The GMC’s race gap

White doctors are less likely to be reported to the General Medical Council (GMC). Before asking if this is bias, we should ask if it’s safe.

I

The GMC matters. It’s meant to guard the public, by regulating doctors. For this, it compels every UK-registered doctor to pay hundreds of pounds annually.

Referrals to the GMC matter too. They can be career-ending, even lethal. Doctors have died under the stress of investigation, several by suicide.

The GMC’s race gap also matters, depending perhaps on your experience.

If you’re a white doctor, you might see the race gap as proof you’re special. You might want to pay the GMC less because you’re less likely to trouble it.

If you’re a non-white doctor, you might voice dismay, without daring to challenge the GMC’s race gap at work. You should worry that certain white doctors can, with impunity, use the GMC as a weapon against you.

If you’re a patient, the GMC’s race gap might fit what you see in the tabloids. [We’ll look at the press take on white & non-white doctors later].

If you’re the GMC, you’d think you’d want to know first whether it’s safe if white doctors (the largest group of UK medics) are under-reported to you.

II

In practice, two common responses to the race gap keep the focus on non-white doctors.

First come the efforts to deny the gap is discriminatory.

For example, it’s argued that non-white doctors are more likely to be reported to the GMC because, with foreign qualifications, they can struggle to adapt to the UK. But this overlooks that: (a) non-whites fare worse than white peers – even when UK-trained; (b) non-white doctors who are referred to the GMC have mostly been in UK practice for years; (c) new recruits, from beyond the European Union, have to pass examinations on top of their medical qualifications in order to meet UK standards and work here.

In truth, the NHS depends on non-white medics. Stereotyping them damages lives. The Prime Minister has finally acknowledged such discrimination. It’s seen starkly in the US. Police gun down unarmed black men, stereotyping them as threats; but they’ll talk down mass shooters who are white.

Second come the efforts to (dis)prove discrimination by researching the gap.

But the GMC’s race gap has been known for years and research hasn’t remedied or ruled out racism. Reluctance to accept bias as a cause of the gap mirrors the years it took for police racism to be officially recognised.

If the GMC or Department of Health fund further research there’ll be concern that findings will be shaped to exonerate them. After all, the GMC might fear further lawsuits if research confirmed discrimination.

III

Given the controversies, it could help to start from a different place, asking about safety before race.

The GMC’s primary purpose is to safeguard the public, of whom white UK-trained doctors treat the most. The GMC can therefore protect the most by first ensuring white UK-trained doctors are safely scrutinised.

So the first question on the GMC’s race gap is not whether it’s discriminatory , but whether it’s safe if, as it appears, white doctors are under-reported.

Sheer numbers mean even slight under-reporting to the GMC of white doctors could leave many patients exposed to poor practice. Misconduct is overlooked or tolerated rather than tackled, as shown in the cases below.

Convicted breast surgeon, Mr Ian Paterson conducted improper surgery for years. Cast now as a “rogue” surgeon, he was in fact sustained by the rogue system. Senior colleagues supported him and left non-white doctors who complained with little alternative but to move away.

The General Dental Council (GDC) struck off surgeon, Mr Roger Bainton, after the avoidable death of a young adult in 1995. The General Medical Council did not strike him off. He moved post, continuing surgery for several years before serious complications and adverse publicity finally forced the GMC to strike him off. Upward of eighty further patients are reckoned to have been harmed.

Early in his career, Dr Harold Shipman was convicted then sanctioned by the GMC for misuse of opiate painkilling medicine. Despite this, he was allowed to re-enter practice without sufficient supervision. He killed upward of 200 patients – using opiate pain-killing medicine. And Dr Shipman might even have walked free due to contempt of court by the British Medical Association (BMA).

There was precedent for Dr Shipman’s case. Dr John Bodkin Adams may have committed mass murder in a similar way, and with similar motive, many years before. It’s said his conviction was averted in part because the BMA exerted influence at the highest levels of Government to ensure his defence team had sight, in advance, of privileged prosecution material.

IV

The GMC’s race gap also reflects public sentiment, and biases in the media and judiciary. The paired cases below raise awareness that non-white doctors can be pictured and prosecuted, while white doctors escape completely when things go just as wrong.

The deaths of Mr James Hughes and Mr Sean Akdemir

Black surgeon, Mr David Sellu, was jailed for manslaughter (now overturned) for Mr Hughes’ death. After a long unblemished career, Mr Sellu’s alleged failings included a delay in obtaining a CT scan and acting on it. Mr Hughes had unfortunately been at significant risk of death in any case.

Mr Sellu’s experience looks totally different to that of the white surgeon involved in the death of Mr Sean Akdemir.

Like Mr Hughes, Mr Akdemir was symptomatic. He also was CT scanned. There was also delay. Alder Hey breached requirements to have systems flag up his abnormal scan.

Unlike Mr Hughes’ case, prompt surgical correction would almost certainly have prevented Mr Akdemir’s death. His surgeon confessed to the Coroner that he’d failed, but he hasn’t had to endure tabloid photographs or prosecution.

The deaths of Jack Adcock and Caitlyn Parry

Jack’s death resulted from systemic failings. But the black junior doctor on duty, Dr Hadiza Bawa-Garba, was demonised in the press and convicted of manslaughter for delays in treatment. She’s been struck off by the GMC to protect the profession’s standing, even though she was a good trainee left in a bad situation.

Caitlyn died because her surgeon cut the wrong arteries in a routine case. Just back from the best part of a year off with stress, he’d been unsupervised after surgical colleagues ignored management instructions to see he wasn’t left as a lone consultant. After her mum’s seven year battle with Alder Hey, the press covered Caitlyn’s death but didn’t name her white surgeon or those white surgeons who failed to protect her from him.

V

In conclusion, we can’t ignore the GMC’s race gap or just explain it away as evidence non-white doctors are worse. It’s also disingenuous to study endlessly whether non-white doctors face discrimination – but do nothing meaningful about the gap.

A better response prioritises safety and investigates the GMC’s race gap to see if white doctors, like Ian Paterson and Roger Bainton, prosper due to less stringent scrutiny.

We should look first at Responsible Officers, the doctors who act as “local magistrates” for the GMC. We need to see how they choose to refer some issues to the GMC while keeping others quietly in house.