Lack of support behind higher GMC referral rate for BAME doctors

High rates of GMC referrals for doctors from black, Asian and minority ethnic (BAME) backgrounds may be fuelled by a lack of support, isolation and poor feedback, a report has found.

BAME doctors are more than twice as likely to be referred by an employer to fitness to practise procedures as white colleagues. More than four in five referrals by an employer are formally investigated by the GMC - creating a significantly increased risk for BAME doctors of receiving a warning or sanction.

The report - commissioned by the GMC - cites research showing that in addition to 'adverse implications for their careers, reputation and wellbeing' doctors who receive sanctions can adopt defensive tactics including 'over-referral of patients, reluctance to handle perceived high-risk cases', and may be more likely to recommend 'more invasive procedures even when these are contrary to their professional judgment'.

The GMC-backed research suggests that isolation combined with a lack of support and professional feedback could be significant factors in driving up fitness to practise referrals for BAME doctors.


It recommends better support for doctors new to the UK or the NHS or whose role is likely to isolate them - including SAS doctors and locums. The report calls for measures to tackle 'systemic issues that prevent a focus on learning, rather than blame, when something goes wrong', and measures to ensure consistently 'engaged, positive and inclusive leadership'  across the NHS.

More than 260 people were inteviewed by Dr Doyin Atewologun and Roger Kline as part of the UK-wide research - with interviews covering doctors and employers in primary and secondary care.

The research found that 'the factors likely to account for disproportionate representation of certain groups of doctors in FtP referrals are multiple and intricately linked' - and that factors that can put some doctors at risk have a 'protective effect' on other parts of the workforce.

The report says poor support starting with induction at the time a doctor enters the UK workforce 'may pre-determine your outsider status' leaving doctors without the support they need to adapt to new social, cultural and professional environments.

BAME doctors

BAME doctors may also be denied 'effective, honest or timely feedback' that could help them avoind problems at a later stage, because some clinical and non-clinical managers duck their responsibility to have 'difficult conversations' - particularly where their ethnicity is different from that of the doctor.

Meanwhile, BAME doctors working in 'isolated roles' may lack access to 'learning experiences, mentors and resources', the research found..

GMC chief executive Charlie Massey said: 'To deliver good patient care, doctors need well-led workplaces with just and fair cultures, and strong clinical leadership that fosters trust and confidence in employees. All of us who are responsible for the UK’s health services have a role to play in developing these environments.

'We want to avoid doctors being referred to us for issues that can be solved earlier locally. We want patients to receive the best possible care, which is best delivered by doctors working in supportive and inclusive surroundings.'

Dr Atewologun, director of the gender, leadership and inclusion centre at Cranfield University, said: 'Our wide-ranging study focused on lived experience, which we felt was the best way to investigate this complex issue. We hope our four key recommendations will have real, measurable impact, encouraging employers and leaders to tackle what is clearly a system-wide problem.

‘The factors behind disproportionate representation of certain groups of doctors in fitness to practise referrals are multiple and intricately linked, with ‘risk factors’ for certain groups of doctors and ‘protective factors’ for others layering upon one another to create a cumulative positive impact for some and a cumulative negative impact for others. We hope this study will help ensure these protective factors are present for everyone, and not just accessible to those doctors who happen to be "insiders".’

Roger Kline, research fellow at Middlesex University Business School said: 'We hope our research will prompt serious, sustained work to ensure that all doctors, irrespective of their background or characteristics or mode of employment, are treated fairly within NHS employment, disciplinary processes or GMC referrals.'

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