Intended for healthcare professionals

Feature Racism in Medicine

What lies beneath: getting under the skin of GMC referrals

BMJ 2020; 368 doi: (Published 12 February 2020) Cite this as: BMJ 2020;368:m338

Read all of the articles in our special issue on Racism in Medicine

  1. Aisha Majid, freelance journalist
  1. London
  1. aisha.majid1{at}

Aisha Majid asks why ethnic minority doctors are more likely to be investigated by the UK’s medical regulator and what is being done about it

If you’re an ethnic minority doctor working in the NHS you’re twice as likely as a white doctor to be referred by your employer to the General Medical Council (GMC). If you trained outside the UK that figure rises to two and a half times as likely.

These facts are not new. But less is known about the reasons why, says Roger Kline, research fellow at Middlesex University Business School and coauthor of Fair to Refer?,a 2019 report1 commissioned by the GMC that sought to understand why certain groups of doctors more often fell foul of complaints about their fitness to practise.

“People have known there’s been an issue around disproportionality without understanding what lies behind it,” says Kline. He says that the case of Hadiza Bawa-Garba, who was struck off the medical register after the death of a 6 year old child and then reinstated, was the tipping point for action.

Although it’s not only employers who can refer doctors to the GMC, only referrals by employers show a disproportionate representation of ethnic minorities (see box). Complaints from employers make up only 4.3% of all referrals—but 77% of these result in a GMC investigation, compared with only 9% of complaints from patients.

Dynamics of belonging

The Fair to Refer? report highlighted a pervasive insider-outsider dynamic in the NHS. Doctors perceived as lower status outsiders—such as doctors trained outside the UK—are not given the support they need by bosses and colleagues and are more likely to end up being blamed and facing disciplinary action when things go wrong.

Ethnic minority doctors, whether trained in the UK or overseas, may also feel less confident about raising …

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