, either in the GMC’s guidance and criteria documentation for decision makers, or the sampled case files.

‘Whilst some parts of the guidance and criteria documentation do reference specific doctor characteristics, notably the doctor’s stage of career, their health and their cultural background, these references are either in the context of discussing factors which could genuinely impact upon a doctor’s fitness to practise or on ensuring that doctors are not disadvantaged within the FTP system.’

However, the report was not completely without criticism of the GMC, which it said could provide more clarity on the reasoning behind outcomes in some cases.

It said: ‘The findings also point to a need for greater clarity and transparency. In some instances, though the outcome decision appeared appropriate for the circumstances of the case, the rationale for it was incomplete or unclear.’

GMC chief executive Niall Dickson said: ‘We commissioned this research to make sure our decision-making is fair and consistent and to see what lessons we could learn to improve our procedures. Independent evaluation is essential to ensure that we remain effective and fair.

‘While the findings of this report have been positive, we accept that this will always be a controversial and sensitive area and we know there is more we can do.

He added: ‘We are also continuing our work to understand better the reasons that some groups of doctors are over-represented in our procedures, and especially why some groups of doctors are more likely to be referred by their employers.’

The GMC has been working on an image problem with BME doctors after a 2014 study found that 60% of BME and non-UK qualified doctors were under the impression that the FTP process is unfair to doctors in these groups.

In January, the GMC announced that it was to make the FTP panel more independent from investigative teams in a bid to further improve confidence among doctors.

Readers' comments (26)

  • FFS...the whole thing is a farce. The wording of their letters is awful for doctors. Guilty until proven innocent with no chance of redress. If you are found guilty and you challenge the decision, your are punished more for not having "insight". They expect you to just take what they feel is right with no course to redress. I thought we lived in country with civil laws and guilty until proven innocent with a right to appeal without discrimination? or is that just for real criminals like murderers and shipman?

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  • Plymouth University in August 2014 were instructed by Hefce to carry out an independent external review of its own governance arrangements. Plymouth University should get its own house in order before conducting a review of another organisation, namely the GMC.

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  • GMC=not fit for purpose and over inflated ego. Needs disbanding.

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  • Una Coales. Retired NHS GP.

    The exodus of UK black and ethnic minority GPs and IMGs continues to Australia, New Zealand and Canada, while the GMC and other UK Establishment institutions refuse to acknowledge subconscious bias or test their FTP panelists or examiners and actors for unconscious bias.

    Correction white UK GPs are also emigrating too. In fact most if not all grassroots GPs are fed up with this NHS culture of fear!

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  • Plymouth and university in one word is that a joke?

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  • [Comment deleted]

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  • This is rubbish. The GMC and the whole of the uk medical establishment is institutionally prejudiced.
    They still are unable after many studies to determine why BME doctors are 30% more likely to be referred to fitness to practice panels. The word is out that the UK has a glass ceiling if your from abroad or have the wrong skin colour or accent. Doctors from the rest of the world are better off trying to practice in the USA, where your skills do the talking. Forget Britain!! ITS THE THIRD WORLD OF THE WEST, a has been empire. ( this coming from a uk born bred and educated doctor who left)

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  • @ above
    If you honestly think that USA is better than the UK in terms of racism you have alot to learn:

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  • @ above India is changing it's medical system of teaching from a uk style training to that of the US. North Indian trainees are shunning the uk and trying for USMLES instead. I'm sure the poster above was referring to the perception of trainees from overseas in the USA compared to that in Britain. America has a long history of welcoming talent from all over the world - hence the high number of indians/ south Asians who work as CEO's, university deans, tech entrepreneurs and a huge number of south asian medical graduates who hold prestigious positions as hospital leads, surgeon generals etc. Uk however uses these very same people in trust grade/ staff grade / associate specialist posts and had done for decades. The comparison with the murderous racist police in the Deep South is a mere distraction here I'm afraid!

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  • We hear this all the time from every institution in the country and Plymouth University is no exception. Its the same old denial. All the BME and FMG doctors have had a huge uphill struggle to get to where they have been allowed to. Its in spite of these institutions and not because of them that these humans have achieved. There are always no specific reasons admitted for this raw deal. The bottom line is - No reason could be found but THERE DEFINITELY IS NO DISCRIMINATION ??? (How come you are so sure about the exoneration). Subconscious bias is actually Discrimination. Its how a person or an institution inherently feels. There are certainly a few good people but it takes a lot more than that to make an Institution.

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  • Who commissioned the report?.the GMC itself?

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  • Vinci Ho

    (1) The interpretation of this report needs to be more prudent . Whether or not the FTP proceedings were not racially discriminatory and current FTP mechanism was fit for purpose , are two distinctive arguments. To conclude after studying 187 'randomised' samples might not gain the credibility GMC set out to acquire yet .
    (2) The fact the 'independent' study was commissioned by GMC itself still raised people's eyebrows . The reality of the lesson learnt from the controversy over CSA of MRCGP examination ,however , is that a proper challenge can only be endorsed if an organisation is to take GMC to a judicial review . Ecen so , the verdict is likely in the league of ' unconscious bias'. But at least there is a 'diagnosis'.
    (3) Whether current FTP proceedings are fit for purpose or not is the bigger picture. Clearly this study has not vindicated GMC as over hundred of doctors died during the proceedings and sanctions. Presumed guilty attitude was not only against human rights and spirit of Common Law , but also precipitated the examples of miscarriage of justice and procedural injustice .
    (4) The only thing I agree so far is GMC has hell a lot more to do to regain its credibility........

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  • Agreed. This was presumably a GMC commissioned response to previous reports and unfortunately has not explained or proved anything given the flawed methodology. Additionally there is no involvement of all stakeholders involved so without agreed conclusions, there is no basis for building working relationships or trust. As a PR exercise it has therefore also backfired but given Farage's and other comments may well show the way the political wind is blowing. It won't help the NHS.

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  • When exposing tyranny does one rely on the testimony of the victimisers? This is nothing more than a whitewash commissioned by the GMC to make them feel good about themselves and carry on with business as usual. A similar mind set to many organisations in the uk ( the met, the political establishment etc)

    Anecdotally speaking with many doctors from the subcontinent over the years and their children who have gone on to become doctors it's obvious that there is an inherent prejudice within the profession although I might add it has certainly become less poisonous over the years. Speaking with some south asian doctors in England who are due to retire shortly and some some of whom have recently retired I hear the same tales claiming they were told they would never make consultant, were told back then to go into inner city general practice etc. Some of these doctors were trained here whilst others who had come from abroad as surgeons etc were told they had no future as surgeons in uk and were required to become GPs!!
    Has it got better, absolutely. You cannot get away nowadays with telling a BME doctor his/her skin colour will preclude him/ her from a job. Also it's very difficult at present because of the high number of BME doctors gaining places in uk medical schools and the heavy reliance upon foreign graduates to keep the NHS in working order.
    However it seems obvious to those on the receiving end of discrimination that something is wrong. There is no satisfactory explanation as to why if you have black brown or yellow skin or if you are from abroad that you are 30% ( a HUGE disproportion) more likely to be referred to a FTP hearing. Why are BMEs more likely to receive complaints and be struck off than their white uk colleagues????? It's appalling that after decades this issue still has not been addressed. It took a judicial review to change the mind set of the RCGP recently whereby in a similar manner to most organisation a they denied any issues were present and obfuscated. Still to this day after a judge stated they needed to address the huge disparity in pass rates they refuse to install video cameras in the exam rooms- something that would have solved this issue from day 1 without dragging the colleges name into disrepute and making it a worldwide laughing stock. The GMC has the same reputation amongst foreign graduates and it is also becoming contemptible in the eyes of many British born and trained doctors for its heavy handed approach and manner in which it conducts itself.

    The narrative here will eventually have to change. The simple fact is that the demographic within uk society is changing and more and more BME doctors will be required and as time goes on won't accept these duplicitous findings and will challenge them.

    Also id like to respond to an earlier poster who posted a link about racist incidents amongst US police when challenging a post stating that the US medical system was more open and fair towards international graduates. I think this was a ridiculous analogy to use particularly since police forces in the uk ( met) have been proven during recent times to have been institutionally racist and also there are many instances in England where black men have died in custody after restraint and no one has been held accountable. This is still a hugely controversial issue and racism within police forces led to riots in England as recently as 2011.

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  • The horse has already bolted.
    Word has got out.
    Look around, where are all the shortages. They are in specialities that for half a century have been filled by IMG's.
    The truth is that the training promised to IMG's does not happen. They have been parked in 'staff grade' posts in hospital. Many general practitioners who are IMG's became GP's because they were shamefully discriminated against in hospital.
    Well they realise it is likely they will become staff grades not consultants (often because they have too much experience for training!!). They realise that there is a very good chance they will not become GPs because of CSA. They also realise that they are much more likely to have their careers ruined because of findings against them by the GMC.
    Of course none of this is because of racism.
    Not racist that the staff grade job was invented to provide consultant level cover for a fraction of the cost by (mostly) IMGs.
    Not racist that they are significantly less likely to pass the CSA.
    Not racist they are significantly more likely to have their career ripped from them by the GMC.

    Well because of the lack of racism IMGs are going to stop coming. They will also leave here much quicker. If somebody comes from India the trip home from London or Sydney has little difference.
    We, the GMC the RCGP & BMA have witnessed the disgraceful way that IMG's have been treated for decades. As general practice walks firmly towards the cliff edge it will be interesting for all of us to reflect what contribution this has made to our speciality. I suspect this is a reflection that will not happen and we will all reassure ourselves that everyone has been treated incredibly fairly and we have in no way contributed to the demise of the UK medical service. (This of course is always the outcome for those guilty of cognitive bias.)

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  • I've had fair treatment from the GMC although there have been some real anxious moments as processes take a lifetime. Can't say that about NHSE.
    Discrimination! No wonder the Practices next door were paid 120- 130 pounds per patient according to recent published data while I sit here on weekends catching up with work working for 91.68.
    (BTW it's a gloomy Sunday today and so easier to sit in the Surgery - last evening I spent about 5 hours today should manage in 2 so life seems bearable)
    But try to utter the word and you have all NHSE bosses immediately reacting demanding an apology. One thing I don't understand is - whether the discrimination in my case is actually pointed at me? No, it mainly affects my patients both white British and BME.
    When they register with a neighbouring practice, NHSE pays for their care anything from above 120 pounds per year ( according to published data) - with Marlowe Park Medical Centre the payment ins 91.68 -With me, they are lesser citizens of this country and their GP is actually being slave driven in this 'modern' society. A lot of them find this disturbing, but I make sure of explaining this to them because people should know - In this part of Strood, a deprived community is being targeted by NHSE because they probably don't like the GP - or maybe his colour. The explanation has always been - 'Payments are 'historical' but then who writes history??

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  • Respect Sanjeev for speaking truth to ..'power' or some other more appropriate word...and for informing the people registered with you just how the system 'works' for the surgery up the road in a posh area?

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  • As someone who has travelled through the indian subcontinent i can say with great pride that the dogs in Great Britain are treated better than the human beings in your native lands.If we Brits are really that bad then please spare us the hypocrisy of your comments and go somewhere better!

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  • @5:04- the Surgery'up the road' is one of the real posh areas and we also have a Surgery called a @village Surgery' which is paid 'rent reimbursement to the tune fo 189k per year - rurality that is suppose to be. The problem is how do you explain a Practice with more than 10000 patients being classified as 'Rural'.
    This is where the 'formula' is an evident manipulation and lack of transparency creeps in. How many pseudo rural Practices do we have and did the concocters of the 'Formula' think what they meant when they coined the term 'Rurality'. In Medway we have some extreme examples but I bet there are some in every part of England.

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  • @11:42- Please don't it take it to heart- nothing personal against Brits- infact, you may have noted that I mentioned that my white British patients are also being discriminated against. I know it is a sensitive subject but we do need to highlight things so things change. As I said, this country took a great step in abolishing slavery - without the British initiative, it would not have been possible. Therefore, I am loathe to accept an argument by NHSE that one Pratice is underpaid because 'It is historical' If indeed it is, then this history needs to be re-written. It isn't historical btw because on year ending 2011 the payments for a list size of 3100 were 311k and year ending 2014 with a list size of 4000 they were lesser.

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  • The Plymouth report was cynical manipulation of research, something the GMC has form on. this time it was all about restricting the research by setting the research question(s). The bulk of the research/report is about whether the Stasi staffers at the GMC were compliant with GMC guidelines, and surprise surprise they were. No doubt similar research into the other Stasi when it existed would have come to the same conclusions. But compliant with guidance (orders) is not necessarily the same as fair.

    The report also confirms by the bye how far lawyers have infested the GMC. Only lawyers are trusted to write the particulars letters, hence the tone. Once upon a time, lawyers were mere vermin, out to damage you and your property, and eat your money. Now we see they are pollutants, like DDT. They get into the system, and poison it from within.

    Dr No
    Retired Doctor

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  • why do BMEs and FMG doctors want to come to this country in the first place.there is no pot of gold at the end of the rainbow.

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  • It's not the pot of's because of the rainbow itself - a wonderful multicultural society one can value and enjoy..

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  • Cases of suspected abuse by the GMC must be reported to the state’s Adult Protective Services agency. If physical harm has occurred, consider reporting to local law enforcement for investigation.

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  • you anonymous sniping brits, whatever your view on FMGs, this disrespect of doctors amounts to slander, stalking and hate crime in the realm of pimping. This only makes you Brits look extremely stupid.

    Brit GP Pa-rtner your utterances are so imbecile, your illustrious predecessor,William C. Durant
    GMC, Founder, must be spinning in his resting place

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  • I sincerely request GMC not to waste doctors hard earned money on conducting such research which has absolutely no meaning.

    1. Once doctors are referred to MPTS the decisions are right in vast majority of cases but not all. BAPIO and BIDA have given some such cases to GMC.

    2. It is only small number of cases which are referred to MPTS. But nearly 2000 doctors are investigated for a year or so only to conclude there is no case to answer. Many of these doctors are good doctors and go through really a prolonged often psychologically, physically and emotionally damaging investigation. GMC has to deal with these doctors much better. Most of these doctors are permanently damaged by their experience.

    3. GMC can only be a reactive organisation and can only deal with doctors who are referred to them. It is difficult to do a study of those doctors who should be referred but are not referred to GMC! NHS is very well known for discrimination, club culture, old boys' network and racism. There are many anecdotal evidence that some doctors who should have been referred are not referred to GMC. GMC has not still done any research to explain why BME doctors are disproportionately referred to GMC by Institutions and not by patients!

    Of course it is important to protect patients but it is equally important to make sure that right doctors are referred to GMC irrespective of race, ethnicity, gender, place of qualification and once the doctors are referred GMC must have robust process to make sure all doctors are treated fairly and action taken are proportionate.

    In the best interest of patients, staff and NHS it is important for GMC to issue a guidance to all ROs with clear guidance on which doctors should be referred to GMC and without such a guidance it will be left to individual ROs to decide who should be referred and who should not. In such a system there will be some ROs who will refer more BME doctors but may not refer White doctors for same kind of mistake, misconduct or behaviour. Sadly human beings are not immune to subconscious bias and this is the fundamental reason as to why BME doctors are disproportionately referred to GMC by Institutions. This puts patients, staff and NHS at risk and GMC will continue to accused of biased against BME doctors.

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