In March 2021, the Royal College of Surgeons (RCS) published An independent review on
diversity and inclusion for the Royal College of Surgeons of England. Much of the report
looks at diversity in relation to the structure of the RCS but it also explores issues around
diversity in surgeons more widely.
We have taken this opportunity to review some of the information we hold on cases
discussed with us which relate to surgeons to understand if similar issues highlighted in the
RCS report are apparent in our cases and are relevant to the services we offer to help
employers and practitioners to resolve concerns about individuals’ performance where they
arise. These cases relate to surgeons of any grade working or training in a surgical
A quarter of all Advice cases for doctors in secondary care involved a doctor in the surgery
group (between FY 2015/16 and 2019/20).
In common with all specialties, International Medical Graduates (IMGs) in surgical groups are over-represented compared to the wider population of medical doctors. For surgeons, just over 50% of cases related to IMGs compared to the 21.3% of surgeons being IMGs cited in the RCS report.
Of the surgeons in our cases, 88% were male which is only slightly higher than the
percentage of surgeons who are male. Overall, male doctors tend to be relatively overrepresented in cases discussed with us.
Looking at cases across all practitioners (including a small number of dentists and
pharmacists), there has been an increase in the proportion of cases where their employer
has cited a concern which relates to behaviour/misconduct. Whilst we cannot be certain as
to whether this relates to increasing awareness of these issues and willingness to
understand and resolve them, or whether it relates to a real change in behaviours, it does
correlate with our experience of receiving increasing number of requests for behavioural
interventions such as behavioural assessments, workplace-based mediations and team
In secondary care the proportion of cases presenting with concerns about behavioural/misconduct is higher and surgeons do not appear to differ significantly from other secondary care practitioners.
Recent analysis of our cases between 2015 and 2020 indicates that doctors from ethnic minority groups and those who qualified outside the UK are over-represented in our cases when compared to the number of doctors on the Medical Register, in line with other findings elsewhere from the NHS (A fair experience for all: Closing the ethnicity gap in rates of disciplinary action across the NHS workforce) and General Medical Council (Fair to Refer?).
We are committed to furthering our understanding of the lived experience of practitioners and managers who bring cases to Advice to guide the continuous improvement of the service. We will shortly be embarking on a piece of qualitative research focused on understanding this important area further, which will include the perspectives and experiences of individual practitioners from ethnic minority backgrounds and/or who are IMGs. The research forms part of our wider programme of work on matters of equality, diversity and inclusion. This research will allow us to continue to improve how we manage cases and help us interact with practitioners in a more compassionate way by ensuring they feel heard, supported and understood. For more information about this work, please email us at Advice.ResearchAndEvaluation@resolution.nhs.uk.
We will also be undertaking a more detailed analysis of behavioural and conduct issues
reported to us.
See below for more information on our services that relate to behavioural concerns about