Reducing disproportionality in fitness to practise concerns reported to the GMC

Abstract

This research was commissioned to understand why some groups of doctors are referred to the General Medical Council (GMC) for fitness to practise concerns more, or less, than others by their employers or contractors and what can be done about it. In the UK, certain groups of doctors are more likely to be subjected by employers and healthcare providers to formal local disciplinary process. These groups of doctors are also more likely to be referred to the UK regulator, the GMC by their employers or healthcare providers. In particular, Black, Asian and Minority Ethnic (BAME) doctors, overseas graduates, older male doctors and some non-specialist doctors are more likely than their counterparts to be referred to the GMC by employers or healthcare providers. BAME doctors have more than double the rate of being referred by an employer compared to white doctors. Non-UK doctors have 2.5 times higher rate of being referred by an employer compared to UK graduate doctors. Previous research and analyses have not identified substantive evidence of bias in decision-making by the GMC, yet concerns remain regarding the considerable differences in the patterns of complaints about different groups of doctors received by the regulator. This independent research aims to identify the factors that lead to, and consequential processes adopted prior to, employers making a decision to refer a doctor to the GMC for fitness to practise (FtP) concerns. Further, this study seeks to understand how these factors may contribute to patterns of disproportionality (that is, the over and under representation of certain types of doctors) in referrals from employers, and makes recommendations for change with a view to reducing these patterns of disproportionality. Although the NHS is a national service, each nation has services structured and governed in slightly different ways and there is wide variation in their culture and approach. Our recommendations seek to address factors we have identified as common, but we are conscious that some Trusts will have strong, positive leadership and an inclusive culture and may have already addressed some or all of the recommendations while others will not have addressed any. Similarly, more or less progress will have been made across the four nations of the UK. Our intent is to improve consistency across all NHS Trusts, Boards and Health Boards in relation to the issues raised in this review by ensuring all NHS Trusts, Boards and Health Boards model the approach of those doing good work in this area, and, that there is similar impact across the UK