Viewpoint: CQC must act fast to level playing field for ethnic minority-led practices

The CQC has acknowledged that its approach can disadvantage practices run by doctors from ethnic minotiries – it now needs to create a regulatory system that is fair for all, say Dr Shikha Pitalia and Dr Anita Sharma from the British International Doctors' Association.

Close up of someone about to tick a rating scale

The British International Doctors' Association (BIDA) welcomes the comments from the CQC acknowledging that some aspects of its inspection and monitoring methodology may inadvertently have had a negative impact on ethnic minority-run GP practices.

As a body representing many ethnic minority doctors, predominantly from India and the Asian sub-continent, BIDA has long held the view that there is a disparity in CQC inspections of these practices.

The CQC report into ethnicity bias highlighted concerns that its regulatory system fails to account for factors likely disproportionately to disadvantage GPs from ethnic minority backgrounds.

Ethnic minority-run GP practices provide much-needed services to their patients and have been an invaluable support to the NHS. It is widely recognised that such practices are often located in disadvantaged areas and face greater health inequalities.

CQC investigation

The CQC has now acknowledged that these practices are also more likely to be run by a single doctor working with limited support, resourcing or capacity, all of which creates local challenges that have often not been taken into consideration by inspectors.

Many of our colleagues have reported significant distress following misleading reports based on generic inspections, which have failed to take account of the often challenging and uniquely demanding local circumstances.  

Equally, there are innumerable examples of ‘outstanding’ practices led by ethnic minority doctors, which often go unreported. It takes a lot of teamwork and infrastructure to get 'good', with overall grading as 'outstanding' results.

Every GP team should employ a robust, consistent and methodical approach for every inspection. This is key and this is where many of our single-handed colleagues and even larger traditional practices are left exposed.

Support for practices

The doctors are generally clinically safe, but their practice processes in terms of providing evidence and audit, for example, are lacking. We recommend all GP leads to plan this well ahead of time. If they need help we recommend they look for experienced organisations to guide them with the appropriate support system needed to satisfy regulatory requirements.

The RCGP can provide help and support for CQC inspection, but this is usually accessed following a negative CQC report rating of ‘requires improvement’ or ‘inadequate’. The college charges a fee, but the aim and objective of the visit is to make sure everything is up to date.

Sadly, the CQC will still likely find flaws at these inspections, but hopefully rather than closing down these practices, serving breach notices or tarnishing them with inadequate ratings, we hope they will give sufficient time to allow remedial actions to be taken.

But what is just as important is that if these practices and doctors feel they have been treated unfairly, they seek expert guidance promptly to challenge the report and findings.

We are pleased that the CQC has now recognised the need for change and we would be more than happy to work in partnership with the regulator to offer further detailed insight to improve the inspection and monitoring regime to create a process that is fair for all.

  • Dr Shikha Pitalia is a member of BIDA's executive committee, medical director at SSP Health and chair of Wigan GP Alliance. Dr Anita Sharma is chair of BIDA's women doctors' forum and a GP in Oldham.

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