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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:

Research Methods

Other Project Outputs and Related Webpages

Project Poster 1 2009
Project Poster 2 2009
Project Poster 3 (Aneez Esmail) 2009

Research Team

Charlotte Humphrey (KCL)

Charlotte is Professor of Health Care Evaluation and Director of the Centre for Evidence and Policy at King’s College London. Other roles include acting as an expert advisor to the National Clinical Assessment Service, the Commission for Health Improvement and the Bristol Royal Infirmary Public Inquiry and as a specialist health researcher for BBC Television. She has undertaken a range of research studies concerned with the conceptualization and implementation of institutional and professional regulatory processes, major quality improvement initiatives and strategies for engaging different stakeholder groups in identifying and dealing with risk and failure and promoting high quality care.
Charlotte is Principal Investigator for Projects 1 and 2.

Aneez Esmail

Aneez is Professor of General Practice at the University of Manchester. Much of his research is based on the premise that the medical profession remains largely unaccountable for the way it controls entry into the profession, shapes career progression, handles complaints and rewards its members. That work has a direct bearing on the current debate on how to make the profession more accountable by revalidation and governance. His earlier work on the GMC led that organisation to set up a 5year review (by the Policy Studies Institute) of the way it handled complaints. His research on medical school admissions led the Council of Deans of Medical Schools to make all information about medical school admissions freely available and also led the Commission for Racial Equality in 1999 to ask all medical schools to review their admissions policies to ensure they did not discriminate against ethnic minority students and later to the establishment of monitoring mechanisms in UK medical schools.
Aneez is Principal Investigator for Project 3.

Martin Gulliford

Martin is Professor of Public Health in the Division of Health and Social Care Research at King’s College London. He trained in medicine at the University of Cambridge and at University College Hospital, London and later trained in public health medicine at Guy’s and St Thomas’ Medical Schools London, where he was a Wellcome Training Fellow in Health Services Research. For several years, he was based in Trinidad, organising a programme of health services research and training with the Commonwealth Caribbean Medical Research Council.

Debbie Cohen

As a doctor with more than twenty years experience, Debbie personally understands the stresses and strains that working in medicine may present. She now works as an Occupational Health Physician and is the Director of the Individual Support Programme at Cardiff University which she developed and launched in 2001. The unit has so far worked with over 150 doctors referred for remediation. As part of this work Debbie has close ties to the National Clinical Assessment Service and is a member of their research and development group. Currently, Debbie heads another related project in the Public Services Programme, ‘Identifying Biographical and Biopsychosocial Risk Factors Amongst Under Performing Doctors’