Fair to refer?
What were the key findings?
The research identifies six key factors that help to explain the higher rates of referrals. These factors aren’t always present together, but do often compound each other:
- Doctors in diverse groups do not always receive effective, honest or timely feedback. Some managers avoid difficult conversations, particularly where that manager is from a different ethnic group to the doctor. This means that concerns may not be addressed early and can develop.
- Some doctors are provided with inadequate induction or support in transitioning to new environments.
- Doctors working in isolated or segregated roles or locations lack exposure to learning experiences, senior mentors, support and resources.
- Some leadership teams are remote and inaccessible. They do not seek the views of less senior staff and do not welcoming challenge. This can allow divisive cultures to develop.
- Some organisations respond to things going wrong by trying to identify who to blame rather than focusing on learning. This creates particular risks for doctors who are ‘outsiders’.
- In groups and out groups exist in medicine including relating to qualifications and ethnicity. Members of ingroups can receive favourable treatment and those in out groups are at risk of bias and stereotyping.
The researchers identified recommendations in four key areas to help address the issues they identify:
- Improving induction, feedback and support for doctors new to the UK or the NHS or whose role is likely to isolate them (such as SAS doctors and locums).
- Addressing the systemic issues that prevent a focus on learning, rather than blame, when something goes wrong.
- Ensuring engaged, positive and inclusive leadership is more consistent across the NHS.
- Developing a UK-wide mechanism to ensure delivery of the recommendations.
Why did we commission this research?
Employers and healthcare providers are more likely to refer doctors to the GMC if they qualified outside the UK, or if they are from a black and minority ethnic background, compared to their UK-qualified or white peers.
This is important because employer complaints are more likely to lead to an investigation — and investigations are more likely to result in a sanction than complaints from other sources.
We commissioned this research to find out why this gap exists and what can be done to reduce it.
What did the research involve?
A rapid literature review and stakeholder engagement shaped the sample selection and identified themes to explore.
Across the UK, the research covered both primary and secondary care:
- In primary care, interviews and focus groups were held with 41 doctors.
- In secondary care, 15 organisational case studies were carried out, with doctors at all levels of seniority and other relevant staff — such as HR directors — taking part in interviews and focus groups
