health is beginning to show. As the nation recovers and the NHS resets, it is important that doctors are supported and treated with dignity and respect.
In terms of remediation and return to safe practice, organisations are able to identify what is needed, but there is a huge gap in the actual provision and no formal mechanism for addressing any performance or issues around professionalism. The Centre for Remediation and Support at Bolton University is one example of a mechanism to address performance issues that needs to be replicated across the country and supported by all. Developing a system of mentorship is needed, especially for first years, international medical graduates and all doctors in the transitional phase of training careers.
General Medical Council response Charlie Massey, the Chief Executive of the General Medical Council, has said that the General Medical Council is listening and will carry out a review to understand whether there are lessons to be learned from this to apply to future cases. It needs to cover the whole pathway from the referral to decision making by the tribunals. The review should be independent and it is important that it is chaired by a senior black and minority ethnic clinician. The General Medical Council has committed to abolish discrimination in fitness to practise reference within 5 years and abolish differentials in educational attainment within 7 years (General Medical Council, 2022b). This is one of their strategic objectives and it is important that unfortunate cases like this do not railroad the work on addressing these inequalities.
This strategic objective is welcome and should be supported by all stakeholders. It is vital that this work is not derailed and that milestones are monitored. Yearly progress reports should be shared in the General Medical Council annual review and with stakeholders.
Fitness to practise and black and minority ethnic doctors The NHS has a huge black and minority ethnic workforce – over 42% of doctors working in the NHS are of black and minority ethnic origin. The issue of racial inequalities and discrimination has been a concern for over three decades, with numerous initiatives by the NHS (Singh et al, 2018). There is increasing recognition and widespread acceptance of the differential treatment of black and minority ethnic doctors and medical students at all levels, and there is a commitment and action plan introduced to abolish this discrimination.
The Fair to Refer review (General Medical Council, 2019b) and analysis of all the data shows that it is not patients but organisations and institutions who complain about black and minority ethnic doctors. The NHS Race and Health Observatory Report (Kapadia et al, 2022) recommended that, instead of denying and defending, organisations should take actions to remove these inequalities. Improvements in outcomes and addressing issues of racial bias have been seen by using anonymised case details (Torjesen, 2022). Many professional organisations have asked for the use of independent scrutiny panels at local levels.
Conclusions The case of Dr Manjula Arora brings into sharp focus the importance of fair, proportionate and robust disciplinary procedures for all clinicians, whatever their background or ethnicity. It also reminds clinicians to reflect on their own interpretation of the terms honesty and integrity, as well as how they might depict these principles in our day-to-day clinical practice. We hope that the learning from this case will help result in positive changes across the whole pathway and move the General Medical Council step closer to its strategic aim to eliminate discrimination in fitness to practise referrals. Finally, this case reminds us all of the overwhelming need for care and compassion to be embedded in regulation.
Author details 1Department of Medicine for Older People, East Lancashire Hospital, East Lancashire Teaching Hospitals NHS Trust, Blackburn, UK
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British Journal of Hospital Medicine | July–August 2022 | https://doi.org/10.12968/hmed.2022.0288