Hospital Dr News

Poor support and isolation result in more ethnic minority doctors facing GMC referral

Disproportionate referrals of black, Asian and minority ethnic (BAME) doctors to fitness to practise processes could be driven by poor induction and support, working patterns which leave them isolated and poor feedback by managers.

These are the key findings of research commissioned by the GMC, which shows providers refer BAME doctors to the GMC at more than double the rate of their white counterparts.

This means they have more chance of being investigated and, in turn, receiving a warning or sanction.

The Fair to Refer? Report finds that a combination of factors could explain disproportionate referrals of BAME doctors to the GMC.

These factors include:

  • Some doctors don’t have adequate induction or enough support in transitioning to new social, cultural and professional environments.
  • Doctors from diverse groups do not always receive effective, honest or timely feedback which could prevent problems later. This is because some clinical and non-clinical managers avoid difficult conversations.
  • Working patterns mean that some doctors working in isolated roles lack exposure to learning experiences, mentors and resources.
  • Some groups of doctors are treated as ‘outsiders’, creating barriers to opportunities and making them less favoured than ‘insiders’ who experience greater workplace privileges and support.

Alongside these factors the researchers found that some organisational leadership cultures have a knock-on effect. Where leadership teams are remote and inaccessible, doctors struggle to approach them for advice and support, and may not be listened to and divisive cultures can develop.

In addition, a focus on who to blame when things go wrong, rather than what needs to be learnt from an incident, compounds the disconnect between doctors and leaders.

Charlie Massey, Chief Executive of the GMC, 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.”

The research recommendations include:

  • Improving support for doctors new to the UK or the NHS or whose role is likely to isolate them (such as SAS doctors and locums).
  • Addressing the systemic issues that prevent a focus on learning, rather than blame, when something goes wrong.
  • Ensuring engaged, positive and inclusive leadership is more consistent across the NHS.
  • Developing UK-wide mechanisms to ensure delivery of the recommendations.

Dr Doyin Atewologun, Director of the Gender, Leadership and Inclusion Centre at Cranfield University, and research co-author, said: “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’.”

Danny Mortimer, chief executive of NHS Employers, commented: “This report and recommendations concerning disproportionate referrals of BAME staff is helpful and welcome, and reinforces the finding of the NHS’ own Workforce Race Equality Standard (WRES). Many of its recommendations reflects themes of work identified within the NHS Interim People Plan, particularly those concerning induction support and health and wellbeing.

“For the NHS to truly be the best place to work it must take action to treat all staff, from all backgrounds fairly. We look forward to working with the GMC and employers to help them deal with issues earlier, locally and to eliminate unfairness.”

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