Dear Professor Marshall,
We were appalled to see the absence of black and Asian representation in the leadership of the RCGP:
• 12 trustees – all white and predominantly male
• 8 members of council – all white and predominantly male
• 4 chairs of the devolved councils – all white
• 18 elected members – 3 Asian, the rest white
• 15 in senior leadership team – 1 black, the rest white.
General practice has been the most diverse medical specialty since the inception of the NHS in 1948 when it drew heavily on the contribution of South Asian doctors. GMC data shows that approximately 32% of GPs are currently from black or South Asian heritage or from other backgrounds that identify as not white. Half of these are international medical graduates. As you will know the last few months have been very difficult for those with this heritage working in the NHS. Firstly, there has been the disproportionately greater morbidity and mortality from Covid-19 on black and minority ethnic communities as well as healthcare staff, exposing the systemic racism they experience. Added to the loss experienced from this, the appalling events in the USA have heightened racial tensions causing further hurt.
We know that doctors from ethnic minority backgrounds continue to face disadvantage throughout their careers. Despite being selected for high academic achievement differential attainment means worse outcomes for these groups. We know that deficit models are now outdated and the causes are a systemic problem that affects everyone as it prevents patients ultimately benefiting from an ethnically diverse medical workforce. Tackling this problem requires a leadership that is representative.
The lack of representation has resulted in a failure of the RCGP to acknowledge the hurt and loss of its black members in response to the Black Lives Matter movement, standing alone among the main medical colleges. It has resulted in the RCGP hosting an event which described Covid-19 as a ‘lifestyle disease’, causing widespread offence among those very communities who feel marginalised and excluded by the college.
Failure to ensure wider representation in the RCGP leadership perpetuates discrimination. We know discrimination against NHS staff causes low morale and predicts poor patient outcomes. Greater proportions of new GP trainees are from non-white backgrounds, many areas and schemes reporting over 50%. We know from Katherine Woolf’s excellent work that differential attainment needs to be addressed by ensuring psychological and cultural safety through positive relationships, role models and career sponsorship.
If the college selection systems cannot address non-representation at board level quickly the systems that select college boards should be changed. This may require the introduction of quotas. Maintaining the status quo is no longer acceptable and the college must learn from other sectors where all White boards are no longer permitted.
We need compassionate and inclusive leadership in 2020. All white boards cannot achieve this. Without action the RCGP will remain on the wrong side of history and become an increasing irrelevance in the future NHS.
We look forward to hearing from you.
Naureen Bhatti – GP
At time of publication, more than 1,100 signatories, mostly GPs, have signed this letter.
Professor Marshall’s response can be viewed here.