CQC process may 'disadvantage' ethnic minority-led GP practices, regulator admits

GP practices led by doctors from ethnic minorities may be 'disadvantaged' by the CQC regulation process, according to a report carried out by the regulator into concerns over ethnicity bias.

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

The regulator announced last year that it would investigate concerns over an ethnicity bias in its regulatory process after concerns that practices led by GPs from minority backgrounds may receive worse ratings or outcomes.

Findings compiled from interviews with CQC inspectors and GPs show that a significant proportion of doctors from minority groups believe the outcome of an inspection is likely to be adversely affected by their ethnicity - and found that some inspectors shared concerns about unequal treatment.

Almost one in three ethnic minority led GP providers felt they had a poorer inspection outcome based on their ethnicity, compared with just 0.5% of non ethnic minority-led practices.

CQC inspection

Among inspectors, although the majority disagreed that ethnic minority-led practices were more likely to have poorer ratings, a significant 26% agreed.

Nearly one in 10 inspectors agreed that ethnic minority-led GP practices were treated less favourably by quality assurance panels because of unconscious bias and discrimination, and 7% agreed that factual accuracy challenges raised by ethnic minority-led practices were less likely to result in changes to the inspection report.

The CQC report highlighted concerns that its regulatory system fails to account for factors likely disproportionately to disadvantage GPs from ethnic minority backgrounds, warning that 'some aspects of CQC’s inspection and monitoring methodology may inadvertently disadvantage practices...leading to inequities'.

It said: 'In the review of a sample of 30 GP practices whose inspection reports had been through CQC quality assurance processes, we found no reference to consideration of issues that were likely to disproportionately affect ethnic minority-led providers – for example, being led by a single-handed GP or having a patient population with high deprivation or significant ethnic diversity.'

Level playing field

Responding to the report, CCQ chief inspector of primary medical services and integrated care Dr Rosie Benneyworth said: 'As the first port of call and foundation of most people’s healthcare, a huge expectation is placed on every practice team. However, what this report finds is that ethnic minority-led GP practices are often not operating on a level playing field in terms of where they work, and the support available to them.

'While the system still has work to do around robust, meaningful data collection and ethnicity, we need to respond to what we do know. It is clear from the experience of the GPs who spoke to us that the challenges they face can be magnified by factors which are outside of their control and make it harder to evidence the quality of care that they offer.

'Everyone, wherever they are, has the right to safe, high-quality care and GPs should be supported appropriately to achieve this.'

BMA England GP committee chair Dr Farah Jameel said: 'Public trust and confidence in standards of care are incredibly important. What this report has identified is that the current format of inspections does not appropriately take into account or seek to address structural inherent inequalities that policymakers have been responsible for.

Discrimination fears

'It is therefore an important piece of work that underlines and recognises not only the poor experiences of, and challenges faced by, ethnic minority GPs during inspection processes, but also wider systemic factors that disproportionately impact this valuable group of doctors and their patients. These are all areas the BMA has been consistently raising for years.

'Worryingly, the report highlights how ethnic minorities were concerned about racial discrimination from regulators, and felt inspections were punitive rather than supportive, with harsh or unfair outcomes. The overriding conclusion is that the unique circumstances that many ethnic minority GPs practise within are not being adequately accounted for during the inspection process.'

Dr Jameel welcomed recognition from the CQC that a 'one-size-fits-all approach to regulation' does not work and said she looked forward to working with the regulator to make regulation 'fit for purpose'.

She added: 'It underlines the need to address wide-ranging structural inequalities, both in society and across the health sector, and the BMA will continue to support our members of all backgrounds while pressuring policymakers and government to both tackle damaging cultures within the health service, and ensure resources are directed to where they are needed most, so that patients of all backgrounds get high-quality care tailored to their needs.'

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