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GP trainees tell HEE plans to address racism ‘do not go far enough’

GP trainees have demanded tougher action from Health Education England to tackle racism during medical training.

In an open letter, signed by trainees and GP colleagues, they said the national training body had not gone ‘far enough’ in its plans to ensure trainees from black, Asian and minority ethnic backgrounds do not experience discrimination.

HEE’s GP school covering Kent, Surrey and Sussex wrote to trainees in an email last week, laying out a six-point plan with the steps they would be taking.

GP schools aim to ‘facilitate discussions on effects of race and ethnicity on trainee experience’, which will include looking at differential attainment levels, said the email, sent on 22 June.

They will also ‘ensure appropriate Covid risk assessment’ is ‘available’ from employers involved in training, will encourage discussion between trainees and trainers, and will review wellbeing resources providing targeted support for BAME trainees.

The plan also commits to holding workshops for those leading training hubs to help raise topics aimed at supporting BAME colleagues and refers to enhanced NHS induction workshops for international medical colleagues.

But in response a group of more than 30 GP trainees and GPs have written an open letter to HEE – as well as the BMA and RCGP – calling for more to be done.

The letter, put together by GP trainee Dr Tobi Isaac Obisanya, said: ‘The GP school at HEE, the RCGP and the BMA acknowledging these challenges and making a commitment to face them is greatly valued.

‘The six-step plan detailed in the email is a good start…However, with all due respect, the proposed plans do not go far enough to effectively address and reverse some of the underlying factors that have created the inequality at hand.’

The letter said HEE’s suggestion for improved induction workshops for international students would not solve the problem of differential attainment in exams for all BAME medical students.

It said: ‘This does nothing to address the conscious and unconscious biases that exist against black, ethnic minority and “foreign” people in the minds of some examiners, senior management, interviewers and GP trainers that often hold the key to the career progression, or the lack thereof, of said BAME staff.’

The GP letter added: ‘Curating more wellbeing resources for traumatised BAME trainees does nothing to address the underlying institutionally racist work environments that these trainees often struggle through and fear to speak up about.’

It also called for training curriculums to be revised, addressing issues such as the ‘poor’ teaching of how dermatological conditions appear on and affect brown skin.

The BMA said it was not involved in drafting the six-point plan in the email sent by HEE to GP trainees on 22 June and that it agreed with the concerns raised by the GP trainees.

Dr Sandesh Gulhane, GP trainee committee chair, said: ‘The BMA as an organisation is dedicated to better understanding and preventing these deep-rooted and systemic inequalities.

‘It is everyone’s responsibility to identify discrimination and take action wherever it occurs, while it is vital that those who experience discrimination are fully supported to speak out. However, it is clear that more needs to be done to end discrimination in the first place.’

He added: ‘The BMA also agrees with the concerns raised in this open letter about the differential attainment seen for BAME and international medical graduate trainees in post-graduate learning and we have previously written to the RCGP calling for new measures to further ensure assessments are free from any bias.’

Dr Gulhane noted the BMA had recently published a joint statement with a number of BAME medical organisations aiming to help develop revised guidance about diverse medical school curricula.

He said: ‘In the last few months racial inequalities have been starkly highlighted by the Covid-19 pandemic and the BMA remains committed to continuing as a leading voice in calling for urgent government action to address these inequalities both during and after the pandemic.’

RCGP chair Professor Martin Marshall said: ‘We’ve received Dr Obisanya’s letter and thank him for taking the time to write. The college is taking his concerns very seriously and will be responding to him in due course.’

HEE’s deputy medical director for primary care, Professor Simon Gregory, said: ‘Health Education England is against racism in all its forms and is keen to play its part in stamping it out by ensuring there is support for BAME trainees who experience it.

‘This is why we are using our influence as a national body and in our own work including work with and through our GP schools to better understand the issues as well as causes, and help find solutions to make sure BAME trainees feel fully supported and are able to flourish.’

A recent review by Public Health England found people of Bangladeshi origin are most at risk of dying from Covid-19, while people from black ethnic groups are most likely to be diagnosed with the disease.

The second part of the report admitted the pandemic has laid bare ‘humbling’ inequalities and included delayed recommendations on reducing black, Asian and minority ethnic (BAME) deaths.