Race equality in GP training

In the first HEE blog to mark Black History Month 2021, Primary Care Dean in Yorkshire and the Humber, Professor Dominic Patterson, considers Race Equality in GP training

In September 2021 I was proud to welcome over 350 people from across the UK to HEE’s first conference dedicated to exploring anti-racism in GP training: the power of allyship: advancing antiracism in GP training. Throughout this ground-breaking day, delegates heard people’s lived experiences, came to understand white fragility, and explored the actions we can collectively take to make a difference.

During the conference we featured Yorkshire and the Humber’s pioneering programme of Race Equity in GP training which has been running since June 2020 and emerged following the death of George Floyd, the prominence of the Black Lives Matter movement, and recognition of the differential outcomes for patients from Black and minority ethnic backgrounds throughout the Covid-19 pandemic. This programme has considered the pre-existing health and social inequalities experienced by ethnic minority communities, as well as the inequalities of experience and outcomes experienced by staff and trainees across the NHS.

The race equality in general practice programme has taken into account some worrying facts:

Racism in medicine

• Black women are five times more likely to die in childbirth than white women
• Ethnic minority doctors are more likely to face referral to the GMC, more likely to have their cases investigated, and face harsher sanctions after an investigation
• Ethnic minorities are under-represented in research
• Workforce and training surveys continue to report staff experiencing racist abuse

Racism in medical education

• In 2016 94 per cent of white GP trainees who were educated in the UK passed the CSA compared to 80 per cent of those from an ethnic minority background
• Black, asian and minority ethnic UK graduates are nearly four times more likely to fail the main GP training examination at their first attempt
• In 2017 the pass rate in postgraduate examinations was 75 per cent among white students and 63 per cent among UK ethnic minority students.

Like many of my colleagues from all backgrounds, the events of 2020 lit a spark in me around anti-racism. Learning about the differential experiences and outcomes for patients and staff across the NHS from ethnic minority backgrounds prompted me to go on my own journey of learning about racism and to really start to think its impact on education and training and what role I play. For too long, I had felt it was enough to say that I wasn’t racist, or that GP training wasn’t racist. I learned that the opposite of racist isn’t not racist, it is anti-racist. In other words, we must be active not passive, and do everything that we can to tackle this problem.

We have a wonderful, diverse training community in Yorkshire and the Humber. So, when I gave my speech to our GP trainee conference in July 2020, I accepted acknowledged and apologised for the current situation and committed to take individual and organisational action to address it. The reverse mentoring offered to me this year by my international graduate GP trainee opened my eyes to the disadvantage many of our trainees experience and this spurred me on.

One of the main actions has been to establish an affinity group which has co-created an action plan to move GP training towards being truly anti-racist. Affinity groups bring together people with a common purpose, are organised in a non-hierarchical autonomous way and offer everyone an equal voice and responsibility. Working with this group has been a highlight of my career.

One of our actions was to deliver mandatory training for all our GP trainers which aimed to:

• Develop participants’ knowledge and understanding about race and racism
• Support participants’ identification of their own starting points with respect to race and racism
• Support participants to identify actions to establish more inclusive processes to GP training with respect to race
• Develop participants’ understanding of whiteness and how it manifests itself
• Support participants to identify actions to address race inequality and racism in postgraduate medical education
• Content included: terminology; statistics; history of race in the UK; theories around racism, critical race theory and whiteness; white fragility; actions to change things; case studies; Q&A

There is limited evidence of the effectiveness of such interventions in isolation, so we are now continuing our learning in small group settings that allow for case discussion and the sharing of lived experience.

As an organisation we must keep striving to make our education and training anti-racist. This will benefit our own staff, the wider NHS workforce in primary care and beyond, and the diverse communities that we serve.