Lessons for nursing from report on BME doctors’ FtP referrals

The report exploring why BME doctors are more likely to undergo fitness to practise procedures has “hugely valuable insight” for other health professions, according to the nursing regulator.

The report, commissioned by the medical regulator the GMC, found lack of support and isolation were among key reasons doctors from BME backgrounds were more than twice as likely to be referred to their regulator than white counterparts.

It comes amid ongoing concern about discrimination within the nursing profession and NHS more generally, with BME nurses and midwives also more likely to be involved in FtP procedures than white colleagues.

The GMC researchers spoke to more than 260 people working in primary and secondary care including GPs, locums and specialist and associate specialty (SAS) doctors.

Those who contributed included doctors from BME and white backgrounds. as well as overseas medics and UK graduates. Researchers also spoke to employers, service providers, senior managers and HR leads.

The Fair to Refer? Report, published today, identified a range of factors that could explain the disproportionate referrals of BME doctors to the GMC.

This included that doctors from diverse background did not always receive effective, honest or timely feedback from managers anxious to avoid “difficult conversations” – especially if they were from a different ethnic group to the doctor in question.

The report found doctors from BME background may not get adequate induction or support to move into new social, cultural and professional environments.

It also suggested the “blame” culture present in some organisations presented a particular risk to anyone who might be viewed as an “outsider”.

The findings echo previous research carried out by the NMC and others looking at why nurses and midwives were more likely to face formal disciplinary procedures and be referred to their regulator.

Key recommendations included the need to improve induction and support for doctors new to the UK or NHS, and tackle organisation cultures that focused on blame rather than learning from mistakes.

The report also highlighted the importance of “engaged, positive and inclusive” leadership when it came to spearheading change and fostering a supportive working environment for all staff.

The Nursing and Midwifery Council said the findings and recommendations were relevant to all professions and professional regulators.

“Today’s important report provides hugely valuable insight, not just for the regulation of doctors but for employers and regulation more widely,” said NMC chief executive and registrar Andrea Sutcliffe.

She said: “We know from our own earlier research that nurses and midwives from black, Asian and minority ethnic backgrounds are also more likely to be referred to us than their white counterparts by their employers.”

Ms Sutcliffe said findings from this previous research had informed the regulator’s new approach to fitness to practise aimed at making the process fairer for all concerned.

“Our new approach includes supporting employers to deal with issues quickly and effectively, taking better account of the context in which mistakes happen, and enabling nurses, midwives, and nursing associates to improve their practice where necessary,” she said.

The NMC would continue work closely with employers and partners across health and social care “to make sure we continue to address this hugely important issue”, she added.

Ms Sutcliffe also confirmed that the NMC would be doing more of its own research.

“We will also be carrying out further research of our own later this year to ensure we have the best understanding possible of the impact of our work on different groups of people, so we can tackle any discrimination we find,” she said.

Miriam Deakin, director of policy and strategy of NHS Providers, described the report’s findings as “troubling”.

She maintained that trusts were working hard to ensure staff were treated fairly and with respect but added there was “clearly more to be done”.

“We know that there is strong evidence linking a diverse workforce and good patient care and it is also important that the NHS has an engaged and inclusive leadership which reflects the diversity of its workforce and of its local population,” she said.

“These findings are therefore troubling, and show just how important it is that we invest in support for equality and diversity across the health and care sector,” she added.

Danny Mortimer, chief executive of NHS Employers, said the report reinforced findings from the NHS’s Workforce Race Equality Standard introduced in 2015 with the aim of improving practice.

Meanwhile, many of the recommendations reflected themes identified in the recently published NHS Interim People Plan, such as the need for robust and supportive induction processes, he said.

“For the NHS to truly be the best place to work, it must take action to treat all staff, from all backgrounds fairly,” said Mr Mortimer.

“We look forward to working with the GMC and employers to help them deal with issues earlier, locally and to eliminate unfairness,” he added.