RCGP demands independent review to check for BAME bias in CQC ratings

CQC inspections on all practices rated 'requires improvement' or 'inadequate' in the past five years should be reviewed for potential bias against black, Asian and minority ethnic (BAME) GPs, the RCGP has demanded.

RCGP council members voted to demand the independent review - which they said must include all practices forced to close after poor ratings - and have urged the CQC to share details of 'any previous or ongoing and/or planned studies and data' on how ethnicity or country of qualification of GPs may affect ratings.

The vote comes after GPonline reported last month that the CQC was planning to investigate ‘longstanding concerns’ that BAME GP partners may be more likely to score lower in practice ratings.

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

CQC inspections

College council members have also called for the regulator to work with the RCGP to discuss how the availability and transparency of information on inspections can be improved to ensure that lived experiences of BAME practitioners are considered.

Members of the BMA and the British International Doctors Association (BIDA) have already supported the CQC’s plan to look into any link between inspection ratings and ethnicity, with the latter describing it as a sensible first step.

The college said it had previously discussed with CQC the challenges faced by some BAME GPs, and the need to ensure they are well supported. Vice-chair for external affairs at the RCGP Dr Gary Howsam also recently wrote to the CQC with questions and concerns raised by college members relating to CQC inspection activity.

The college confirmed that Dr Howsam and representatives from the college’s BAME group would meet shortly with Dr Benneyworth to discuss the issues raised by the college.

BAME GPs

Dr Howsam said: ‘The college’s BAME action plan commits us to delivering positive change for all our BAME members and we will continue to work constructively with the CQC towards an improved system of inspection that is supportive of GPs and keeps patients safe as we move away from the immediate crisis of the pandemic and into recovery.

Responding to the points raised by the RCGP, Dr Benneyworth said: 'We know that there are longstanding concerns that GP practices 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. We want to monitor ethnicity so that we have better data to see whether this could be a factor in ratings, as well as the type or location of a practice.

'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 [the CQC report] 'State of Care' that services in deprived areas are more likely to have difficulty recruiting staff.'

Post-pandemic care

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 RCGP and fellow regulators in this space and are already taking steps to do so.'

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 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.

What RCGP members voted for the CQC to do:

  • Share details of any previous or ongoing and/or planned studies and data to explore whether or not there is evidence of the conduct or outcomes of its inspections being affected by the ethnicity and country of qualification of practising GPs.
  • Work with the RCGP (at Officer level and involving representatives from the College’s BAME Task and Finish Group) to discuss how the availability and transparency of such information can be improved, and to ensure that Black Asian and Minority Ethnic GPs’ experiences of being regulated by the CQC are heard.
  • Commission an independent review of inspections of GP practices rated ‘requires improvement or inadequate’ over the past five years - including those practices which have been closed down due to CQC regulations - to assess if there is an association between the outcomes of inspections and ethnicity or country of qualification of the GP partners, and taking into account considerations such as population size, number of doctors and levels of deprivation in the communities they serve. If an association is found, the Council motion calls for the reasons to be explained with a view to tackling evidence of less favourable treatment of BAME GPs and their practices, thereby improving transparency in its processes and building confidence in the CQC.

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