Skills test discriminates against non-white GP trainees, court hears

An assessment that all trainees must undergo before they can become GPs in the United Kingdom discriminates directly and indirectly against doctors from ethnic minority groups, the High Court in London was told this week.

“The consistent theme running through all the statistics is that white groups do better,” Karen Monaghan QC told Mr Justice Mitting.

Monaghan was opening the case for BAPIO (the British Association of Physicians of Indian Origin), which is challenging the fairness of the clinical skills assessment (CSA) required to become a GP in the UK. The rate of failure in the assessment, an important test for trainee GPs, is much higher among ethnic minority candidates than among white candidates.

BAPIO launched the case, which alleges that the exam is racially discriminatory, against the Royal College of General Practitioners, which administers it, and the General Medical Council, which is alleged to have failed in its duty as a public sector body to ensure equality.

Ramesh Mehta, a consultant paediatrician and president of BAPIO, said that many GP trainees from ethnic minority backgrounds “have had their careers and prospects hijacked at this crucial CSA stage, having previously secured a successful track record during what is both a stringent and lengthy qualification process.”

The assessment, which includes a mock consultation in which an actor poses as a patient, is a crucial part of the training for the royal college’s membership qualification (MRCGP). White UK graduates were more likely to pass the exam than ethnic minority candidates from the UK and ethnic minority candidates who trained in overseas universities.

Monaghan told the judge that the CSA was an exit exam, taken at the end of three years of training. She said that non-UK graduates, who were overwhelmingly from India and Pakistan, had to show that they had undergone training that was comparable to that of UK graduates, who had to complete two foundation years. Entry to the GP vocational training scheme was highly competitive, and overseas doctors who were not from the European Economic Area had to undergo two language assessments, she said.

Monaghan said that the test that applied before the introduction of the CSA in 2007 also had known disparities in outcome. The royal college ought to have dealt with these disparities in introducing the CSA but had not done so, she added.

A report in The BMJ last year concluded that, although there was no hard evidence of racism, “subjective bias owing to racial discrimination” could not be ruled out.1

A spokesman for the royal college said, “As the court hearing in relation to this issue is taking place, we do not believe it is appropriate to comment at this time.”

The hearing is expected to take three days, with the judge reserving his decision for a few weeks.