CQC to explore 'longstanding concerns' over potential ratings bias against BAME GPs

The CQC is planning to investigate ‘longstanding concerns’ that black, Asian and minority ethnic (BAME) GP partners may be more likely to score lower in practice ratings.

CQC chief inspector of primary care Dr Rosie Benneyworth
CQC chief inspector of primary care Dr Rosie Benneyworth

CQC primary care chief inspector Dr Rosie Benneyworth said the regulator is looking to collect and monitor ethnicity data on partners as part of its registration process to help it understand links between ethnicity and ratings.

The move comes after the GMC highlighted concerns in 2019 that BAME GP partners may be more likely to receive lower ratings following CQC inspections.

GPonline understands that plans to investigate the link will be discussed at a meeting this week between the CQC and the BMA.

CQC inspection

Dr Benneyworth's comments follow the launch of the BMA's first national member forum for BAME doctors and medical students, which aims to ‘tear down’ structural inequalities within the NHS.

Meanwhile, the British International Doctors Association (BIDA) said it is ‘broadly supportive’ of the CQC review, calling it a ‘first step’ towards providing insight into the extent of racial bias during inspections.

Dr Benneyworth said the CQC wanted to monitor ethnicity so it had better data to see when it is a factor in ratings, as well as the type or location of a practice. She said: ‘We know that there are longstanding concerns that GP practices which are led by BAME GPs are more likely to receive lower ratings.

‘We understand how important these concerns are and while we don’t currently collect ethnicity data of GPs, we are planning to do so as we develop our new registration information collection.

GP ethnicity

‘There is some evidence, such as the GMC’s ‘Fair to refer’ report, which suggests that practices led by Black or minority ethnic GPs are more likely to be working in deprived areas with less support. We also know from State of Care that services in deprived areas are more likely to have difficulty recruiting staff.’

She added: ‘We are committed to understanding and addressing inequalities wherever they may occur in health and social care. We don’t have all the answers and are limited by the data available, but we will work with our partners, including the BMA and fellow regulators in this space and are already taking steps to do so.’

One GP who spoke to the GMC as part of its Fair to refer report said: 'There is a widespread view that there is a risk of bias by appraisers, CQC inspections, and performance list teams. Certainly CQC inspections are much more likely to fail BME practices and the CQC should be curious about that not just dismiss the possibility of bias.'

BMA GP committee deputy chair Dr Mark Sanford-Wood said: 'The announcement that the CQC intends to study its operations to establish whether ethnicity is a factor in the awarding of ratings for general practice is a positive step.

Discrimination

'The BMA is absolutely committed to ensure that BAME GPs are not treated unfairly or discriminated against in any aspect of their work and the BMA GP Committee has been actively pursuing this agenda with NHSE. We are therefore pleased that CQC has signalled its intention to address this issue and we are in discussion with them regarding how we can best work to support their efforts.'

A BIDA spokesperson said: ‘We would be broadly supportive of the [CQC investigation and] would support collecting data as the first step, which gives an insight into the extent of the problem.

‘Comparison of data with equivalent caucasian practices with matching deprivation and demographics will help dig deeper into the issue and explore difficult areas like discrimination, perception by patients and CQC outcomes that practices run by BAME colleagues do not achieve the higher level of rating as practices run by caucasian GPs.’

COVID-19 pandemic

BAME doctors are twice as likely to be referred to the GMC by their employer as white doctors. At the end of last year GMC chair Dame Clare Marx encouraged health leaders to use the pandemic as a springboard to tackle systemic discrimination.

GPonline has previously reported on a string of factors that call into question the fairness of CQC ratings - including evidence that better-funded practices score higher, and evidence that small practices and those in deprived areas are less likely to receive top ratings. The GMC's Fair to refer report highlighted that BAME GPs are more likely to work in deprived areas in smaller practices.

GPonline reported last December that the CQC had inspected five GP practices a week in England since the second wave of the COVID-19 pandemic began, including 56 on-site inspections in the 12-week period from the start of September to 24 November.

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