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Recent reports have highlighted a shocking level of racism against medical staff within the NHS, including in primary care. Racial discrimination comes from colleagues, patients, and institutional biases, and presents in many forms. It impacts on staff well-being and career progression, and drives doctors to leave their jobs, which ultimately affects patient care.

In keeping with the theme for this October’s Black History Month, ‘Time for Change: Action not Words’, this article focuses on countering racism in primary care, to ensure that ethnic minority doctors are treated fairly and equitably in their workplace. GPs and their employers need to understand their responsibilities and know what they can do to challenge racism in daily practice.

Widespread racism in primary care has a profound impact

Sadly, the latest surveys show that racism is still pervasive across UK medicine. In the BMA racism in medicine survey, 76% of respondents, including GPs, said they had experienced racism at least once during the previous two years. Of those, 17% had experienced racist incidents on a regular basis. A Health Education England (HEE) survey also revealed a huge problem of racial discrimination and harassment in primary care in London, with about half of respondents reporting harassment or discrimination based on personal characteristics. The racism came from both patients (39%) and colleagues/managers (29%).

The impacts of racism against ethnic minority primary care doctors can be profound. Experiences of racism often affect doctors’ well-being, with negative effects including depression, anxiety, low self-esteem, insomnia, demotivation, and anger. Racism is also a barrier to career progression and many ethnic minority doctors perceive a ‘culture of fear’ as they are twice as likely as white doctors to be referred to the GMC by their employers. As a result of such discrimination, many ethnic minority primary care doctors have either left or considered leaving a job. Consequently, racism is exacerbating the problems of staff retention and recruitment, and thereby threatening patient care.

Employers’ responsibilities and workers’ rights

Tackling racism in primary care is critical to provide a safe and supportive working environment. This is reflected in health and safety law and in medical guidance; the BMA states, “All healthcare workers have a right to work in an environment free from abuse, harassment, and unlawful discrimination”.

Although there are few easy solutions, employers and staff should take steps to reduce the risk and impact of racism. The BMA racism in medicine survey includes examples of good practice, emphasising the importance of safe and open discussions, supportive managers who listen, diverse leadership teams, staff training, and appropriate policies implemented by engaged leaders.

Addressing racism in practice

The NHS has a zero tolerance approach towards violence and abuse against healthcare staff, and primary care staff should be familiar with the government’s violence reduction strategy, which aims to protect staff and ensure quick and effective punishment of offenders. Patients should be informed that racial discrimination and abuse towards primary care doctors is unacceptable and unlawful.

The BMA provides guidance on ‘How to manage discrimination from patients and their guardians/relatives’.

Key principles of the BMA guidance:

  • “Employers should take active and explicit steps to protect their staff from abuse, harassment, and unlawful discrimination. This should involve the police and social services where appropriate.” Employers who do not take such action could be subject to litigation.
  • “The impact of discrimination on doctors should be acknowledged and appropriate support including wellbeing interventions provided for those who are on the receiving end of abuse and discriminatory behaviours.”
  • Although all patients have a right to emergency healthcare regardless of their behaviour, where this can be provided safely, the right to non-emergency care is conditional.

GP practices can take active steps, providing:

  • Clear notices on premises and websites that unlawful discriminatory behaviour is unacceptable.
  • Zero-tolerance policies, and mechanisms for reporting and recording incidents.
  • Wellbeing support for staff members who experience racist incidents.
  • Bystander training for staff to respond effectively to racism.
  • Clear communication with any patient (or carer) exhibiting abusive or discriminatory behaviour, via a formal letter, to explain the impact of their behaviour and potential action that could be taken, such as reporting unlawful behaviour to the police.
  • In some cases, it may be necessary to remove a patient from the GP practice list. The BMA provides guidance on how to do this.

Doctors and their colleagues can take positive action

The GMC’s guidance on Leadership for all doctors states, “You must tackle discrimination where it arises and encourage your colleagues to do the same”.

The BMA advice includes the following points:

  • If a patient is abusive, make the environment safe if necessary; this may mean calling the police or security services.
  • Engage with the patient clearly, calmly, and objectively, to challenge the behaviour; give specific examples and explain that it is unacceptable.
  • Where the patient has requested a doctor with a particular characteristic, explain that this cannot be accommodated. Explain that the available healthcare professional is capable of delivering their care.
  • Ask the doctor concerned whether they are willing to continue to deliver care if the patient rescinds their request.
  • Explain to the patient the likely consequences of continuing their unacceptable behaviour in terms of their ongoing care. Ensure that they understand.
  • Note that if the patient needs emergency care or if the behaviour is related to an underlying medical condition, the situation may need to be handled differently, as explained in the BMA guidance.
  • Document the incident objectively and record any actions taken.
  • Where necessary, report the incident to the police.

Doctors on the receiving end of an incident are advised to talk to colleagues and managers about any concerns and the impact on their wellbeing, and to discuss with their employer what actions they would like to be taken. If no action is taken, they may consider making a formal complaint and should seek advice about how to do this.

If you have experienced or witnessed racial abuse or discrimination, please contact us at Medical Defense Society. Our team of medico-legal experts can support you and your practice in managing such incidents effectively and ethically.