MRCGP should be declared ‘unlawful’, claim international doctors in High Court submission

Exclusive The RCGP is ‘directly racially discriminating’ against some groups of candidates through the MRCGP exam, and the assessment should be declared unlawful, according to legal papers submitted to the High Court by an international doctors’ group.

But the RCGP says the claims ‘have no merit’, and that there is no evidence that examiners mark people from ethnic minorities differently simply because of their ethnicity.

The submissions from the British Association Of Physicians Of Indian Origin (BAPIO) and the RCGP - obtained from the High Court by Pulse - reveal the legal arguments that the judical review into the MRCGP exam will be based on. A date for this review has yet to be set by the High Court.

The courts granted BAPIO leave to apply for a judical review of the MRCGP earlier this year after a large disparity between the pass rate of white UK doctors and that of international medical graduates and UK-educated black and minority ethnic doctors. However, the High Court dismissed the call from BAPIO for the GMC to face a judicial review over its role in the CSA issue.

The RCGP has commissioned a review of this disparity, carried out by King’s College London, but this is yet to be published.

BAPIO is seeking an order for the courts to declare ‘the constituent parts of the nMRCGP, in particular the clinical skills examination (CSA)’, the ‘requirements for membership of the RCGP’ and the ‘requirements for the obtaining of a CCT’ as unlawful.

The claim calls on the courts to review ‘the continuing adoption and application of the CSA as a condition for membership of the RCGP and the obtaining of a certificate of completion of training’.

It said the RCGP has failed to uphold the Public Sector Equality Duty under section 149 of the Equality Act 2010, citing the lack of an equality impact assessment.

It added: ‘In their assessment of candidates for the nMRCGP and, in particular, the CSA, the RCGP is directly racially discriminating against certain groups of candidates.’

‘Direct discrimination against IMG candidates and candidates of minority national and/or ethnic origin in the assessment of their performance in the constituent parts of the nMRCGP, in particular the CSA, may be properly inferred from the differences in treatment (scoring/pass/fails) and the differences in race as between those who pass and those who do not…; the subjective nature of the assessments and the absence of any check upon the outcomes.’

But the RCGP has said it has no case to answer, originally calling on the courts to throw out the judicial review application and to order BAPIO to pay costs.

With regards to its public sector duties, the college said: ‘This duty applies (as relevant) to bodies exercising “public functions”. The RCGP does not admit that, as regards the matters challenged in this claim, it exercises any public functions within the meaning of section 149.’

It added that the claim that there was direct discrimination was ‘baseless’.

It said: ‘The direct discrimination claim must, in the circumstances, be that the CSA examiners mark people from ethnic minorities harshly simply because of their ethnicity… This contention is baseless. There is no evidence for this.’

‘Further, and in any event, it is a critical part of BAPIO’s case that, at point of assessment by the CSA, all those being tested have the same level of skill in the area being tested. However, BAPIO has presented no evidence at all to show the necessary premise i.e. that all those taking the test have the same level of skill/aptitude in the areas being tested by the CSA.’

‘The CSA scores are not informed by direct discrimination. They properly reflect the performance of candidates.’

International doctor groups, led by BAPIO, were involved in discussions with the RCGP to find a solution towards the end of last year, but these were fruitless, leading to a judicial review.

An RCGP spokesperson said: ‘The CSA has been developed with the aim of ensuring those who meet the standards are fit to practise independently as GPs in the best interests of patient wellbeing and safety. We do not think it is appropriate to comment further when we are undergoing legal proceedings which we are defending vigorously.’

The GMC is also conducting a review, led by Professor Aneez Esmail, who has written extensively on racism in medicine, which is due to be published imminently.