Fair to refer

What were the key findings?

The research identifies six key factors that help to explain the higher rates of referrals the GMC receive from employers of certain groups of doctors. 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 because 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 therefore develop.
  • Some doctors are provided with inadequate induction and/or ongoing support in transitioning to new social, cultural and professional 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, not seeking the views of less senior staff and not welcoming challenge and this can allow divisive cultures to develop.  
  • Some organisational cultures 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 (including by country and within the UK by medical school) and ethnicity (including within BME populations). 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 who obtained their primary medical qualification outside the UK and those who are from a black and minority ethnic background to the GMC than they are to refer their UK qualified or white peers. This is particularly important as complaints from employers are more likely to result in an investigation being opened and, ultimately, more likely to result in a sanction being applied, than complaints from other sources. We commissioned this research to understand why this disparity exists and to identify steps that can be taken to reduce it. 

What did the research involve?

A rapid literature review and stakeholder engagement informed sample selection and identified themes to explore. Across the UK, in primary care interviews and focus groups were carried out with 41 doctors; in secondary care 15 case studies of organisations were undertaken; in each case study doctors of all levels of seniority and other relevant staff (e.g. HR directors) took part in interviews and focus groups.

Full report

Download the Fair to refer research