Interview with BAPIO's Dr Ramesh Mehta: Making the CSA exam fair

A year on from the landmark legal challenge by the British Association of Physicians of Indian Origin (BAPIO) over CSA pass rates, the organisation's president Dr Ramesh Mehta talks to David Millett.

Dr Ramesh Mehta: BAPIO president says CSA fairness has improved
Dr Ramesh Mehta: BAPIO president says CSA fairness has improved

Black and minority ethnic (BME) pass-rates are ‘better than ever before’, but the British Association of Physicians of Indian Origin (BAPIO) has not ruled out renewing its legal challenge against the RCGP, its president Dr Ramesh Mehta says.

These improvements are welcome, but would have been ‘impossible’ without BAPIO’s landmark case against the RCGP, he tells GPonline.

‘Over the last at least 20 years since we have existed as an organisation, we have been talking to colleges, deaneries, the GMC about differential attainment of BME doctors. Everyone agreed that there was a problem, but no steps were being taken.

GP exam pass rates

‘However, since the court case, everybody seems to be admitting they want to do something about it – and things are happening already.

‘Now the establishment has realised that to use the full potential of doctors working in the NHS, they need to be looked after properly and they need to be treated equally. So there is a very obvious and positive change in the thinking of the establishment in how they deal with BME doctors.’

Dr Mehta is ‘delighted’ about the progress, but he warns that BAPIO remains open to challenging the RCGP again if discrimination persists.

Earlier this month, GPonline reported that black GPs were twice as likely to have revalidation deferred as their white counterparts.

It was over a year ago that BAPIO took the RCGP to the High Court on the grounds that the CSA section of its exams was racially discriminatory, and it ‘wasn’t an easy decision’ – coming at great cost to its members.

There is a positive change in the establishment in how they deal with BME doctors.'

Dr Ramesh Mehta, President, BAPIO

Although the CSA exam was officially ruled to be fair, Judge Justice Mitting conceded that BAPIO had won a ‘moral victory’ in the landmark case.

Because he deemed BAPIO to have acted in the public interest, he ruled it would not be liable to cover all legal costs accrued by the RCGP and GMC.

The case ended up setting them back around £250,000, but Dr Mehta says it was all ‘absolutely worth it’.

‘There is no doubt it was the right course of action,’ he tells GPonline. ‘Since the court case, all of the royal colleges have opened up and been contacting us on a regular basis. There has been a big momentum into looking at the differential attainment of ethnic minority doctors.’

The RCGP has defended the CSA exam, but changes it has set in motion show it has ‘accepted there is a problem that needs to be solved’, Dr Mehta says.

The RCGP and BAPIO now meet regularly, and Dr Mehta says BAPIO feels ‘very closely involved’ in driving improvements.

‘Whether it is the academy of royal medical colleges, the BMA, the RCGP – they have been very closely talking to us, and we are contributing to the consultation.’

Bias in CSA exam

Recognition that there was ‘unconscious bias’ in its examination process is the most important change made so far, he says.

‘To be fair to the RCGP, it has been very co-operative with us. We are working in a collaborative manner now, which did not happen before the court case.

‘What we have agreed to do as an organisation is to support the college in improving the situation.’

The RCGP has already drafted in BAPIO to help make the changes real. ‘To give an example,’ he says, ‘the college has recognised that there is a problem of examiners not being aware of the cultural differences between ethnic minority and white doctors, and so they invited BAPIO to train the examiners to improve their understanding of these issues.’

He also welcomes help for BME candidates who may require extra support ahead of the exam. He says many changes the RCGP is planning ‘are on the right track’.

Support for GPs

‘But,’ he warns, ‘if at any time we felt there was a recurrence of the issue, or the college was involved in any sort of discrimination, then of course we will consider challenging the college again. However, that is not the case at the moment.’

The CSA exam, he says, ‘is still unfair’ to BME doctors – ‘but it is better than it was before’.

But he wants to see the pass rate between different groups of candidates become equal.

‘People taking the CSA exam are not just taking it straight from being graduates. They are selected to be trained in general practice, they are trained for three years.

‘So how come there is such a significant difference in the CSA pass rate?’

He cites the official GMC figures that sparked the legal action, which showed UK-trained BME doctors were four times as likely to fail the CSA test as their white counterparts.

Dr Mehta remains concerned that bias may have been involved. But he says: ‘The pass rates of BME doctors are already significantly better. We are not looking for any compromise with the quality – because at the end of the day, patient safety is crucial.

‘I think it is important that we keep discussing it and talking about it so that the unconscious bias gradually disappears.’

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