Black, Asian and minority ethnic (BAME) doctors are more likely to be referred to the GMC in fitness to practise cases than their white counterparts.

“Employers and healthcare providers are more likely to refer doctors who obtained their primary medical qualification outside the UK and those who are from a black and minority ethnic background to the GMC than they are to refer their UK qualified or white peers.”

The report, Fair to Refer?,  looked at the factors that contributed to the disproportionately high fitness to practise referrals to the GMC relating to BAME doctors.

The report concluded that there were six factors that contributed to this:

1. Doctors in diverse groups do not always receive effective, honest or timely feedback because some managers avoid difficult conversations, particularly where that manager is from a different ethnic group to the doctor. This means that concerns may not be addressed early and can therefore develop.
2. Some doctors are provided with inadequate induction and/or ongoing support in transitioning to new social, cultural and professional environments.
3. Doctors working in isolated or segregated roles or locations lack exposure to learning experiences, senior mentors, support and resources.
4. Some leadership teams are remote and inaccessible, not seeking the views of less senior staff and not welcoming challenge and this can allow divisive cultures to develop.
5. Some organisational cultures respond to things going wrong by trying to identify who to blame rather than focusing on learning. This creates particular risks for doctors who are ‘outsiders’.
6. In groups and out groups exist in medicine including relating to qualifications (including by country and within the UK by medical school) and ethnicity (including within BME populations). Members of ingroups can receive favourable treatment and those in out groups are at risk of bias and stereotyping.

The report found that the factors likely to account for disproportionate representation of certain groups of doctors in fitness to practise referrals are multiple and intricately linked.

The researchers identified recommendations in four key areas to help address the issues they identify:

1. Improving induction, feedback and support for doctors new to the UK or the NHS or whose role is likely to isolate them (such as SAS doctors and locums).
2. Addressing the systemic issues that prevent a focus on learning, rather than blame, when something goes wrong.
3. Ensuring engaged, positive and inclusive leadership is more consistent across the NHS.
4. Developing a UK-wide mechanism to ensure delivery of the recommendations.

Getting a right start

The researchers found that ensure a smooth pathway into UK medical practice by BAME doctors is an essential element to avoiding fitness to practices issues later in a Doctor’s career.

“Your pathway into UK medical practice may pre-determine your outsider status and the level of support you receive from the outset, starting with induction.  A doctor who fails to have a supportive start to UK medical practice, can then continue to experience further disadvantage as an outsider.”

The report acknowledged that the opportunities to improve “the risk of bias in the referral process” does not sit with the doctors but “…rather lies with the leadership within each organisation to provide frequent, direct and honest feedback across difference, design ongoing socialisation support, integrate certain roles and teams, role model senior leadership cohesion, adopt a learning focused culture in response to mistakes and implement strategies for inclusion that counter insider/outsider groupings and hierarchies.”