Racism in medicine: NHS publishes action plan to tackle discrimination in workforceBMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p299 (Published 08 February 2023) Cite this as: BMJ 2023;380:p299
Tackling race inequality in the medical workforce
Partha Kar: It’s time for action on race equality in the medical workforce
An engaged and empowered SAS workforce will provide vital capacity in the current workforce crisis
Doctors are being hamstrung by toxic cultures that damage them and the care they’re able provide
The NHS has published a five point plan to tackle racism, aimed at ensuring that employees from ethnic minority backgrounds have equal access to career opportunities and receive fair treatment in the workplace.
Among the target areas that regulators and medical leaders need to tackle is the disproportionate number of ethnic minority doctors and those who trained abroad who have disciplinary procedures against them. A special issue of The BMJ in 20201 highlighted how ethnic minority doctors working in the NHS are twice as likely as white doctors to be referred by their employer to the General Medical Council, while those who trained outside the UK were two and a half times as likely.2
The report from Medical Workforce Race Equality Standard (MWRES)3 says that reducing this inequality will require a critical focus on data on referrals to both local and national regulators.
In a foreword to the report, Charlie Massey, chief executive of the GMC, said, “The case for change is irrefutable. Discrimination and disadvantage are not only morally indefensible, they are also a drag on a doctor’s ability to provide the best possible care for their patients. Thankfully, there is now broad agreement that the status quo is damaging for practitioners and patients alike, and there is great will from all corners of the health service to make things better. What is needed now is action and an unshakable commitment to change.”
The second target area in the report is to encourage greater representation in senior medical positions and promote inclusive recruitment, and the third is to improve representation of minority ethnic doctors in senior royal college positions.
Two other linked targets are to standardise support arrangements for international medical graduates (IMGs), and to ensure parity for specialty and associate specialist (SAS) doctors—many of whom are trained outside the UK—who are “more likely to face inequality in terms of appraisal success, disciplinary referral, and revalidation, as well as bullying, harassment, and discrimination.”
Noting that IMGs often report poor experiences of induction, the report said, “Various recent independent reports recommend a comprehensive induction programme to support IMGs and note that their initial experiences in the UK can have an ongoing adverse impact.”
MWRES will monitor the outcomes of pilot projects, such as enhanced exam preparation and improved access to reasonable adjustments, which are being led by the GMC, statutory education bodies, and others to improve outcomes for ethnic minority and overseas qualified trainees.
Mala Rao, senior clinical fellow at Imperial College London and medical adviser for NHS England’s workforce race equality strategy implementation team, said that “transformation in culture and attitudes” would be needed across the NHS to tackle the deep inequalities highlighted by the report. “Having led the development of MWRES and its indicators and the guide to induction for IMGs, I am delighted to see these reports being acted on. It is gratifying that they are providing an evidence base for clear practical advice on how to implement their recommendations. It is reasonable for the NHS to be asked to work on a limited number of domains to begin with, and actions to tackle one domain are likely to benefit others,” said Rao, who was co-editor on The BMJ’s racism issue.
“The path to delivering these goals must begin with the health leadership reflecting on how staff expected to care for the country’s most vulnerable people could be so poorly treated, and embed a culture of justice, kindness, and friendship on which high quality, safe care depends.”
Vaishali Parulekar, an associate specialist in radiology who co-chairs the Academy of Medical Royal Colleges SAS committee with Vinita Shekar, told The BMJ that she hoped the report would be a catalyst for SAS doctors being treated more fairly. “What we generally find is that SAS doctors have good representation nationally, they are being invited to many committees and working groups. However, at the trust level, at local employer level, there aren’t many leadership opportunities. But a report like this tackles that. MWRES have been a good ally to the SAS workforce which we are grateful for. The report is a good start.”
In a joint introduction in the report, Anton Emmanuel, head of the Workforce Race Equality Standard, and Partha Kar, who leads MWRES, said that the five core areas aimed to represent “a data led and evidence based approach” to tackling the inequality faced by ethnic minority doctors in the NHS. “As targets are met, this document will be updated to focus on future steps. But for now we have a clear vision of what to work on, a fellowship of staunch stakeholders, and the support of many in the workforce,” they wrote.