When I first started as a reporter at Pulse in 2012, I went to my former editor with a potential story: that an international doctors’ group was thinking of taking the RCGP to court over its clinical skills assessment. Seven years later, my reporter said the exact same words to me.
The issue of high failure rates of black and minority and ethnic (BME) GP trainees – including UK-trained candidates – taking the RCGP’s clinical skills assessment has, therefore, been around for a long time. And it has not changed a bit in the meantime.
Yet there has been a judicial review in that period that told the RCGP that it was ‘time to act’ on the issue. The judge indicated that, without change, a second judicial review around BME failure rates was likely to succeed.
Well, here we are. As our figures on p16 show, there has been no change in the failure rates. UK-trained BME candidates are faring worse than their white counterparts, and international BME medical graduates do even worse proportionally than their white counterparts.
Some of the latter can be explained away by culture. And it’s true that UK-born BME students have worse results than UK-born white students in all areas of education, including the RCGP’s own applied knowledge test. There are hugely complicated reasons for these why this is. I won’t claim to know these, and even with the best will in the world, the RCGP would struggle to swim against this societal tide.
And there is a strong argument that we can’t simply decrease standards to make the CSA easier to pass. This would be in no-one’s best interests: patients, other GPs and even the trainees themselves.
I do believe there are particular characteristics of the CSA that means these differentials are a bit more problematic for the college, though. It is a subjective exam, and it is based on a particular form of general practice, where the patient population – ie role players – are predominantly white, middle-class, middle-aged women. This is very different to much of the general practice faced by GPs in Newham, east London, or Blackburn, for example.
There’s been no change in CSA failure rates since the judicial review
But, for me, the biggest problem here is that the RCGP is giving the impression of seeing the problems as an inconvenience. It continues to maintain that its own reviews – which were published with little fanfare last year – had found nothing wrong with the exam. It has made what Professor Aneez Esmail – an expert on the issue who wrote the GMC-commissioned review of the exam – called ‘superficial changes’. Throughout the whole judicial review, the college took a defensive line.
There is another way. Take a look at the GMC’s response to the furore following the Bawa-Garba case. Regardless of your views on the regulator, I feel it has shown it is willing to tackle similar problems head on. It commissioned its own review into why there were more complaints against BME doctors than white ones, and why BME doctors are more likely to be investigated. I’ve said before, but chief executive Charlie Massey deserves credit for answering difficult questions on race and Bawa-Garba at BAPIO’s own conference.
It may be that the GMC’s review will lead to nothing – the recommendations were, after all, pretty weak, focusing on developing leadership and mentoring. But the willing on the part of the GMC is clear.
I have a lot of respect for outgoing RCGP chair Professor Helen Stokes-Lampard. She has done a good job in treading the line between highlighting the crisis in workload and developing an optimistic view of the future, even if some of it might be wishful thinking.
But one of the biggest challenges for the next chair of the RCGP is to acknowledge the problems with the CSA, and show that the college is genuinely keen to address them. One-third of GPs are BME, and unless the RCGP fully recognises there is a problem and proactively does something about it, there is a danger that it will lose more credibility.
Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at email@example.com