Presentation on theme: "Thank You For Inviting Me. Thanks to GMC! Always Nice to be Amongst Friends."— Presentation transcript:
Thank You For Inviting Me. Thanks to GMC! Always Nice to be Amongst Friends
My Background Dr P Umesh Prabhu FRCPCH Consultant Paediatrician Lead Clinician Medical Director NPSA Board Member NCAS Adviser Overseas Doctors Mentor Clinical Adviser to the HCC Member DOH, BMA, NCAS Equity & Diversity Group
Our NHS I am very proud of our NHS I have always been very passionate about it NHS is one of the best asset that we have in our country.
Our NHS Vast majority of care is of very high quality. NHS is about Good Doctors Trying to Do A Good Job.
That Is All The Good News I Have For You!
Back Ground I have been very fortunate. Have met lots of very nice people from various backgrounds. UK is one of the fairest countries in the world. UK is one of the fairest societies in the world I am proud to be British and Britishness.
In Fact Whenever I have expressed my concerns, it is my White Colleagues who have taken them seriously and done something about them. Many BME friends tried to discourage me!
The leadership shown by the GMC My role in the NCAS My discussion with Healthcare Ombudsman My recent experience with the DOH. My own Trust Chief Executive. Just Some Examples
Other Hand Nothing changes so why bother. My bum is not on fire – so why bother? You are doing a good job Umesh – Carry on. Please do let me know if I can do anything. There is no racism – Go home – BMA, College, and MDU.
Doctors Role In The Society Being doctor gives us lot of privilege Ours is the most trusted and respected profession. Doctor patient relationship is based on trust and mutual respect.
Who Do the Public Trust? Doctors89% Teachers86% Clergy78% Police63% Man on the street52% Journalists18% Politicians17% MORI May 2005 (After Shipman) MORI May 2005 (After Shipman)
Patient safety and their well being should be at the heart of our duty as doctors. Our conduct, behaviour should be above board all the time. We should always maintain the patient and public confidence in our profession. Doctors Role In The Society
Due to Poor Professional Regulation. Shipman Rodney Ledward Richard Neale Alder Hey Pathology Bristol Cardiac Babies Kerr and Haslam Clifford Ayiling Many More
Doctors, NHS, Patient Safety and Medical Errors Let me now put these in context
Patient Safety - UK 1 in 10 Patients suffer an adverse event due to medical error. 900,000 adverse events per year. 20,000 deaths each year due to medical errors in UK 50,000 Patients may be harmed due to medical errors each year.
Doctors with Problems At any given time 6% Doctors have problem with their clinical performance. 1 in 16 doctors drink excessively or take drugs in the UK 5% doctors behaviour is so disruptive that it puts patients at risk
Professional Regulation To some extent self-regulation has failed Many patients harmed. Untold misery to our patients. By those whom they trusted! We need to refine professional regulation.
But it is equally important that doctors are treated fairly, equally and action taken are fair and proportionate.
BME Doctors in the NHS
Black and Minority Ethnic Doctors (BME) Statistics 220,000 Doctors registered with the GMC 155,000 work in the NHS 60,000 (40%) 0f BME doctors 35,000 Overseas qualified.
BME Doctors Significant Medical Workforce Contribute tremendously to the NHS Most single handed, inner city GPs Deal with the most deprived population of the society. We are like Carling Black Label
Consultants in less popular specialities 70% of SAS doctors But only 22% of Consultants 80% of non-training posts are taken up by BME doctors. Less Clinical Excellence Awards BME Doctors
Let us now look at Disciplinary action and BME doctors
Evidence 5 Published Evidence –GMC Data –NCAS Data –Manslaughter Data –National Audit Office Data –Deanery Data on RITA D and RIAT E
Doctors Reported To The GMC
GMC and Doctors Doctors referred by patients –There is no difference in the ethnicity –I find this very interesting and encouraging. Doctors referred by Institutions –Significant difference –Disproportionately more BME doctors are referred. –Question is why?
Doctors Charged With Manslaughter
Doctor Manslaughter Charges Since 1972 Since Cases involving manslaughter charges 25 Cases involving manslaughter charges 30 Doctors charged with manslaughter 30 Doctors charged with manslaughter 22 Ethnic minority (70% Ethnic Minority) 22 Ethnic minority (70% Ethnic Minority) 8 Europeans 8 Europeans 6 times more likely! 6 times more likely! I now know off 4 BME doctors who have been suspended because they may be charged with manslaughter. I now know off 4 BME doctors who have been suspended because they may be charged with manslaughter. In my opinion these are genuine human errors and there were systems failures. In my opinion these are genuine human errors and there were systems failures.
Requests for NCAS Help: 2001 – 2006
NCAS Adviser One of the best jobs I have done One of the best Institutions I have worked for. I am amazed at the Quality Assurance systems which are in place. I am amazed at the length to which NCAS goes to make sure that doctors are treated fairly and correctly. It is an advisory body and not a regulator. I am very proud of NCAS
National Audit Office (NAO) Report NHS used to spend £46 Million on suspended doctors NHS used to spend £46 Million on suspended doctors Longest suspension – 12 years Longest suspension – 12 years NAO report concluded NAO report concluded BME doctors are three times more likely to be suspended for long term BME doctors are three times more likely to be suspended for long term BME doctors are less likely to be reinstated even when they win the case. BME doctors are less likely to be reinstated even when they win the case.
IMG and Trainees RITA D and RITA E and IMGs –3 times more likely to get RITA D and RITA E –Even local graduates from EM tend to get more often RITA D and E.
Why Disproportionately more IMGs?
Reasons 1. Discrimination (Institutional Racism) 2. System Failures 3. Something about IMGs themselves
Racism, Sex and Private Practice.
Sex and Private Practice –Most do it –Most enjoy it –No one talks about it –No one feels they had enough. Racism –Most of us know it exists –I dont think anyone enjoys it. –No one wants to talk about it. Racism, Sex and Private Practice.
Most White colleagues really find it hard to believe that there is discrimination or racism. They genuinely believe Discrimination is not a big problem. Most Ethnic Minority doctors believe that discrimination and Racism is a big problem. Some blame racism for everything! Racism/Discrimination.
If it is only bad people who are prejudiced, that would not have such a strong effect. Most people would not wish to imitate themand so, such prejudices would not have much effect except in exceptional times. It is the prejudices of good people that are so dangerous. Vikram Seth. A suitable boy. London: Phoenix, 1993.
Discrimination I dont like the word Institutional Racism Institutions are not racists Most White Colleagues get upset and rightly so.
Discrimination Exists Because: 1. Poor leadership in the organisations. 2. Most Organisations have one or two individuals who do not want to see any changes. 3. Some of so called Our Own (BME) collude with the system or dont challenge the system.
4. NHS Tokenism 5. BME doctors inability to stand up for their rights. –Our apathy –Our inability to unite –Our inability to stand up for our rights. 6. Experts and NHS Leaders tend to be White and most doctors facing discipline tend to be overseas qualified BME! Discrimination Exists Because:
Consultant saw a private patient during NHS time. Consultant rang off sick and did private work. Consultant found guilty of plagiarism SpR forged signature of 4 consultants Examples – None of them are NCAS Cases.
SHO downloaded pornographic material. Registrar downloaded pornographic material SHO took down the phone number of a patient and rang and went to her house. Registrar hit a patient in A&E Examples – None of them are NCAS Cases.
Consultant raised concerns about patient safety regarding two of his White colleagues He was suspended for bullying His concerns have not even been investigated. Consultant accused of bullying – Dismissed Consultant accused of bullying – Not even investigated Examples – None of them are NCAS Cases.
My Personal View Most of the time discrimination is not wilful or malicious. But it is about trying to protect our own. Less weight is given when it is One of us. BME doctors are less well supported, guided. Investigated more thoroughly and dealt formally.
2. Systems Failure - UK Poor induction Poor induction Poor Resource Poor Resource Inner city, single handed GPs Inner city, single handed GPs Career Barriers for overseas doctors Career Barriers for overseas doctors More often isolated More often isolated More often - Bullied and harassed More often - Bullied and harassed Obstruction at every level Obstruction at every level Poor representation at senior levels Poor representation at senior levels
Overseas training is different. ALS, PALS, NLS – Not taught More of a theoretical training Struggles to deal with emergencies. NHS –Different culture and different environment –Patient and Colleagues expectation is different. –Relationship is different. Not trained in softer skills of being a good doctor. Doesnt know the duties of a doctor. 2. Systems Failure - Overseas
3. Poor Softer Skills Poor Communication Poor Communication Working in isolation – Poor Team Working Working in isolation – Poor Team Working Poor integration Poor integration Poor Leadership skills Poor Leadership skills Poor Organisational skills Poor Organisational skills Not keeping up with skills Not keeping up with skills Poor interpersonal skills Poor interpersonal skills Poor reflection on patient safety, quality Poor reflection on patient safety, quality Poor in seeking help Poor in seeking help Fatalistic attitude Fatalistic attitude Cultural Differences Cultural Differences
Failure on the part of NHS Poor induction. Poor training in softer skills Poor training in dealing with complaints, litigation, being open and so on. NHS leaves local bullying, harassment and so on until it is too late.
NHS has no system to identify poor performance early. Leaves till the Helicopter crashes No help, support or guidance for failing doctors. Doctor gets more isolated, becomes more introvert, more diffident and more difficult. Failure on the part of NHS
Failure on the NHS Single handed GP with no clinical governance or quality assurance for years and now suddenly dismiss them. Poor medical leadership in many NHS organisations. Very few BME Medical Leaders.
GMC Is there is Racism in the GMC? Absolutely No. Is the GMC Perfect Answer is No GMC gets it right in most cases.
GMC But GMC policies and procedures are stacked against doctors. GMC also takes conduct and probity too seriously Many doctors are not aware. Overseas doctors are not taught –Duties of Doctors. Many need help, support, guidance and reprimand.
GMC By asking them to appear before the FTP the only people who benefit are lawyers. Neither patients are protected nor doctors are guided or educated. This month there are three cases – I am amazed. Many of these cases should be dealt locally.
Others BMA, Colleges and IMG organisations –Failed to show leadership that deserves by their members. We, as a profession failed to regulate ourselves well. At an individual level - Most of us do But failed to address our colleagues
Turned a blind eye. Poor Medical Leadership at local level. Reactive and Crisis management. NHS is not a proactive organisation. Others
Is There Anything Happening? Nationally I see a real determination to address this issue. I am very proud to be closely involved. I commend the GMC for the leadership it has shown. I am proud of NCAS
But it is local employer level that we still have a long way to go. It is there discrimination and differential treatment is common. Collectively we got to do something Is There Anything Happening?
We moan and groan about racism We talk about it But dont actually do anything about it We must also make sure we keep our house in order. Not blaming racism for everything IMG Organisations
What we should do? Charity begins at home Things dont change because we want them to. They dont change because it is the right thing They change only if we make them happen.
Show true leadership We should be in the forefront of Clinical Governance and quality assurance Should always put our patients first Their safety, their well-being must be at the heart of our role as doctors Take keen interest in the NHS leadership. Must address our colleagues when they fail. Educate our colleagues What Can We Do?
Take active part in the College activities Challenge your college on their Council and other group membership and ethnicity Challenge your Trust and PCT Challenge BMA – We pay £9 Million a year! What Can We Do?
The Profession Must take the lead –Patient safety and patient involvement –Clinical Risk Management –Quality Assurance systems –Clinical Governance –Effective and robust appraisal –Early identification of poor performance –Support and help for our colleagues –When necessary – Local disciplinary action. –Develop leadership skills and take on the role
Lastly Shipman Rodney Ledward Richard Neale Alder Hey Pathology Bristol Cardiac Babies Kerr and Haslam Clifford Ayiling
It is not just about Institutional Racism But we put patients lives at risk by not dealing with these doctors early! Lastly
NHS Equality and Diversity Trendy Brochures Policy documents Very little change Tokenism E Mail
NHS Equal Opportunity Committee
Equal Opportunity It is not about having policy documents It is not about having policy documents It is not about Mission Statements It is not about Mission Statements It is about Mindset and Heart & Soul It is about Mindset and Heart & Soul EM doctors do contribute tremendously EM doctors do contribute tremendously Needs to be treated Equally Needs to be treated Equally
How Do I Feel As A Doctor In The Modern NHS! CHAI GMC NCAS NPSA Audit Lawyer Whistle blower Complaint IRP College Appraisal BME Doctor Patient Manslaughter College Expert
Lord Bhikhu Parekh If you are willing to behave like worm, dont blame others for trampling on you!
Our Future is in Our hands!
Be The Change You Want To See In Others. It is our NHS and it needs us. We are the system and let us stop blaming the system.