Home » Research Projects » Equality, Diversity and Fitness to Practise: exploring and explaining variation in the identification, handling and outcomes of concerns about doctors
Equality, Diversity and Fitness to Practise.
There has been concern for some time about possible inequalities in how poorly performing doctors are identified and dealt with by the NHS and in the formal regulatory processes of the General Medical Council. Several previous studies have found that doctors from ethnic minorities and/or doctors who trained in other countries are over-represented in various aspects of these processes, from complaints to formal hearings. The Public Services Programme has commissioned three interlinked projects, co-funded by the UK General Medical Council (GMC), to investigate.
Project 1 aims to develop a conceptual model of the part that racial discrimination or migrant status might play in the chain of events that leads to the raising of concerns about doctors and how these are subsequently dealt with.
Project 2 aims to improve understanding of the factors associated with increased risk of less favourable decisions (i.e. decisions with more serious consequences for the doctor involved) in the GMC’s Fitness to Practise process. Specifically, the study will investigate whether doctors trained in other countries and/or from ethnic minority backgrounds have a greater chance of receiving less favourable decisions and will explore the role of other factors relating, for example, to work setting or professional experience in influencing those decisions.
Project 3 aims to develop methods to assess workplace discrimination, prejudice and attitudes towards diversity in healthcare organisations for use in investigating how such factors operating at organisational level may affect the identification and handling of concerns about doctors’ performance.
What the research will mean for policy-makers and the wider community
The findings of these projects will be of value to individual doctors, their professional and legal advocates, healthcare employers and regulators both nationally and internationally. They will:
- Help explain both how and why inequalities in the identification and handling of poorly performing doctors may come about and identify what might be needed to address these issues;
- Contribute to more general understanding of how the experience of diversity may be linked to disadvantage, particularly in the context of professional work;
- Provide a more refined and robust understanding than has previously been available of the relationship between ethnicity, place of qualification and other factors associated with differential outcomes for doctors who go through the GMC’s Fitness to Practise process;
- and Develop ways of measuring the extent of workplace discrimination, prejudice and attitudes towards diversity in healthcare which will help those organisations and researchers interested in developing and using such measures.
Research Methods
- Project 1 comprises a critical review of the international literature on challenges encountered by doctors and other healthcare workers trained in other countries and/or from minority ethnic groups. The findings will be set in the context of the wider literature on: precursors of medical performance problems; the experience of ethnic minority groups in their encounters with other regulatory instutitions; and theoretical literature from the field of inequalities in health on the relationship between diversity and disadvantage.
- Project 2 involves quantitative analysis of anonymised data held by the GMC about doctors going through the Fitness to Practise process. The analysis will focus on decisions at three key points in that process. The sample includes all doctors who have entered the process since April 2006.
- Project 3 involves appraisal and adaptation of existing measures of organisational diversity (mainly used so far in the US) and pilot work to assess their feasibility in the UK context, undertaken with a small number of NHS Trusts.
- Project 1 ‘Challenges encountered by ethnic minority and migrant doctors, healthcare workers and related groups and the implications for performance regulation’ runs from July 2008 to April 2009.
- Project 2 ‘Clarifying the factors associated with progression of cases in the GMC’s Fitness to Practise procedures’ runs from July 2008 to June 2009.
- Project 3 ‘Measuring organisational attitudes to workplace discrimination, prejudice and diversity: an exploratory study of NHS organisations’ runs from September 2008 to September 2009.
Research Details