Poor induction and employer support could be the drivers behind the high number of referrals of black, Asian and minority ethnic doctors to GMC investigations, a major GMC-commissioned review has found.
The independent Fair to Refer report found that black, Asian and minority ethnic (BAME) doctors are at more of a disadvantage when they don’t have enough or adequate induction.
Dr Doyin Atewologun and Roger Kline, who led the review, also found that employers evade having difficult conversations with BAME doctors about their practice, which is a primary factor in why more BME doctors are referred to the GMC for investigation.
The report made four recommendations, including comprehensive support for doctors new to the UK, a focus on learning and accountability rather than blame, and ensuring more consistent leadership across the NHS.
The GMC announced the review at the British Association of Physicians of Indian Origin conference last year following the backlash from the profession against its actions in the case of Dr Hadiza Bawa-Garba.
The GMC has long acknowledged that BAME doctors are more likely to face a complaint and have a complain investigated than white doctors.
A BBC investigation last week also found that 44% of complaints made against black doctors over five years led to investigations compared with 29% of complaints made against white doctors.
The review, published today, concluded: ‘A doctor who fails to have a supportive start to UK medical practice can then continue to experience further disadvantage as an outsider. We found that evading conversations regarding concerns relating to a doctor’s practice (in particular regarding conduct) was a primary factor.
‘The lack of timely, direct and honest feedback, that is sensitive to difference, can have a huge impact on a doctor’s opportunity to demonstrate learning from mistakes and improvements to their practice. Further exclusion from ongoing socialisation support, often referred to as learning the informal rules of the NHS, is an additional factor.’
The BMA welcomed the review into the factors behind the ‘unfair treatment and bias at work’.
BMA council chair Dr Chaand Nagpaul said: ‘It is unacceptable in the 21st century NHS that BAME doctors face unfair treatment and bias at work, and we look forward to working with the GMC, employers and national organisations throughout the UK to bring about the improvements outlined in this report for the good of doctors, patients and the whole health service.
‘Worryingly, they are also more likely to face referral to fitness-to-practise processes to the GMC than their white counterparts, are more likely to have their cases investigated and are more likely to face more serious sanctions following an investigation.
‘Therefore, we very much welcome this research into the factors behind not only this, but why being an overseas-qualified doctor, a locum, or a staff associate specialist and specialty (SAS) doctor, increases the risk of being unfairly treated.’
The GMC commissioned Dr Doyin Atewologun and Roger Kline to conduct the review last year.
GMC chief executive Charlie Massey commented on the findings, saying the regulator wanted to avoid doctors being referred to them for issues that could be solved locally.
He said: ‘To deliver good patient care, doctors need well-led workplaces with just and fair cultures, and strong clinical leadership that fosters trust and confidence in employees. All of us who are responsible for the UK’s health services have a role to play in developing these environments.
‘We want to avoid doctors being referred to us for issues that can be solved earlier locally. We want patients to receive the best possible care, which is best delivered by doctors working in supportive and inclusive surroundings.’
Dr Atewologun and Mr Kline recommended the GMC address four issues:
- Providing comprehensive support for doctors new to the UK or the NHS or whose role is likely to isolate them (including SAS doctors and locums)
- Ensuring engaged and positive leadership more consistently across the NHS
- Creating working environments that focus on learning and accountability rather than blame
- Developing a programme of work to deliver, measure and evaluate the delivery of these recommendations
Professor Aneez Esmail, professor of general practice at the University of Manchester, who helped with aspects of the report, said many managers use the GMC as the first port of call rather than have difficult conversations with BAME clinicians.
He said: ‘For many BAME clinicians, managers use the GMC as the first port of call rather than have the difficult conversations that the authors of the report refer to. If you are white then your treatment is more lenient and understanding. It is one of the reasons why there is a disproportionate referral of BAME doctors to the GMC.
‘I think that this is a particular problem in primary care because individual practices do not have the expertise or time to properly investigate things when there is a cause for concern – it seems much easier to contact the GMC and pass the buck.’
Head of primary care at Imperial College London Professor Azeem Majeed said doctors need to have proper support from experienced colleagues and to not be treated as ‘outsiders’.
He said: ‘The findings of the report illustrate the need for employers to put in place strong induction programmes for overseas-trained doctors and ensure these doctors have readily available support from more experienced colleagues. They also need to fully be integrated into clinical teams and not treated as “outsiders”.
‘Complaints are very stressful for doctors and also cost the NHS large sums to deal with. Hence, effective processes in supporting overseas-trained doctors – particularly in the early part of their UK-based careers – will benefit doctors and the NHS, as well as improving patient safety and leading to better clinical outcomes for patients.’