NHS ‘treating minority ethnic doctors as outsiders’

Doctors from ethnic minorities are too often treated as outsiders by their NHS bosses and peers and not given the support they need, according to an investigation into why they are twice as likely to face disciplinary action as white doctors.

A report commissioned by the General Medical Council (GMC), the regulatory body for doctors, talks of “multiple and intricately linked” factors behind the disproportionate number of referrals of doctors from ethnic minorities by their employers.

At the heart of the problem appears to be a club culture in some parts of the NHS. The report describes an insider/outsider dynamic; those most likely to be left on the outside are foreign-born and trained doctors. They are often not given enough help to settle into the UK and the new job. It can be hard for them to find a place to live and school for their children as well as struggling to understand what is needed of them at their hospital or GP practice.

It is not just racism. “The dynamic is a lot more complex than could be explained by focusing on racism,” said Dr Doyin Atewologun from the Cranfield University school of management, one of the authors. “There are multiple reasons why people could be considered to be outsiders. There are locums who are not overseas-qualified or black, Asian or minority ethnic [BAME] doctors, but also experienced a degree of otherness. I would not say it can all be explained by racism.”

Minority ethnic doctors told researchers of the pitfalls they encountered when trying to assimilate. “What people were telling me isn’t what they meant,” said one. “It can be as simple as how you ask for things – not just the words but the tone. The teams we join don’t always appreciate that,” said another. People in the NHS from overseas are expected “to just soak up the culture as they go along”, said a consultant.

Some organisations ensure there is support for newly arrived doctors. “Some doctors may only need a week but others really need longer,” said one clinical director. “It is unreasonable to expect someone to travel halfway across the world, land in a different social and clinical environment, social mores and language and not expect there to be challenges. We try to put ourselves in their shoes.”

But feedback can be poor. Managers afraid of confrontation may fail to raise issues that should be picked up early, such as misunderstandings between cultures over attitudes to patients or the importance of consent.

The GMC chief executive, Charlie Massey, said: “Quite often doctors who are BAME may be less likely to get open and honest and timely feedback, which means that little things could escalate into bigger things which may make them more likely to be referred to us.

“When things go wrong, those people who are outsiders are more likely to be blamed.”

The report was commissioned after the case of the trainee paediatrician Hadiza Bawa-Garba caused uproar within the profession. Bawa-Garba, considered a good doctor, was struck off and then reinstated over the death of a boy at the understaffed hospital where she was working without proper supervision.

Twice as many minority ethnic doctors as white doctors are referred to the GMC by their NHS employers for an investigation that could damage or end their careers. The report says support is especially needed for locum doctors, who fill in for others, and for specialists. These doctors are most likely to be isolated. It calls for “engaged and positive leadership” and a focus on learning and accountability rather than blame.

Atewologun said she was “quite optimistic that the results from our study will make a change in the system”. The GMC and other organisations were ready to move, she said. “With all of the stakeholder groups there is a sense that this is an issue – let’s get our teeth into it and have some practical specific action to implement.”

The Doctors’ Association UK said it welcomed the report, “which worryingly highlights that fitness to practice referrals could be influenced by cultural differences. We therefore believe there needs to be a much harder line taken on zero tolerance of discrimination within the NHS and its stakeholders, which includes patients and the GMC.”

The British Medical Association has long raised concerns about the way doctors from ethnic minorities are treated. Dr Chaand Nagpaul, the BMA council chair, welcomed the report. “It is unacceptable in the 21st-century NHS that BAME doctors, international medical graduates, locums and SAS [specialist] doctors face discrimination and we look forward to working with the GMC, employers and national organisations throughout the UK to ensure these changes are delivered for the good of doctors, patients and the whole health service,” he said.