A recent analysis conducted by researchers at the University College London (UCL) on performance assessment data by the UK’s General Medical Council (GMC) between 1996 and 2013 found that foreign doctors, especially Indians, were five times more likely to undergo the appraisal than British doctors – even though doctors with Indian medical qualifications are the second largest group in the National Health Service (NHS), after those trained in the UK.

The study, which looked at GMC’s fitness-to-practice (FTP) investigations conducted when complaints are made by patients or the police, found that doctors trained in non-EU countries were more likely to face these performance appraisals – with Bangladeshi doctors 13 times more likely to face investigations, and Egyptian and Nigerian doctors faring eight times more – indicating an inherent racial bias within the NHS.

Foreign healthcare workers, the backbone of NHS

According to a report by the Organisation for Economic Co-operation and Development (OECD), Britain heavily relies on foreign doctors, more so since more healthcare workers from the UK are choosing to move abroad.

In a race to increase GP numbers by 5,000 by year 2020, the NHS recently increased its recruitment of Indian doctors by signing a ‘memorandum of understanding’ with Apollo Hospitals in India. The agreement provides Indian medical graduates with two to three years of training in the UK and simultaneously fills GP shortages.

"We welcome any expressions of interest from doctors outside of the EU wanting to work in the NHS - but they would first have to undergo GP specialty training, and pass our rigorous entrance assessment. They would also have to pass the GMC's professional linguistic and assessments board test,” said Dr Maureen Baker, chairwoman of the Royal College of GPs.

Xenophobic bias within the medical system

However, there are other sources to suggest an increasing xenophobic sentiment within the health service. For instance, a separate NHS Workforce Race Equality Standard (WRES) report published last year showed that at 81% of medical trusts, more Black and Ethnic Minority (BME) staff reported personal experiences of discrimination from supervisors and colleagues compared to white staff members.

Most BME staff also did not believe that their organisations offered equal career progressions, a claim substantiated by the 2014 NHS report, which found that only 5.8% of members in the NHS trust were from BME backgrounds.

That same year, the British Association of Physicians of Indian-origin (BAPIO) launched a high court battle claiming the GMC was deliberately failing foreign doctors taking GP tests.

"There is no doubt that there is an inherent problem within the system,” said BAPIO president Dr Ramesh Mehta.

“BAPIO has always spoken up for fairness and equality. We are very proud of the services given by Indian doctors and while we do believe things are gradually improving, we are still concerned there continues to be differential treatment."

Other factors may be at play

The WRES has led the NHS to invest £2 million in 2015 to 2017 to identify and share methods of improving recruitment and career progression, and to reducing bullying as well as harassment of BME staff.

According to chief executive of the NHS Simon Stevens, “these staff survey results are both deeply concerning and a clear call to action. As this is the first year of the WRES, it provides a transparent baseline from which each employer will now be seeking to improve.”

Co-author of the recent UCL study, Dr Henry Potts, added that racism was unlikely to be the only factor of bias within the health system. “We have raised these issues and we think more research is needed to tease apart different explanatory factors," he said.

To differentiate between racism and poor conduct, the report recommends the NHS apply a more globalised assessment method to better identify doctors more suited to work in the UK.

"We believe doctors and patients are best served by bringing in a single route to UK practice, replacing the multiple routes that exist now,” said Deputy Chief Executive of the GMC, Susan Goldsmith.

"We are now consulting on a medical licensing assessment that would be taken by every doctor wishing to practise in the UK, regardless of where they qualified in the world." MIMS

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