Disparities in fitness to practise referrals based on ethnicity have continued to reduce, but the GMC has admitted that more needs to be done.
The regulator’s annual update on progress in tackling discrimination indicated that it will be ‘close to achieving’ its target on eliminating disproportionality in referrals by 2026, and that gaps in specialty training attainment are ‘narrowing’.
But the report also revealed a ‘disappointing’ lack of improvement on reducing disparities in earlier stages of education, and chief executive Charlie Massey declared today that ‘inequality is embedded in medicine throughout a doctor’s career’.
He stressed that ‘cultural upheaval’ and a ‘focus on longer-term systemic issues’ are needed in order to eradicate these ‘persistent and pernicious inequalities’.
The report showed that the gap in referral rates in the five years up to 2023 was 0.13 percentage points, where 0.31% of ethnic minority doctors had a referral compared with 0.18% of white doctors.
This marks a decrease from the 0.19 percentage point difference in the 2018-2022 period, and the 0.28 point difference in 2016-2020.
Calculating the disparities over five-year periods with a ‘time lag’ means that the GMC is unlikely to know ‘with certainty’ in 2026 whether it has achieved its target.
But the report said: ‘Forecasts for [Fairer Employer Referrals] key performance indicators (KPIs) show that we expect to be close to achieving our targets by the end of 2026.’
In 2021, in addition to the target on disproportionate FTP referrals, the GMC also committed to eradicating disadvantage and discrimination in medical education and training by 2031.
The latest data shows that the gap in specialty training attainment for international medical graduates (IMGs) compared to UK-qualified doctors has narrowed only very slightly from 22.7 percentage points in 2022 to 22.1 points in 2023.
However, there has been an overall decrease of 7.1 percentage points since 2019.
Disparities between white and ethnic minority doctors on preparedness for foundation year 1 posts have noticeably increased over recent years, from 7.8 percentage points in 2019 to 11.7 in 2023.
The GMC said that this deterioration ‘needs to be understood’, but work to improve this has a ‘long lead-time’ with the impact only expected to be measurable from next year.
Setting out its plans for the next year, the GMC said it is ‘particularly keen’ to expand its influence into primary care, since work in previous phases ‘focused on secondary care’ and ‘more work is needed’ in settings such as GP practices.
The regulator also called on NHS leaders across the UK to ‘mandate’ the recently launched induction for IMGs and to deliver a ‘suite of anti-racism resources’ in order to help tackle inequalities in referrals.
Mr Massey said: ‘There is real will across the system to deliver meaningful change. And, as this report shows, efforts are bearing fruit.
‘But, although we’re positive about the improvements we have seen, there is more to do. A fairer system is a stronger system, and it is in all our interests to deliver it.’
The MDDUS said that reducing disproportionate referrals is a ‘critical task’ for the GMC, and the medical defence organisation welcomed this latest report which showed the ‘gap is narrowing’.
Head of medical Dr Naeem Nazem said: ‘The fact so many IMGs have little or no faith in the process for reporting their concerns about racism should serve as a call to action for the entire healthcare system.
‘This is especially the case for the GMC, given it has said it wants to make whistleblowing effective.’
The Medical Protection Society (MPS) said the report ‘shows there is still a long way to go to eradicate discrimination and inequality in medicine’.
President Professor Dame Jane Dacre said: ‘While we welcome the progress that has been made in recent years, the current disparity continues to be worrying.
‘All doctors have the right to a fair and inclusive environment and more action is needed to stamp out disproportionate referrals by employers against ethnic minority doctors and those who qualify outside of the UK.’
Last year, the GMC’s same report suggested that it was ‘likely’ on track to achieve its target of eliminating disproportionate referrals.
President Professor Dame Jane Dacre was coorect when she said: ‘While we welcome the progress that has been made in recent years, the current disparity continues to be worrying”. The issues raised in the report about disparities in fitness-to-practice (FTP) referrals and broader inequalities in medicine reveal deep-seated problems that I believe stem from five core factors: lack of continuity of care, insufficient collegiality, inadequate interaction between healthcare systems, cultural barriers, and a misunderstanding of what true diversity means.
1. Lack of Continuity of Care and Understanding of a Person
Continuity of care, not just for patients but within professional teams, is fundamental to fostering a deeper understanding of individual doctors. In healthcare systems where doctors, particularly ethnic minority doctors or international medical graduates (IMGs), are moved frequently or work under transient supervision, their competencies are often judged based on isolated incidents. This lack of personal and professional continuity increases the likelihood of disproportionate FTP referrals because these doctors aren’t given the benefit of being seen over time, in different contexts, and as growing professionals. Continuous professional relationships are critical in developing a more nuanced, supportive approach rather than relying on punitive measures.
2. Lack of Collegiality
A significant factor in these disparities is the lack of true collegiality within medical teams. Collegiality is vital for offering support, mentoring, and integrating individuals into the team’s culture. In my international experience, I’ve seen how systems in countries like Canada or New Zealand emphasize peer support and guidance, which can make a significant difference in the performance and career progression of ethnic minority doctors and IMGs. In contrast, in environments where collegiality is lacking, these individuals can feel isolated, excluded from professional networks, and without the same informal support structures that could help them navigate complex workplace issues. This lack of collegiality can contribute to increased FTP referrals, as minority doctors are often left vulnerable and unsupported.
3. Insufficient Interaction Between Healthcare Systems
As someone who has obtained medical qualifications and worked across multiple continents—USA, Canada, UK, Italy, and New Zealand—I have witnessed firsthand the challenges that arise from insufficient interaction between healthcare systems. Each country has unique strengths in medical training and practice, but in the UK, IMGs are often left to bridge these differences on their own, without enough structured support. The discrepancies in FTP referrals often arise because IMGs are judged by UK-specific expectations, without accounting for the value their international training brings. Countries like New Zealand and Canada, where healthcare systems are more open to fostering interaction and integration with foreign-trained doctors, tend to show more equitable treatment and greater success in integrating IMGs. The UK healthcare system must improve cross-system communication and provide better transitional support for IMGs to ensure fair treatment.
4. Cultural Barriers and Embedded Inequality
The report highlights that inequality is culturally embedded in the medical profession, and I can confirm this from my international experiences. In countries where there is a stronger focus on inclusion and understanding cultural differences, such as New Zealand, ethnic minority doctors are better supported and seen as assets rather than outliers. In contrast, the UK still struggles with deeply entrenched biases that result in ethnic minority doctors and IMGs being disproportionately referred for FTP. A shift in culture is urgently needed to break down these barriers and promote an environment that values diversity not just in appearance but in thought, experience, and approach. As an international professional, I’ve seen how healthcare cultures that are inclusive of diverse practices—both clinical and cultural—create healthier, more supportive environments for all doctors.
5. Misunderstanding Diversity
One of the most critical issues is the misunderstanding of diversity. From my experience across different continents, I know that diversity should not be reduced to just ethnicity or skin color; it’s about embracing the range of experiences, perspectives, and training backgrounds that doctors bring to the table. Discrimination often arises when differences in approach are misinterpreted as inadequacies. The UK’s current system tends to overlook the rich diversity of clinical experience and methods that IMGs contribute. In healthcare systems like those in Canada or the USA, there is often more acknowledgment of the value that diverse medical backgrounds bring, which results in fewer discriminatory outcomes. The UK must move beyond surface-level diversity initiatives and recognize that different educational and clinical experiences can enhance the system, rather than viewing them as deficiencies.
In conclusion, my international experience in diverse healthcare systems has given me a clear understanding of how different approaches to continuity of care, collegiality, system interaction, and the understanding of diversity can either perpetuate or mitigate the disparities we see in FTP referrals and career progression for ethnic minority doctors. To make real progress, the UK must embrace a cultural shift, foster stronger relationships within teams, and promote a more inclusive understanding of diversity. Only then will we begin to see a true reduction in the disproportionate referrals and inequalities that continue to plague the profession.
Or just give doctors the time, resource and authority to do their job without pandering to every single person who wishes to make a vexatious complaint.
Thanks Edoardo for sharing the broad based experience and views. It goes to show how deficient in support we are. The profession currently lacks confidence in the GMC and the CQC. How can a person who has no medical degree or has ever work in a health care system lead or inspect. It is not sensible and makes us a laughing stock internationally. If I were to be asked to inspect a bank ort heating system, I would not dare to take on a job that I have no experience or I am not qualified for. This is pure arrogance and having a cavalier attitude.