No evidence of racism in GMC complaints procedures

BMJ 2000; 321 doi: (Published 15 July 2000) Cite this as: BMJ 2000;321:136
  1. Linda Beecham
  1. BMJ

    Health authorities, NHS trusts, and other public bodies, including the police, in the United Kingdom refer proportionately more doctors who qualified overseas than in the UK to the General Medical Council, says a report from the Policy Studies Institute (PSI).

    The report, a summary of which was considered by the council this week, says that this finding partly explains why doctors who qualified overseas are overrepresented in the GMC's fitness to practise procedures.

    The PSI found no evidence of any overt or covert racial discrimination in the GMC, but it criticises some aspects of the council's processes, particularly on consistency and transparency.

    When complaints from the general public and public bodies were taken together, doctors who qualified overseas were not overrepresented. But because reports from public bodies were more likely to be better documented—many complaints from the public are trivial and may not even mention a doctor's name—the screeners referred a much higher proportion of these complaints to the next stage, the preliminary proceedings committee.

    The institute says that this does not explain why relatively more doctors who qualified overseas were referred on from the preliminary proceedings committee to the professional conduct committee. The report speculates that the complaints against these doctors might simply be more serious.

    The director of the GMC's fitness to practise department, Isabel Nisbet, said, “There is no suggestion that any of the overseas qualified doctors who were referred should not have been.”

    The chairman of the GMC's racial equality group, Lord Patel, said that he could only speculate on the reasons. It might be that a greater proportion of doctors who qualified overseas were doing temporary or locum work, perhaps as a singlehanded GP, and were less supervised. Other possibilities were that it could be a cultural issue, or there could be institutional discrimination. Discussions were already taking place with medical directors to ensure that those referring cases to the GMC did so evenhandedly.

    The council has agreed to address all the institute's recommendations as a matter or urgency. Some changes have already been made. In 1997 a screeners' handbook was produced, which set out how complaints were handled and made it explicit that the GMC “screens out” rather than “screens in.”

    From 1997, all non-trivial complaints about conduct or performance were disclosed to the doctor at an early stage and the doctor was invited to comment. All members and staff involved in the fitness to practise procedures and all assessors in the performance procedures have training in racial awareness.

    Lord Patel said, “The challenge now is to look urgently at the report's conclusions and take all steps to ensure our procedures are demonstrably fair, objective, transparent, and free from discrimination.”

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