GMC targets elimination of 'shameful' bias in regulation and education

The GMC has set a five-year target for eliminating disproportionate complaints from employers about minority ethnic doctors and a strategy to halt bias in education within a decade.

GMC chief executive Charlie Massey told GPonline that the regulator had a ‘moral obligation’ to stamp out prejudice against black, Asian and minority ethnic (BAME) clinicians - insisting it should be a ‘bottom line issue’ for the NHS.

Mr Massey said he was ‘confident’ the regulator could end disproportionate reporting of BAME doctors by 2026, and go on to eradicate disadvantage and discrimination in medical education and training by 2031 - a target he described as ‘more complex’.

The targets have been welcomed by the BMA - although it warned that nothing short of 'wholesale genuine cultural transformation' in the NHS would end inequality.

GMC investigations

The targets follow calls from the GMC for changes to legislation to allow it ‘greater autonomy’ to choose the complaints it investigates, to help combat bias against doctors from BAME backgrounds.

The regulator has overhauled its referral form to try to ensure that only appropriate cases are submitted to the GMC in a first towards achieving its 2026 target. The GMC has also pledged to support organisations in building understanding of thresholds for fitness to practise referrals to help ensure ‘fairer outcomes’ - and will work with responsible officers to make workplaces more ‘inclusive and supportive’.

Doctors from ethnic minority backgrounds are twice as likely to be referred to the GMC by their employers for fitness to practise concerns than white doctors - and the referral rate for doctors qualifying outside of the UK is three times higher than that for UK doctors, according to the GMC's Fair to Refer report.

In education and training, there is a 12% gap in exam pass rates between white and BAME UK graduate trainees - rising to more than 30% for overseas graduates.

GP workforce

Mr Massey told GPonline that the targets were ‘hugely important’ to ensuring the future health of the NHS workforce. He said: ‘Dealing with inequality is, I think, quite a bottom line issue for the NHS in terms of making sure that it gets the most out of its medical workforce. But I think there is also a huge moral obligation on us because I think the inequality in the NHS is shameful.'

He said inequality was also a patient safety issue because it could 'drive doctors into positions where they run into trouble’.

The GMC chief executive defended proposing changes during the COVID-19 pandemic, arguing that the coronavirus crisis had presented an opportunity to reset services. He said the past year had 'woken a lot of people up in senior roles'.

The GMC will target support at areas with the highest levels of disproportionate referrals, he added.

GMC referral

‘There are some places where there seems to be a greater level of disproportionality, and that isn't going to tell us necessarily exactly what the issue is. But it will tell us that we need to spend more focus in area "x" than we do in area "y" in terms of supporting responsible officers and possibly upping the ante in terms of our engagement with boards,’ said Mr Massey.

Work has already begun to address differential attainment in education in parts of the country. Mr Massey said: ‘In north-west England we have been providing additional support to GP trainees who failed their clinical skills assessment and that extra support made a huge difference in terms of their success rates, and in terms of their retaking of the CSA assessment.’

Last week GPs warned that 'perfectly good trainees' were being lost to general practice because the recorded consultation assessments (RCAs) brought into the MRCGP exam during the COVID-19 pandemic had deepened a long-standing attainment gap for minority ethnic GP trainees.

BMA chair Dr Chaand Nagpaul said the attainment gap between BAME and white medical trainees and disproportionate referrals were 'disturbing'.

He warned: 'It is good that the GMC has set these targets to end this clear structural inequality afflicting ethnic minority doctors. However, this cannot be achieved by simply chasing targets, but by wholesale genuine cultural transformation in our NHS, where there is a full commitment to equal opportunity and enabling each doctor to progress and achieve their full potential.

'We must no longer tolerate a health service in which dedicated doctors, working tirelessly against the odds are disadvantaged and discriminated against. Only a system and culture that is inclusive and fair to doctors regardless of their background can truly deliver its best for patients.'

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