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'There is an undercurrent of racism'

The GMC needs to ask why BME doctors are more likely to be complained about, says Professor Aneez Esmail

The GMC’s latest findings provide much-needed updated information, which backs my own research going back to the early 1990s and a series of studies done more recently by the GMC that have consistently shown the same disparity in complaints and sanctions against BME and white doctors.

It is important that this data is collected and that the GMC monitors what is happening. GMC needs to be commended on publishing the information but I remain concerned that there is no concerted and serious attempt to understand and deal with the problem. The GMC cannot just keep publishing data of this sort without suggesting how they intend to tackle those discrepancies that they have identified. But the question remains – why?

The key challenge is understanding why there are these discrepancies? It does not mean BME people are any more criminally minded than white people, or BME doctors are any worse than white. However it is my view that the reason we have these discrepancies is that when a white doctor does something wrong, the threshold for investigating it and following it up is higher. I am not saying the BME doctors who are investigated and sometimes disciplined by the GMC are not guilty of misdemeanours – inquiries have shown the GMC has been rigorous and fair in how they have handled fitness to practice cases that come before them. Rather I have always said I believe white doctors who do wrong are not complained about or dealt with as seriously in the first place.

The GMC has itself shown more cases involving BME doctors come from public health authorities, and have concluded these complaints tend to be investigated and end up with sanctions more often than those made by the public – where you don’t see this large disparity in complaints between BME and white doctors – because such organisations are much better at preparing a case.  

But that begs the question – what are health authorities doing? They may be more willing to ignore issues that arise with white doctors than they are with BME doctors. In my own work, I have seen cases where the PCT has not investigated despite enormous concerns about a white GP, whereas GPs from BME backgrounds are investigated straight away.

Whenever you try to understand issues around race, you have to be cognisant of how racism operates in society – for example, how far more BME people are stopped and searched by police yet very few are convicted and how we have disproportionate numbers of BME people incarcerated. And if you look at the NHS, there are major problems in how BME staff are treated – Roger Kline’s report Snowy White Peaks of the NHS showed how there are massive discrepancies in terms of who gets promoted, and the NHS bullying and harassment survey shows BME staff were much more likely to suffer.

So you cannot have a discussion about this without examining potential racial prejudice - not individuals being racist necessarily but how systems and cultures of institutions reflect society’s prejudices. The GMC needs to ask these legitimate questions about why this is happening – and needs to be aware when investigating there is an undercurrent of racism. You cannot separate what is happening in society from what is happening in the profession.

Professor Aneez Esmail is professor of general practice at the University of Manchester

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Readers' comments (8)

  • A patient is less likely to complain about a doctor they particularly like.

    It's a widely accepted psychological principle that people are more likely to like people they identify with.

    And a patient is more likely to identify with somebody of the same ethnic group as themselves.

    So it seems the findings may simply reflect aspects of ordinary human psychology.

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  • @ 1:32pm
    It still doesent explain why they are 50%likely to get sanctioned by GMC though
    GMC should be acting as a professional body not " Ordinary human psychology" could it not be explained as unconscious subjective bias?

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  • @1.32 - applying ' ordinary human psychology ' to findings of GMC report in this article demonstrates stone age thinking and complete lack understanding of human psychology.

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  • To the above may I add ' tribal Stone Age thinking '

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  • I have wondered at times that to be struck off it's enough to make a small mistake or gesture if you were a BME doctor but you would need to be a Shipman if you were white British. No disrespect to my white British colleagues - it is the GMC approach that has been erroneous over the years and it is heartening that we have the likes of Prof Esmail who have had the guts to voice concerns.
    We must remember - in the NHS we are not an Ethnic minority but a majority - especially in some regions of the country where the NHS workforce is 60-80% formed of asian and african personell.

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  • Racism is not the only reason. It's 'poshism' and 'beaurocratism' in combination with racism.
    If you look/speak/act differently, from the stereotypical white middle aged doctor with posh accent, then you are up for game. And the beaurocrats and medical managers have no guts to support the individual caught up in this, so they either evade support or actively harm by 'investigating' for it's sake.
    There is a logic in this. It's called 'Clinical Governance' It employs so many managers and medical managers at all levels. Keeps them busy, improves their job satsfaction of 'preventing risky doctors'. But no one can explain what happens if they make the doctor unemployable by this procedure(s).
    We have our trade unions, which are a blot on our conscience.

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  • can of worms springs to mind and I mean Kevin Bacon is not here to save the day and Tremors are going to be felt for years upone end the fall out would be catastrophic and un imaginable if this was honestly discussed and fact on fact .
    Now if you are not part of the solution then quit being part of the problem...John Mclain said that Hanz Gruber however was a movie character where Good wins over Evil , Fairness honesty is winning end ...lets face it its more like Gone Girl now .
    Well enough of my anaologies but its plain to see and not really an undercurrent ,it like a barn door and that too a barn door in the Land of Giants ...but labor omnia vincit ..just maybe , just maybe Caesar was correct

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  • It's difficult isn't it.In a way one can argue that this tendency towards 'tribalism' is hardwired into our DNA.I wouldn't use the word racism because that has more sinister connotations.

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