Equality, Diversity and Inclusion: The GMC & BAME healthcare professionals
At the start of June 2019 the GMC published an independent review of gross negligence manslaughter (GNM) and culpable homicide (CH). The report explored the fractured relationship between healthcare professionals and the GMC. As part of the report equality, diversity and inclusion issues were explored with a particular focus on the vulnerability that is faced by Black, Asian, Minority Ethnic (BAME) healthcare professionals.
BAME and gross negligence manslaughter
The report explores the work of RE Ferner who conducted research into media reports published between 1970 and 1999 that related to gross negligence manslaughter in the healthcare profession. It found that three quarters of those accused and subsequently featured in media reports in this time period were BAME healthcare workers.1 It could be suggested that this media attention has created a perception that BAME healthcare workers are more vulnerable to serious accusations such as GNM than Caucasian healthcare professionals.
The report does however stress that subsequent research into a number of GNM prosecutions relating to healthcare workers have revealed that the number of prosecutions are too small to extract meaningful analysis.2 This indicates that negative perceptions have been created through the media which cannot be supported by the currently available data.
Developing the available data relating to the ethnicity of healthcare workers who are facing allegations of GNM would allow a more accurate analysis of whether BAME healthcare professionals are at a greater risk of facing GNM allegations.
Despite the lack of data relating to the ethnic origins of those facing GNM allegations, there is a more general perception of a greater sense of isolation and vulnerability faced by BAME healthcare workers. A BMA survey revealed that 57% of BAME healthcare professionals feared being blamed when things went wrong. This was higher than the response received from Caucasian respondents. This sense of fear experienced by some BAME staff that they will face individual blame for what might be organisational failings may be heightened following the case of Dr Bawa-Garba which has deepened the mistrust between healthcare professionals and the GMC.
BAME and the fitness to practice process
In 2018 the Williams Report produced evidence that BAME registrants are over represented in the various fitness to practice processes operated by a number of professional regulatory bodies. The report did however stress that while BAME referrals are higher than expected, there is no suggestion that the regulators or their fitness to practice processes are discriminatory.
It should be noted that the GMC has taken to steps to increase BAME representation on their fitness to practice panels. As a result in 2015 BAME representation was present on 80% of MPTS panels.
In 2018 the GMC commissioned research into why BAME registrants are more likely than Caucasian registrants to be referred for fitness to practice proceedings. The research is being carried out by Roger Kline and Dr Doyin Atewologun into primary and secondary care which is provided across the UK.
The GMC hopes that this research will enable them to develop open working practices and to ensure that the GMC fitness to practice process is fair and appropriate.
The focus on developing open working practices would go some way to addressing the fact that a BMA survey which revealed that BAME healthcare professionals were twice as likely to say they would not feel comfortable raising concerns compared to their Caucasian colleagues.
These concerns are reflected in internal disciplinary processes. In research published in 2010 found that BAME staff were almost twice as likely to be disciplined as their Caucasian colleagues.3
The research conducted by Kline and Atewologon has already produced some indication as to the potential reasons behind the referral patterns mentioned above.
These include a culture of avoiding difficult conversations regarding a team member’s performance, an unfamiliarity with the unspoken rules of British medical practice, unapproachable leaders, a lack of openness and transparency, and a culture of blame where “outsiders” experience significant bias.
The GMC currently offers a voluntary “Welcome to UK Practice Programme” which is a half day course that registrants who are new to the UK can attend. The independent review identified that increased support is required to prepare registrants for the expectations and pressures facing doctors in the UK.
The independent review into GNM and CH included a valuable insight into the concerns of BAME healthcare professionals. At present there is arguably a heightened anxiety across healthcare professionals in the NHS about a culture of blame and punishment, and this is not an issue facing the GMC alone but the whole of the healthcare profession in the UK. However, the independent review identifies that the GMC is able to influence a culture of change by working with other bodies to encourage a change in how BAME healthcare professionals are treated in the healthcare profession and how they are supported in the work place.4
1 Re Ferner “Medication errors that have led to manslaughter changes” (200) BMJ
2 Williams Report 2018 p.43
3 Professor U Archibong and Dr A Darr, 2010 “The Involvement of Black and Minority Ethnic Staff in NHS Disciplinary Proceedings “
4 P.29 para 68
More information about the GMC’s independent review of gross negligence manslaughter and culpable homicide, and their final report can be found here.
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