Racism in the workplace 

Tackling discrimination and creating an inclusive working environment is everyone’s responsibility. This includes employers making sure that organisational policies and practices create an inclusive non-discriminatory environment.

This section sets out advice for doctors witnessing racism from colleagues and patients. It includes sections on:

• Advice for doctors with extra responsibilities tackling racism and supporting doctors in training
• What you can do if you witness racism
• Information on active bystander training
• Treating patients with respect and patients reporting racism

You don't have to be the subject of the abuse to tackle it. All doctors have a responsibility to tackle abuse where it arises.

If you see something that you view as racist abuse, consider how best to act in the moment and support the individual who has experienced that behaviour. 

Peoples’ perceptions of unacceptable behaviour can differ – it is important to recognise that certain words and actions may cause offence to some individuals and not to others. Being an active bystander also includes acting in situations in which the person who has experienced the behaviour considers it abusive. 

What is racism? 

The definition provided by the Institute of Race Relations states that racism is the belief or ideology that ‘races’ have distinctive characteristics which gives some superiority over others. It also refers to discriminatory and abusive behaviour based on such a belief or ideology. In the UK, denying people access to goods and services on the basis of their colour, nationality, ethnicity, religion etc is illegal and called racial discrimination.

Doctors with extra responsibilities tackling racism

The BMA’s Racism in medicine report showed how many experiences of racism go unreported as individuals feel that their concerns wouldn’t be addressed and fear they’d be ‘perceived as a troublemaker’.

Doctors who are in any form of leadership or management roles are responsible for actively creating or maintaining a positive working environment free from discrimination. 

This could include:

• Addressing reports of discrimination that are brought to your attention directly – in cases where this isn’t appropriate, support colleagues who wish to escalate their concerns.
• Providing a safe space – or route – for colleagues to share concerns of harassment or discrimination.
• Becoming familiar with routes to escalate concerns or signpost colleagues to.
• Use your influence to create an open and inclusive culture in which staff feel supported to speak up. We signpost to advice for employers in our section on tackling discrimination as a healthcare provider – this includes links to resources produced by several organisations. 

Our case study, in the section on experiencing racism in the workplace, demonstrates the importance of you taking reports of racism seriously and not assuming there is an alternative explanation. It also shows the positive impact that senior support has on staff in the workplace. 

The BMA report, Delivering racial equality in medicine, outlines further recommendations for implementing structural measures to reduce discrimination. While these recommendations are primarily targeted at employers, these can be considered at a local, individual level by those with a role in managing staff and resources.

Supporting doctors in training and medical students

The need to take reports of racism seriously and support colleagues also applies to those supporting and managing doctors in training and medical students. Our standards for medical education and training, Promoting excellence, make clear that learners must not be subjected to, or subject others to, behaviour that undermines their professional confidence, performance or self-esteem (R3.3).

What you can do if you witness racism

It may be difficult or intimidating to speak up in instances where you witness racism. But there is no one single way to act and there is always something that can be done to tackle discrimination. For example:

• If you’re able to – and feel it’s appropriate and safe to, speak up in the moment and address the colleague or patient that is demonstrating racist behaviour.
• Report the incident to a senior member of staff, HR or via a different route.
• If racism is directed at your colleague by a patient, consider privately offering support to your colleague and ask if they are comfortable still treating the patient.
• If you don’t feel you can intervene in the moment, record the incident by writing it down as soon as possible. Follow it up later by checking in with the colleague the behaviour was directed at to see if they’re ok and if they would appreciate support.
• Find out about relevant local training i.e. our Professional Behaviours & Patient Safety programme.
• If you’re considering raising a concern with us, you can visit our supporting you with your concern page, which provides further information on our processes and whether we’re best suited to help with the issue you’re bringing forward.

Active bystander training

Active bystander training sets people up with the skills to tackle discrimination when they witness it. Workshops are offered by a range of healthcare employers and training providers across the UK including: 

• NHS England 
• Health Education and Improvement Wales (HEIW) via their Professional Support Unit. 
• NHS Education for Scotland (NES) education. 
• The Royal College of General Practitioners (RCGP) also provide an eLearning course for their members.

The impact of micro-aggressions

Treating patients with respect

Doctors must never discriminate unfairly against patients. No patient should experience discrimination at the hands of their healthcare provider. If you witness a colleague expressing racist behaviour towards a patient, follow our guidance:

• You must treat patients fairly. You must not discriminate against them or allow your personal views to affect your relationship with them, or the treatment you provide or arrange. You must not refuse or delay treatment because you believe that a patient’s actions or choices contributed to their condition. (Good medical practice, paragraph 19)
•  You must not abuse, discriminate against, bully, or harass anyone based on their personal characteristics, or for any other reason. By ‘personal characteristics’ we mean someone’s appearance, lifestyle, culture, their social or economic status, or any of the characteristics protected by legislation – age, disability, gender reassignment, race, marriage and civil partnership, pregnancy and maternity, religion or belief, sex and sexual orientation (Good medical practice, paragraph 56)
•  If you witness any of the behaviours described in paragraphs 56 or 57 you should act, taking account of the specific circumstances. For example, you could:

1. check in and offer support to anyone targeted or affected by the behaviour, and/or let them know that you feel that the behaviour you witnessed is unacceptable
2. challenge the behaviour by speaking to the person responsible – either at the time, if
   safe to do so, or at an appropriate time and place
3. speak to a colleague and/or consider reporting the behaviour in line with your workplace policy and our more detailed guidance on Raising and acting on concerns about patient safety. Before you report the behaviour you witnessed, try and make sure that the person who was targeted is aware of, and supports, your intention to report it. 

We recognise some people may find it harder than others to speak up4 but everyone has a responsibility – to themselves and their colleagues – to do something to prevent these behaviours continuing and contributing to a negative, unsafe environment  (Good medical practice, paragraph 58)

• When making decisions about using resources, you must make sure that decisions about setting priorities that affect patients are fair and based on clinical need and the likely effectiveness of treatments, and are not based on factors that may introduce discriminatory access to care. (Leadership and management for all doctors, paragraph 85.3)
• All doctors have a duty to raise concerns where they believe that patient safety or care is being compromised by the practice of colleagues or the systems, policies and procedures in the organisations in which they work. They must also encourage and support a culture in which staff can raise concerns openly and safely. (Raising and acting on concerns about patient safety, paragraph 7)

You can also consider acting in the moment using some of the tools listed in this resource. This could include challenging a colleague’s behaviour or raising a concern in line with local policies. 

If a patient reports having experienced racism 

A patient may report to you that they’ve experienced discrimination that you either haven’t witnessed or relates to care they’ve received from a provider/specialty separate from your own. In this instance, you can direct them to our local help services page, which signposts to different support services available in each country – this includes complaints processes for private providers. 

Anyone working in healthcare should not tolerate racism from colleagues or patients. Employers should have robust local policies in place to protect all staff from such abuse at work. 

This section sets out advice for doctors experiencing racism from colleagues and patients. It includes sections on: 

• Advice if you’ve experienced racist behaviour from a colleague 
• Responding to racist behaviour from patients, which includes specific advice on emergency settings and advice for GPs
• Patients in non-emergency settings refusing to be seen by doctors of a particular ethnicity
• Racism from those close to the patient

The ways in which discrimination is expressed can be wide-ranging. It can be expressed through micro-aggressions, discriminatory behaviours, and through actions and comments which could be seen as jokes or friendly exchanges, but can cause offence. It is the responsibility of senior colleagues and employers to create an environment which supports staff in reporting these instances and speaking up. 

Experiencing racist behaviour from a colleague

Follow the steps and advice set out on our speaking up page. This includes specific information on:

• How to speak up within your organisation
• Organisations that can support you
• Practical tools and advice to help you 
• Advice on raising concerns externally
• A visual guide to help you decide how to raise your concern and get the right support.

The BMA also provide advice for doctors on what to do if you’re discriminated against.

If you’re experiencing bullying or harassment by a colleague online, while these pages remain relevant, you can also visit our social media page. This contains further advice and makes clear that abusive comments that discriminate against someone based on a protected characteristic, are always unacceptable.

Responding to racist behaviour from patients

There are times when a patient may display unacceptable behaviour and as a result, the professional relationship between a doctor and patient breaks down. 

Our guidance on Ending your professional relationship with a patient explains that one factor that can lead to the breakdown in this relationship are instances in which a patient has been violent, abusive or made threats to you or a colleague.  

If you’ve decided to end the relationship based on abusive language or behaviour, you must follow the steps we set out in our guidance. Each situation will be different, and context is vitally important – doctors should take into account the mental health and clinical presentation of the patient and any other health conditions which may influence their behaviour. 

It’s crucial that colleagues work collaboratively in these situations. For example, arrangements for the continuing care of the patient shouldn’t necessarily fall to the doctor of the patient who has been abusive.

Where necessary, call security or the police as they have the powers and responsibility to take the steps needed to keep staff and service users safe, which can include removing people from the premises. Many employers also have zero-tolerance policies in place, which sets out the approach to be taken if staff face violence and aggression from patients, their families or the public. It’s important to review your employer’s zero-tolerance policy to understand the measures they advise doctors to take if experiencing abuse from patients. To do this, you could speak to your line manager or senior colleagues and seek their advice.

Responding to racism from patients in emergency settings

In emergency settings, situations and responses may differ as you may be seeing the patient for the first time. We’d encourage you to be familiar with local policies and procedures that relate to handling abuse from patients. For those with responsibility for setting and updating these policies, keep them under review. 

We support the approach set out by the BMA, which makes clear that patients must be treated in an emergency, but that their behaviour should be followed up when they no longer require emergency care. 

If a patient is being racist to a member of the healthcare team while receiving emergency care, if it is safe and possible to do so, raise with a senior colleague to seek their advice. Colleagues should work collaboratively and support each other to manage the situation. This could include offering support to your colleague and asking if they are comfortable still treating the patient

However, it is also important that this support doesn’t undermine the doctor that is being discriminated against. They may choose to continue the consultation and address the behaviour themselves. In this instance, support could include offering to join the consultation, or act as a point of follow-up once the consultation has finished.

Advice for GPs

In their guidance on managing discrimination from patients and their guardians and relatives, the BMA have set out specific advice for GPs.

They also provide advice on removing patients from your practice list and removing violent patients and the special allocation scheme.

NHS England have also updated the primary medical care policy and guidance manual, which includes a chapter on managing [non-violent] inappropriate and unacceptable patient behaviours, including protecting against discrimination, harassment or victimisation.

The Medical Defence Union provide advice on the processes that should be followed in England, Wales, Scotland and Northern Ireland in relation to removing patients that have verbally abused and threatened staff. 

Patients in non-emergency settings refusing to be seen by doctors of a particular ethnicity

If a patient refuses to be seen by a doctor of a particular ethnicity, dependent on what you know of their health condition, it may be appropriate to explore the reasons behind their request. 

Where there is no reasonable explanation for the patient’s refusal - and only their care is at stake - the  patient’s position may amount to them refusing the care offered by the service that employs the doctor.  By ‘reasonable explanation’, we are suggesting that doctors take into account – on a case-by-case basis – the mental health and clinical presentation of the patient and any other health conditions which may influence their behaviour.  

We advise doctors to discuss with patients the possible consequences of refusing treatment. But we don’t suggest that it’s the responsibility of the doctor – who the patient refused – to make alternative arrangements on behalf of the patient. The service provider may be required to support the patient to obtain care elsewhere. We’d advise that doctors familiarise themselves with their organisation’s policies and procedures for transferring the care of patients to other providers.

Racism from those close to the patient

Racist behaviour may not always come directly from the patient. It could be coming from someone accompanying the patient to the consultation i.e. their parent, guardian, carer etc. In taking action, it’s crucial to take into account the patient’s care needs and overall best interests.  

If the parent, guardian or carer is your patient and you’re ending your professional relationship with them as a result of their behaviour, it’s also important to consider the impact on those close to them (i.e. children, young people and dependant adults). In taking action, you should not automatically end the relationship with those close to a patient. 
In instances where it is necessary to end the relationship with those close to the patient (this may be due to risks arising from ongoing contact with that patient) you must make sure arrangements are in place for the continuing care of children, young people or dependent adults.  See our guidance on Ending your professional relationships with a patient, paragraphs 8, 11 and 12). 

The BMA provide further advice on behaviours from a legal guardian of the patient in their guidance on managing discrimination from patients and their guardians and relatives

Our guidance applies to individual doctors. However, issues of discrimination go much wider than the individuals affected. Medical leaders have a responsibility for establishing the policies, processes and culture of the healthcare environment. 

This tab signposts to advice for employers – it includes sections on: 

• Advice on tackling discrimination as a healthcare provider
• Communicating anti-discrimination policies to patients
• Training on professional behaviours and race equality
• Addressing areas of inequality in regulation

The scale of the challenge 

The scale of racism within healthcare is stark. It has been demonstrated by a range of reports by organisations including the BMA, which reported that 76% of respondents to their racism in medicine survey had experienced racism in their workplace on at least one occasion in the last two years.  

Tackling discrimination as a healthcare provider

All employers have a duty to provide a working environment where staff are treated fairly and equally, free from unlawful discrimination and harassment. Members of staff who are experiencing discrimination should not be expected to address the situation on their own. There should be local support in place to help them to speak up and take action to resolve matters. 

Responding to discriminatory behaviour is a matter that needs to be addressed and prioritised at an institutional level. 

Organisations must make sure staff know how to raise a concern and are supported when they do. 

The BMA report, Delivering Racial Equality in Medicine, outlines further recommendations for implementing structural measures to reduce discrimination.

Communicating anti-discrimination policies to patients

The BMA’s guidance on managing discrimination from patients and their guardians and relatives, sets out preventative steps for employers to take to protect their employees from harassment or abuse. We’d recommend you read these in full, but have highlighted below several steps relating to communicating with patients:

• have clear notices on premises and on websites that unlawful discriminatory behaviour is not acceptable
• make clear in notices and communications with patients that such behaviour is not acceptable
• make it explicit in zero-tolerance policies for violence that these also cover discrimination from patients (and their guardians/relatives) against healthcare workers
• create a specific zero-tolerance policy for unlawful discrimination against healthcare workers
• take steps actively and publicly - such as displaying posters across NHS premises - highlighting its zero-tolerance approach to discrimination

[This information was copied from the BMA’s guidance on Managing discrimination from patients and their guardians and relatives on 06/10/2022]

Training and support

GMC: Professional Behaviours and Patient Safety programme

The Professional Behaviours and Patient Safety programme (PBPS) aims to support positive culture change through collaboration, communication and development of training/support. The PBPS programme involves engagement around culture change, and a half day training session that supports healthcare professionals to recognise and challenge concerns about unprofessional behaviour. To get in touch to find out more about this programme, contact our outreach team.

The problem

Treating our colleagues with courtesy and dignity should be a given. Unfortunately, we know that that is not always the case which is why we have developed this training to discuss ways of responding to unprofessional behaviours. Unprofessional behaviours are detrimental not only to staff but also to patient safety. 

Our objective

To help doctors and employers improve patient safety through early intervention training that promotes professional behaviours and develops individual’s skills and confidence in challenging unprofessional behaviours. 

Our offer

Our guidance says that doctors have a responsibility to challenge unprofessional behaviour of colleagues, but we know they find this difficult in practice. We have developed a three-hour workshop to support doctors to:

1. Define and identify unprofessional behaviours in practice, and reflect on their own behaviours and responsibilities
2. Understand the harmful impact of unprofessional behaviours on patient safety
3. Develop individual and practical skills to challenge unprofessional behaviours in the workplace

We recognise that educating and upskilling groups of doctors is just one part of the solution for achieving culture change. To have significant and sustained impact, we also want to collaborate with organisations to share good practice and create the optimum environment for positive professional behaviours to thrive. 

NHS Providers: race equality programme

In March 2022, NHS Providers published Race 2.0 - Time for real change, which highlighted the scale and scope of the challenge to improve racial equality across the NHS.  Their research highlights just 4% of trust leaders think race equality is fully embedded as a core part of their board’s business. 

The NHS Providers race equality programme has been shaped based on feedback from ethnic minority and white trust leaders, and focuses on the following elements: 

• Hearts and minds change – creating more safe spaces and committing to have the difficult conversations drawing on data and personal testimony. 
• Confidence and capability to act – peer learning sessions on ‘the how’, with a relentless focus on outcomes. Signposting to wider resources, other support offers and networks.
• Taking accountability – embedding race equality into the heart of the board’s business, looking at how progress is evaluated and reported, and key questions to ask. 

The programme, aimed at board members, provides a range of events and resources to support each of these three requirements to drive progress on race equality. The content aims to challenge mindsets, increase personal accountability, and places a strong focus on leading by example and white allyship.

Addressing areas of inequality in regulation 

We recognise that we have work to do to in tackling and addressing areas of inequality. You can find out more on our website about the work we’re undertaking in partnership with employers, education bodies and others.

Work is also being done by other regulators including the Care Quality Commission (CQC) who consider workforce equality, diversity and inclusion within its assessments of whether health and social care services are well-led. The CQC is changing the way that it regulates – you can find more about the CQC’s new assessment framework.

In order to access advice on reporting routes, and organisations that can support you in doing so, visit our speaking up page.

You can also call our confidential helpline on 0161 923 6399 Monday to Friday, 9am - 5pm.  We can provide guidance on how to raise concerns you might be struggling with, and you can remain anonymous. 

The information on our speaking up page can be applied to tackling and reporting all forms of discrimination. However, on our identifying and tackling sexual misconduct page, we do signpost to a range of helplines for anyone specifically affected by sexual misconduct in the workplace.

Professional support and wellbeing

Racism can have a significant impact on doctors’ confidence and mental and physical wellbeing. There are a range of resources on our speaking up page that you can access if you need support.