Experiences of ethnic minority and IMG practitioners: Improving fairness in the management of concerns

Date published:

Today our Practitioner Performance Advice service (Advice) has published research and resources, including an Insights paper and case studies, aimed at:

i) Understanding the lived experience of ethnic minority and international medical graduate (IMG) practitioners who are the subject of performance concerns reported to us.

ii) Improving the fairness in how performance concerns are managed for all practitioners.

Lived experience research

We know that ethnic minority and IMG practitioners are overrepresented in the performance concerns reported to us. Existing equality, diversity and inclusion (EDI) research and analysis across the health system has also indicated systemic bias resulting in practitioners having discriminatory experiences of regulatory/organisational interventions.1 Having commissioned focused qualitative research to better understand the lived experience of ethnic minority and IMG practitioners who are the subject of performance concerns reported to our service, we are committed to:

  • learning from the findings;
  • sharing the learning with the wider health system; and
  • achieving meaningful change to improve fairness in how practitioner concerns are managed.

Key findings

The findings from the research were mixed and highlighted that most participants:

  • felt discriminated against based on their ethnicity and/or where they qualified;
  • did not feel they had been treated fairly by their employers;
  • were unclear on how their performance concerns would be handled;
  • felt Advice did not always treat them fairly;
  • described a culture of bullying, discrimination and blame within the NHS;
  • experienced an unwillingness within the NHS to address the prevailing culture; and
  • felt the NHS is reluctant to listen to practitioner concerns.

However, some participants expressed pride and admiration for the NHS and some felt Advice had treated them fairly by listening to them and taking into account relevant information.

Addressing the issues raised

We have:

  • Met with representatives from the following groups to discuss our findings and how we can collaborate to share best practice to achieve solutions:
    • ethnic minority practitioner networks;
    • employers;
    • defence organisations;
    • regulators; and
    • national bodies.
  • Drawn up and enacted an initial action plan in response to the research findings.
  • Initiated the setting up of a broader programme of EDI activities led by our Director of Practitioner Performance Advice and Appeals.

Achieving meaningful change

We recognise that achieving meaningful change to improve fairness will take time and be incremental in nature. Systemic change requires collaboration across the health system. We are committed to continuing the dialogue we have initiated with key stakeholder groups in the health system and to identifying opportunities for collaboration. Internally, we are currently seeking to identify additional areas within our service where we can effect meaningful change, with the aim of building on our initial action plan.

We will regularly review and report on our progress via our Equality, diversity and inclusion in our casework webpage, and in our Insights paper we invite employers to consider the findings and relevance for managing performance concerns at their own organisation.

The findings from our research into the personal impact that performance management can have on ethnic minority and IMG practitioners are disappointing, but sadly come as no surprise. That is why we at NHS Resolution are working towards a vision where all practitioners working in the NHS have an equitable and fair experience of the management of concerns about their practice, which is not adversely affected by their diversity. We have developed actions in response to the findings and are working in collaboration with our partners, including those who represent practitioners, to achieve meaningful systemwide change in line with our ambition to promote a fair and just culture across the health sector.

Vicky Voller, Director of Advice and Appeals, NHS Resolution

The British Association of Physicians of Indian Origin (BAPIO) is delighted to collaborate with NHS Resolution on this important piece of work. It is essential that concerns about the performance of any medical practitioners are handled in a sensitive manner, with equal attention given to the viewpoints of all parties involved. This is particularly important in the case of complaints against international medical graduates / ethnic minority doctors, where there is frequently an element of systemic bias against the doctors involved.

Dr Ramesh Mehta, President, BAPIO

The findings of the report are disappointing, but unfortunately not surprising. It has been a long-standing concern that IMG doctors and those of ethnic minorities can be treated as outsiders and may not have the same opportunities as their UK-qualified colleagues to receive early, supportive feedback. The lack of this early intervention can cause concerns to snowball when they could have been avoided or resolved through better support from colleagues and employers.

Professor Partha Kar, Clinical Advisor to the GMC international medical graduate induction

The health service workforce has long been amongst the most diverse in the country and we all benefit from the contributions of healthcare professionals from a wide range of backgrounds. A wide range of evidence however suggests that there is a very long way to go to make our working environments amongst the most inclusive. All of us within healthcare have a responsibility to address this and Medical Protection Society are therefore very pleased to support the Lived Experience project and NHS Resolution’s work in this area.

Dr Sarah Townley, Deputy Medical Director, Medical Protection Society

We have known that ethnic minority doctors and IMGs have been at a disadvantage for too long. We acknowledge and sympathise with the doctors who shared their difficult experiences as part of NHS Resolution’s research and believe it will be a valuable lever for effective change.

Charlie Massey, Chief executive, GMC


1. MWRES annual reports; GMC Fair to refer research; NHSE EDI improvement plan; CQC Discrepancy in regulatory outcomes for ethnic minority GPs; and NHS People Plan