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.