The GMC’s latest findings provide much-needed updated information, which backs my own research going back to the early 1990s and a series of studies done more recently by the GMC that have consistently shown the same disparity in complaints and sanctions against BME and white doctors.
It is important that this data is collected and that the GMC monitors what is happening. GMC needs to be commended on publishing the information but I remain concerned that there is no concerted and serious attempt to understand and deal with the problem. The GMC cannot just keep publishing data of this sort without suggesting how they intend to tackle those discrepancies that they have identified. But the question remains – why?
The key challenge is understanding why there are these discrepancies? It does not mean BME people are any more criminally minded than white people, or BME doctors are any worse than white. However it is my view that the reason we have these discrepancies is that when a white doctor does something wrong, the threshold for investigating it and following it up is higher. I am not saying the BME doctors who are investigated and sometimes disciplined by the GMC are not guilty of misdemeanours – inquiries have shown the GMC has been rigorous and fair in how they have handled fitness to practice cases that come before them. Rather I have always said I believe white doctors who do wrong are not complained about or dealt with as seriously in the first place.
The GMC has itself shown more cases involving BME doctors come from public health authorities, and have concluded these complaints tend to be investigated and end up with sanctions more often than those made by the public – where you don’t see this large disparity in complaints between BME and white doctors – because such organisations are much better at preparing a case.
But that begs the question – what are health authorities doing? They may be more willing to ignore issues that arise with white doctors than they are with BME doctors. In my own work, I have seen cases where the PCT has not investigated despite enormous concerns about a white GP, whereas GPs from BME backgrounds are investigated straight away.
Whenever you try to understand issues around race, you have to be cognisant of how racism operates in society – for example, how far more BME people are stopped and searched by police yet very few are convicted and how we have disproportionate numbers of BME people incarcerated. And if you look at the NHS, there are major problems in how BME staff are treated – Roger Kline’s report Snowy White Peaks of the NHS showed how there are massive discrepancies in terms of who gets promoted, and the NHS bullying and harassment survey shows BME staff were much more likely to suffer.
So you cannot have a discussion about this without examining potential racial prejudice – not individuals being racist necessarily but how systems and cultures of institutions reflect society’s prejudices. The GMC needs to ask these legitimate questions about why this is happening – and needs to be aware when investigating there is an undercurrent of racism. You cannot separate what is happening in society from what is happening in the profession.
Professor Aneez Esmail is professor of general practice at the University of Manchester