The report by Humberside LMC highlights racism by patients towards staff – but also racism from colleagues – and shows that only around half of black, Asian and minority ethnic (BAME) staff felt empowered to speak up or act when they experienced or witnessed racism.
The BMA commended the LMC’s work to investigate racism – and told GPonline it believed issues identified in the report were likely to be widespread across the UK.
Polling by the LMC found that around two thirds of Asian or Asian British primary care staff with Chinese, Indian or Bangladeshi backgrounds said they had been the subject of racism in their professional lives. A similar proportion of staff of mixed ethnicity reported experiencing racism in their professional lives, along with more than half of black or black British staff and around 40% of Asian or Asian British staff with Pakistani backgrounds.
Racism in primary care
Around one in six BAME respondents felt their career choice had been affected by racism or discrimination, and more than one in five said racism or discrimination affected their ability to train in their career.
Respondents to the survey – which gathered feedback from 238 people – cited a wide range of examples covering overt, direct experiences of racism to more subtle microaggressions.
Some doctors reported patients demanding to be seen by a white doctor – with these demands in some cases accommodated by colleagues. Others cited cases of patients being directly racist towards medical or reception staff, and while in some cases appropriate action was taken, in other cases colleagues laughed off or downplayed the incidents.
One respondent said they had been forced to leave their first choice of speciality training because a postgraduate training dean had told them: ‘We do not want people who are not from around here.’ Others reported being undermined by colleagues making generalisations or assumptions about them based on their ethnicity – and witnessing colleagues delivering poor quality care because they stereotyped or behaved dismissively towards patients for whom English was not their first language.
Concluding the report, Humberside LMC medical director Dr Zoe Norris – who led a working group that compiled the findings – said the work had brought to light ‘heart-breaking examples that make me ashamed of my profession and my patients’.
Dr Norris said all staff in primary care have ‘a duty to look for racism, to call it out in all its forms, and to be actively anti-racist’. The LMC has set out plans to develop an anti-racism charter by the start of 2022, alongside a string of further measures intended to tackle discrimination.
The BMA warned that ‘systemic change’ was required to tackle racism, and called for formal NHS race equality monitoring to be extended to cover primary care. The BMA warned of an ‘evidence gap’ in primary care because it is not covered by the NHS staff survey or the NHS England workforce race equality standard (WRES) included in the standard NHS contract.
BMA GP executive committee member and workforce lead Dr Krishna Kasaraneni said: ‘This report is very distressing and highlights the significant steps that must be taken to tackle the unacceptable levels of discrimination experienced by black and ethnic minority staff and patients in general practice.
‘All doctors and staff have the right to work in an environment that values diversity and is inclusive, which is of benefit not only to the staff themselves but also to the patients at practices.
‘In order to progress on race equality, we need a joint effort from everyone involved in primary care and everyone has a responsibility to act by calling out all forms of discrimination. But this goes beyond individual efforts and requires a much wider systemic change which gets to the very root of the issues with effective evidence gathering and mechanisms in place to ensure those impacted are adequately supported and that this behaviour is eradicated going forward.
‘It is also important to address the wider pressures on general practice and the demands of current workloads which can hamper and stall efforts to develop a more inclusive and supportive workplace cultures.’
Dr Norris said: ‘The report is not an easy read, and starkly illustrates the challenges our colleagues and patients are encountering every day due to racism and discrimination.
‘It’s based on the lived experience of both clinical and non-clinical staff working in primary care across the Humber region, and we’re incredibly grateful to all the staff who shared what are clearly very difficult experiences with us.
‘Despite the problems highlighted we hope that, through shining a light on these issues, this will be the beginning of a conversation between all of us working in primary care to tackle discrimination.’
In a conclusion to the report, Dr Norris urged colleagues to listen and ‘put yourself in the shoes of those who have shared their experiences’. She wrote: ‘However uncomfortable and awkward you may find it, it is nothing compared to the daily challenges they encounter simply because of their name, the colour of their skin, or their accent.
‘Rather than disbelieving, or pointing to your own lack of racism, recognise that it is no longer acceptable to stand by. We all have a duty to look for racism, to call it out in all its forms, and to be actively anti-racist.’