Disparities in fitness to practise referrals based on ethnicity have continued to reduce, but the General Medical Council (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 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.
A version of this story was first published on our sister title Pulse.
