‘Stamp out racism to secure the future of NHS’

THE General Medical Council’s [GMC] chief executive has recognised discrimination in medicine is, “persistent and pernicious.”

This is an essential first step: ethnic minority doctors are subject to disproportionate GMC complaints and referrals. Although the GMC’s recent equality, diversity and inclusion report highlighted progress towards closing this gap, we can’t afford to ignore this issue. Racism in the NHS must be stamped out if we are to create a system that works for everyone.

International Medical Graduates – professionals who qualified overseas and are registered to practise in the UK – are the backbone of the NHS. According to the 2023 GMC workforce report, over half (52 per cent) of doctors who joined the workforce in 2022 were IMGs. The top five countries that IMGs joined the NHS from were India, Pakistan, Nigeria, Egypt and Sri Lanka.

But despite being essential to the functioning of the NHS, a 2023 MDDUS survey of healthcare professionals found that 58 per cent of IMGs had experienced racist microaggressions. These are patterned behaviours that (intentionally or unintentionally) undermine, belittle, stereotype, or insult those in minority ethnic groups.

Examples of racist microaggressions might include patients asking for a white British doctor, questioning an IMG doctor’s ability to speak English, or telling an IMG doctor to use a different name that is easier to pronounce.

The psychological impact of racism – even so-called ‘microaggressions’ – shouldn’t be underestimated. Every instance can be painful, and over a long period of time this can become especially draining. It can significantly impact emotional wellbeing and mental health.

Doctors are already stretched to breaking point. They face the pressures of the ongoing impact of the pandemic, lack of funding, staff and medicine shortages and high workloads.

Unsurprisingly, doctors of all backgrounds are feeling stressed, burned out and looking for a way to leave the NHS. For those from ethnic minority backgrounds, facing racism adds yet another unwelcome burden.

The NHS can’t afford to lose experienced professionals. It urgently needs IMG doctors to support hospitals and GP practices and would collapse without them. Experts believe that if the current number of IMGs falls back to levels seen before the pandemic, there will be 23,000 fewer doctors in the UK by 2030.

When NHS staff were attacked during the racist, Islamophobic riots in August, health secretary Wes Streeting said people abusing NHS staff, “can be turned away and should be turned away.”

This verbal commitment to a zero-tolerance of racism is a step forward, but to be effective, it must be reinforced with action. Staff should be able to feel empowered to turn patients away and report instances of racism, knowing that they will be backed by their managers, NHS Trusts, health boards and regulator.

But, of the 58 per cent of IMGs who had experienced racist microaggressions, 76 per cent didn’t report it to their manager. They didn’t have confidence their concerns would be listened to or taken seriously and feared the impact it might have on their jobs.

The GMC, as the regulator for the medical profession, must use its influence with NHS Trusts and health boards to ensure doctors can confidently report concerns about racism through processes that are accessible and trusted to deliver results.

However, given the GMC’s history of treating healthcare professionals differently based on race, it is unsurprising that 41 per cent of IMGs feared the impact reporting incidents of racist microaggressions might have.

I often hear from IMG doctors, worried a low-level complaint or concern about them will be referred to the GMC, almost by default and in contrast to their non-IMG colleagues. I know the devastating impact receiving correspondence about a GMC investigation can have on a doctor’s wellbeing, including the uncertainty of what will happen next and if they will be able to continue practising medicine.

The progress made by the GMC to address the disproportionate referrals of ethnic minority doctors is encouraging. I hope that work develops until we reach a time where all doctors receive the respect support and appreciation they deserve, irrespective of their ethnic background.

 Dr Naeem Nazem is the head of the medical division for the Medical and Dental Defence Union of Scotland (MDDUS). He qualified as a doctor in 2002, before specialising in neurology. He began his legal training in 2008 and gained a first-class honours degree in law. Dr Nazem joined MDDUS in 2013.