GP leaders have urged practices to do more to tackle racism and discrimination as a new report highlights ‘alarming’ disparities in patient experiences of primary care.
The NHS Race and Health Observatory has today published results from a survey which found that just under half of respondents (49%) had experienced ‘discrimination from their primary care providers based on personal characteristics’.
Former BMA chair and GP Dr Chaand Nagpaul, who is launching the report today, said it is ‘essential’ that practices use the ‘deeply concerning’ findings to improve engagement with their diverse communities.
The survey, carried out in 2022 with over 2,680 participants, highlighted a ‘worrying lack of trust amongst certain ethnic minority groups of the service or care that they receive’, according to the Observatory.
It found that a third of South Asian participants say they rarely or never trust primary care to meet their health needs, compared to 16% of White British participants who said the same.
Patients from Bangladeshi, Pakistani, non-British White, and Black communities all reported significantly poorer experiences in primary care compared to White British patients.
The report, based on analysis of the survey data by the University of Oxford, also raised concerns about the ‘lack of medical competence’ and ‘cultural awareness’ around health conditions such as sickle cell disorder or lupus which ‘disproportionately affect ethnic minority communities’.
Responses from women highlighted complaints that primary care providers ‘ignore, or minimise, the reporting of pain’ due to their being a woman or a person of colour.
More findings
- Only half (55%) of participants trust primary care to meet their health needs most or all of the time;
- 38% of Asian participants and 49% of Black participants reported that primary care providers treat them differently due to their ethnicity;
- 31% of Bangladeshi and Pakistani participants felt that, when they do access primary care, healthcare professionals do not act on their concerns;
- Compared with 17.5% of White British participants;
- 25% of all participants felt they were treated differently in primary care due to their ethnicity;
- 51% of those who reported some form of discrimination said it was because of their ethnicity;
- Among Black Caribbean and Black Other participants, over 50% reported discrimination due to ethnicity.
Source: NHS Race and Health Observatory
The report made a number of recommendations for healthcare bodies, including a call for NHS England and the RCGP to ‘raise awareness’ among GPs and other healthcare professionals about racial and ethnic disparities in patient experience.
There should also be continued investment in ‘cultural competency’ training by the RCGP, as well as a framework from the CQC or NHS England to ‘hold healthcare providers accountable’ for addressing disparities, according to the Observatory.
RCGP chair Professor Kamila Hawthorne said that patients ‘must be able to access care without facing discrimination’, and stressed that GPs ‘all have a responsibility’ to recognise that racism continues to be a ‘very real issue’.
She said: ‘This report makes for very difficult reading – it is disheartening to see the number of patients who report negative experiences in primary care.
‘It is critical that all branches of our health service, including general practice, take every necessary measure to prevent this kind of behaviour.’
Professor Hawthorne also pointed to the ‘unprecedented pressure’ GPs are under due to underfunding and ‘poor workforce planning’.
She added: ‘GPs need more time to spend with their patients so that they get the care they deserve. The current Government’s pledges for general practice sound encouraging. We now need to make these promises a reality, otherwise it is our patients who will bear the brunt.’
Dr Nagpaul, who is chairing a roundtable on the report today, called on GPs and other primary care providers to use report findings to improve care for their populations.
He said: ‘It is deeply concerning to hear of poorer experience, racial bias and discrimination faced by patients of ethnic minority groups and the negative impact this has on their engagement with the health service and the care they receive.
‘It is essential the primary care sector use this insight report from patients to improve communication and health care delivery for our diverse population of patients who need support and compassion to equitably support and treat their health needs.’
The roundtable today will also launch work to tackle low levels of vaccine uptake in hot-spot areas such as East London.
NHS England said the report’s findings ‘clearly outline an unacceptable variation’ in patient experience of primary care, as ‘all patients, regardless of background, deserve the best care’.
A spokesperson continued: ‘We remain committed to reducing inequalities in care, which is why we are currently working with local NHS organisations to make care fairer for all – and with the government on the upcoming 10-year health plan to build a service fit for the future.’
You’ve got to love Carr Hill.
When you consistently take funding away from urban areas and give it to rural areas.
I come from an ethnic minority background myself.
Determining whether discrimination in healthcare is real or just perceived is incredibly difficult. Just because a patient feels they were treated unfairly doesn’t mean they actually were. How do they know the white patient next to them is getting better care? Are they comparing identical cases, or is their experience just a reflection of how the NHS operates for everyone?
We recently had a difficult patient at our practice who would throw around accusations of racism whenever she didn’t get exactly what she wanted. She was from the same ethnic background as me, which made it even more frustrating. Was she actually experiencing discrimination, or was she just using it as a weapon to demand more than what was clinically appropriate? Our practice does not discriminate. Fact.
If we really want to investigate potential discrimination, we need proper evidence-based research. A good study would compare outcomes for patients of different ethnic backgrounds with the same condition, looking at whether they receive the same investigations, referrals, and treatments.
The reality is that dissatisfaction with care doesn’t automatically equal discrimination. The NHS is stretched thin, and inefficiencies affect everyone. Sensationalist journalism, like this article, thrives on these opinion surveys rather than objective facts, creating a narrative that isn’t always backed by solid data.
Facts, not feelings, should drive discussions about discrimination in healthcare. If disparities exist, they need to be proven with objective research—not lazy surveys that tell us nothing about the real causes of patient dissatisfaction.
I think it is a very hard area to investigate – and the change in figures is perhaps the most important factor.
When looking at experience, I’d say it’s very hard. I’m sure a white and black 50 year old newly diagnosed with hypertension for example would wonder why they have been given different first line medicines; but it is nothing to do with racism.
“Methods: An online survey was created using Qualtrics. To recruit participants, the survey was advertised via the RHO’s social media accounts (LinkedIn and Twitter), and was also distributed through stakeholder networks using email and Whatsapp. It was also distributed through a GP surgery’s contact list in London. The advert stated that the survey was intended to assess how Black, Asian and ethnic minority communities trust the NHS Primary Care services they engage with.”
Perception is different to reality.
When you experience an inadequate service (yes, because of Carr-Hill) in a deprived urban area, that might just be because of where you live and inadequate resourcing of primary care, rather than a form of discrimination based on race.
Especially considering that practices serving deprived areas with high proportions of BAME and immigrant patients typically have a high proportion of GPs who are themselves IMGs. This ‘news’ might be demoralising to those GPs and practices.
Being paid to participate in a “round table” would be a great way to spend a friday
Agree with KC above and comments re poor funding for inner city. I’d question the basis and methodology of this report and I’d suspect its meaning and timing. Eg., is it BAME patients complaining of discrimination by IMG drs or by White drs? I also think these issues can become charged and easily politicised especially by the extreme right in their culture war.
My brother in law, an Indian IMG in a 6 partner inner city practice for 15 years with a high BAME population, has often said that patients originally from South Asian countries bring their “home” values and prejudices with them into the UK and this can lead them to view that race, caste or religion has played a part in their treatment as these issues are live and real also in their countries of origin. Moreover, on the contrary, he tells stories of South Asian patients refusing to see one of the GP’s who they say is “a lower caste” or a GP who’s from a different religion or Asian country as they’re “not one of us” !
But two points we’ve distilled are that early integration by overseas patients into UK’s Public values is crucial (while keeping one’s Private identity) and, notwithstanding past histories, that the UK is one of the fairest countries in dealing with its multiracial issues.
Points taken as regards validity or otherwise of these sorts of poorly recruited satisfaction surveys, but the results are the results – or are they? If this was a formally conducted patient survey 40 years ago when I first tip toed into General Practice as a GP assistant “with a view” racism and misogyny appeared to be rampant amongst the mainly white male GP partners. But hang on 40 years has slipped by the vast majority of current GPs (>60%) are from ethnic minorities (most of whom gained their primary medical degree overseas) and barely any GPs these days are white men (16%) with UK medical degrees. So who is doing all this racial discrimination of patients – sounds as if the tiny minority of todays (16%) white male GPs must be incredibly busy with their racism and misogyny? I don’t think so. Are ethnic minority GPs who make up the majority of todays GP workforce really so racist and misogynistic? I would have thought unlikely given the majority qualified overseas and since coming to the UK, will have seen first hand and experienced the racist nature of the Great Brexit population – why would they then inflict the same reprehensible behaviour towards their vulnerable patients – perhaps its part of trying to fit in? I sincerely hope not. Ps I’m deeply saddened that I happen to share a 1st name with UK’s Klu Klux Klan leader – my deceased parents fault
Nigel, count your blessings. At least they didn’t name you Adolf or Oswald….
I wonder how many FTE GPs could be funded by the abolition of the NHS Race and Health Observatory? Sounds like they are justifying their own existence to me. No fan of Elon here, but really…
How much is this related to different health expectations from experiencing different health care systems?
good example–different races react differently to some medications. I guess the difficulty will be in persuading white or black of this fact if they do not want to believe you.