A recent ruling that the GMC discriminated against a doctor on the grounds of race, calls into question the future role of the regulator, argue these authors
In a landmark case against the General Medical Council (GMC), an employment tribunal has ruled that a doctor was discriminated against on the grounds of race. The case was brought by Omer Karim, a consultant urologist, of Sudanese and Irish heritage, who worked at Heatherwood and Wexham Park Hospital NHS Foundation Trust, now Frimley Health NHS Foundation Trust. The Reading Employment Tribunal judges’ verdict, declared on 7 June 2021, is damning on how the GMC approached the case. [1] Karim claimed that he was targeted after he raised concerns about alleged poor practice at the hospital where he worked. In its ruling vindicating Karim, the tribunal said “UK graduate ethnic minority doctors are 50 per cent more likely to get a sanction or warning than white doctors.” The case is all the more relevant because of the direct comparisons made with the preferential treatment afforded to a white urologist, referred to as Mr L, who was also under investigation and who worked in the same department as Karim. The employment tribunal stated that two of the allegations were similar in both cases, and yet Mr L was let off lightly while the GMC continued to pursue Karim discriminately.
This case comes after a long line of some high profile, and many lower profile cases, of racism which have dogged the GMC for many years. The GMC has left a trail of devastation for doctors from ethnic minorities such as David Sellu and Hadiza Bawa-Garba. [2,3] They have felt the heavy hand of the regulator, and in some cases of the law, without any apology or compensation for professional and personal costs to their lives and careers.
For the purposes of the law, the GMC is a “qualifications body” under sections 53 and 54 of the Equality Act 2010, because it is responsible for registration of doctors. Therefore there is a requirement that in applying sanctions against doctors who might fall foul of the GMC, it is entirely impartial so that no doctor is sanctioned because of any bias. This case demonstrates that nothing much has changed in how the GMC tackles what appears to be an uncomfortable truth, “discrimination infecting the referral process,” as the employment tribunal has judged.
The British Association of Physicians of Indian Origin (BAPIO) was inaugurated in 1996. In the same year, two reports were published. One by the Audit Commission looking into its processes for determining a doctors’ fitness to practise. [4] The other was by the Policy Studies Institute looking into suggestions of racial bias in its handling of complaints against doctors. [5] Both reports concluded that deficiencies in the GMC’s data recording and decision making processes make it impossible to tell to what extent racial bias exists. These reports were commissioned following the revelation in 1994 by Esmail and Everington that ethnic minority doctors were over six times more likely to be investigated by the GMC than white doctors. [6] There are parallels that can be drawn between the structural and institutional racism in the NHS that we have witnessed and previously reported, to that witnessed in the GMC. [7]
We believe that the GMC is not doing enough to tackle racism in its own approach to regulation. Despite the problem first being raised in 1994, and a raft of reports—some of which were commissioned by the GMC itself— it is our contention that for too long there has been a lack of meaningful action in what seems to be an issue that is “difficult to tackle” for the GMC. Almost a third of the NHS medical workforce comes from an ethnic minority background, and there are lives that have been impacted by the GMC’s decisions, such as those of David Sellu, Hadiza Bawa-Garba, and the most recent and tragic case of Sridharan Suresh who took his own life when he was informed that he was going to be investigated by the GMC. [8]
In the case of Omer Karim, the GMC have announced that it will appeal the verdict. [9] In our view, this will simply create more anguish for ethnic minority doctors, who are firmly of the belief that the GMC is not tackling racism in medicine seriously. A more fundamental problem is that despite 27 years of research showing that the GMC has processes and structures which discriminate against ethnic minority doctors, it has failed to adequately address the problem. Failing organisations are sometimes judged to be irredeemable. If this ruling is upheld, it would be hard to justify how the GMC can continue its role in the regulation of doctors, when the employment tribunal has ruled that it has discriminated against a doctor on the grounds of race. Surely the time has now come for its role as the investigator of complaints against doctors to be removed, and a new organisation created, which must gain the trust of doctors and ensure that everyone is treated fairly and equally.
JS Bamrah, chairman, British Association of Physicians of Indian Origin
Ramesh Mehta, president, British Association of Physicians of Indian Origin
Sam Everington, GP and chair of Tower Hamlets CCG
Aneez Esmail, professor of General Practice
Competing interests: none declared
References:
1. Employment Tribunals report (2021). Karim+v+GMC+ET+Judgement.pdf (squarespace.com)
2. https://blogs-bmj-com.manchester.idm.oclc.org/bmj/2018/03/20/the-case-of-david-sellu-a-criminal-court-is-not-the-right-place-to-determine-blame-in-complex-clinical-cases/
4. Allen I, Perkins E, Witherspoon S. The handling of complaints against doctors. Report by the Policy Studies Institute for the Racial Equality Group of the General Medical Council. London: Policy Studies Institute, 1996.
5. Brearley S. Seriously deficient professional performance. BMJ 1996; 312: 1180–1
6. Esmail A, Everington S. General Medical Council. BMJ 1994; 308: 1374.
7. The NHS is 72 this year, covid-19 has taught us some tough lessons – The BMJ
8. https://www-bmj-com.manchester.idm.oclc.org/content/373/bmj.n1525
9. https://www.bmj.com/content/373/bmj.n1619