This site is intended for health professionals only


Why ‘I don’t see colour’ isn’t enough


GP support package Pulse editorial


I know many readers will have read the cover feature and not been convinced systemic racism exists in general practice. You might say exams are colourblind; you might doubt that investigation panels treat minority ethnic GPs differently; and you might think that, although CQC inspections are pointless, ratings aren’t based on the colour of partners’ skin.

These views are not necessarily incorrect and holding them certainly doesn’t make you racist.

But I’d encourage you to look at the data. Non-white GPs fare worse in pretty much every measurable outcome and, tragically, that now includes Covid outcomes and deaths. And it has nothing to do with place of birth – the same differentials can be observed for UK-born minority ethnic GPs.

So, how can this be explained? If we accept there isn’t something inherently superior in white GPs (and I sincerely hope no one reading this holds that view), then we have to look at the system. 

In our cover feature, we touch on many points about the system within general practice. The fact ethnic minority GPs are more likely to work in smaller practices and in more deprived areas undoubtedly feeds into worse outcomes. (Except, ironically, patient satisfaction is higher for smaller practices – but this isn’t a factor for regulators). And I do believe unconscious bias exists in the process of regulating, inspecting and examining.

But understanding the factors that drive systemic racism – even in the relatively narrow field of general practice – is well beyond the scope of a 2,000-word article.

Because this is not specific to general practice. It is a society-wide issue. Indeed, general practice has greater equality than most areas of society. Around a third of UK GPs are minority ethnic – way above the proportion in the wider population. And minority ethnic GPs hold many leadership positions even if, as I have argued before, there are few black GPs in such roles.

I don’t blame the likes of the RCGP, the CQC or the GMC. Indeed, in the case of the latter, I will never forget  seeing chief executive Charlie Massey address the British Association of Physicians of Indian Origin’s conference just weeks after the decision to strike Dr Hadiza Bawa-Garba from the register. He faced an understandably emotionally charged audience and while I didn’t agree with all his justifications, there was a genuine desire to scrutinise the system. The GMC’s latest review of many last month recommended ‘targets’ on ethnicity and fitness-to-practise panels. I await the detail.    

The RCGP and CQC have not gone as far to understand the systemic issues within general practice, but each has undertaken work.

However, we have yet to see real changes in outcomes. So, what can be done? I don’t know. A cop out, perhaps, but so is concluding that it is the sole responsibility of the ‘ivory towers’.

But I know what I think can help: a rejection of the view – among individuals as well as institutions – that not seeing someone’s race is the epitome of anti-racism. Because only through the acknowledgement that race does matter, and that someone’s race will affect their progress, will we ever come to a solution.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk.

READERS' COMMENTS [3]

Patrufini Duffy 5 May, 2021 8:38 pm

You have to be it to feel it. If only we can all be like water, says Jackie Chan.

Stuart Buchanan 5 May, 2021 11:37 pm

Dear Jaimie
Thank you for a more sensible and nuanced article. I accept that there are differences between outcomes, that is measurable and hence there is no dispute over that, but to automatically make the presumption that this is all due to ‘systemic racism’ until the research has been done to tease out causative from associative, the influence of poverty etc is jumping the gun a bit.
If we come onto cultural sensitivities, then attacking other races tends to result in conflict. If the solution is going to involve working with colleagues of various ethnicities, then poorly written articles that basically imply, even if not intended, that one race is racist by default isn’t likely to bring barriers down, it’s more likely to have the opposite effect. Would you, or anyone, want to work alongside someone else who kept accusing them of racism? The answer is clearly no.
If you are going to go on the attack then you need to be able to explain contradictory points in the data, and argue the facts, not opinions. The problem with this topic is that it is very emotive, and some people have made up their minds before the problems are fully understood. As you say General practice is more equal than many other areas, and a balanced article will highlight the good points, not just the negative, and you have acknowledged yourself that the data shows clearly that doctors from ethnic minorities hold disproportionately more medical school places and currently Nikita Kanani holds the ‘Top GP’ post, these measurable facts simply do not fit with a rampantly racist system. The original article would have been more credible if it acknowledged that there are also many positives here. The solution will have to involve all races addressing all issues, not just one telling another what they think everyone else should be doing for their own section of society. White under-achievement/under representation is a real issue, and doesn’t fit with racism against ethnic minorities at that point in the medical career does it? So, can you please ask the authors and contributors to the original article to publish their thoughts on that specific data rather than avoid dealing with it. Do they feel it is an acceptable statistic? They shouldn’t be allowed just to present data that fits their arguments and not deal with data that doesn’t, after all, that is the basis of good research and evidence based medicine.
I am also serious about the racism against the deaf, it is deaf awareness this week after all. Deaf people have measurably poorer healthcare outcomes, and feel marginalised by medical professionals. How many doctors reading this article can sign? How many deaf doctors do you know? You do know that hearing people can learn many languages, including learning to sign, but deaf people can not learn to hear, so how many doctors here can claim to be truly inclusive of the deaf community before criticising other cultural groups?
There are more barriers for people in life and a medical career, than just racism, being disabled, being a single parent, having mental health issues to namer a few. To get an idea of the severity of a problem you have to have comparators for other negative influences so comparisons can be drawn.
For this conversation to get anywhere meaningfully, then we need cultural awareness from ALL sides looking at ALL the issues that form barriers for ALL groups and produce an agreed plan that works for all parties.
I’m signing off with a quote from Little Buddha- ” I have come to learn the hard way that when we blame others, we avoid seeing the truth about ourselves. When we focus on what someone else did wrong, we’re not able to see our part and learn about what we need to do differently going forward.”

Jonathan Heatley 6 May, 2021 7:14 am

well said stuart