Lived experience research

Introduction

Practitioner Performance Advice undertook research to better understand the lived experience of ethnic minority and international medical graduates (IMGs) practitioners who are the subject of performance concerns referred to us. The actions flowing from this research now sit within our broader programme of equality, diversity and inclusion (EDI) work and present an opportunity to consider how the research outcomes can be used to support improvement in our own service and to help effect change in the wider NHS.

The research represents the lived experience of practitioners. We fully acknowledge the experiences shared by practitioners and the significance and toll of the impact on individuals and their families. We have used the research report and linked case studies to develop a programme of actions to improve our service for all practitioners.

We are also working with a range of key stakeholders to support positive change in the management of performance concerns.

Healthcare employers and contracting organisations need to consider the findings and resources in the context of their own processes for the management of performance concerns and organisational culture and take steps to ensure a fair experience.

We encourage employers and organisations to contact us at an early stage when concerns arise: there is no formal threshold to be reached before they can do so. Our involvement should be seen as supporting the prompt and fair resolution of performance concerns.

Context

Ethnic minority and IMG practitioners are disproportionately impacted by formal disciplinary processes as published by the GMC1, and the NHS.2 We have also found that these groups are overrepresented in concerns reported to us by employers and contracting bodies3 and that Black and Black British practitioners are statistically more likely to face exclusion.4

Following on from these findings, we commissioned qualitative research from the company Opinion Research Services (ORS) into the lived experiences of ethnic minority and IMG practitioners for whom we received a request for advice from our Practitioner Performance Advice service.

Report findings

ORS produced a report, outlining the findings of the qualitative research we commissioned:

The findings of the research show a mixed range of experiences with the Practitioner Performance Advice service and of the handling of cases by employers and contracting organisations, as well as experience of racism in the wider NHS.

Insights

Our Insights publications share analysis and research which draw on our in-depth experience providing expert, impartial advice and interventions to employers and contracting organisations.

Our lived experience Insights paper looks at key themes from the research we commissioned and outlines our response to the research findings, with the aim of highlighting opportunities for learning and improvement to the health system:

Case studies

To aid and support learning from the research findings, ORS produced two case studies representing one positive and one negative experience of management of concerns related to performance. These case studies were based on the lived experience of two of the participants interviewed by ORS for the commissioned research.

The aim of the case studies is:

  • To gain an insight into individual practitioners’ experience of management of concerns related to performance
  • To aid reflection on how performance management can be best handled

These case studies have been designed for use either individually or as part of a discussion with peers to allow the exploration of the rationale for decisions and approaches.

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

Action plan

As a result of the lived experience research, we developed an initial action plan:

The intention was to make a tangible difference to the service we offer, with consideration given to the lived experience of practitioners. Those actions (including review and amendment of our website to be clear about our role and considering how practitioners are told about our involvement in a case) are all either underway or complete. However, after that plan was written, we identified a number of other strands of work that related to EDI. That led to the creation of a broader EDI work programme which is now taking forward a range of actions – including those that flowed directly from the lived experience research.

Healthcare engagement

We engaged with key healthcare partners during the build up to the publication of this research, including representatives from the following groups:

  • ethnic minority practitioner networks;
  • employers;
  • defence organisations;
  • regulators; and
  • national bodies.

This helped to shape our communications, gain support for our actions, raise awareness about our service and promote the wider sharing of the report.

EDI initiatives

A number of healthcare partners are engaged in relevant work that can complement the objective of a better and fairer experience for ethnic minority and IMG practitioners who are the subject of performance concerns. We have created a reference page which brings together those various initiatives in one place:

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

Acknowledgements

Significant contributions were made to the design, data collection, authorship and communications by the following individuals and organisations. We are extremely grateful to everyone who added their input to this work:

1. Research

Practitioner Performance Advice would like to sincerely thank the participating practitioners for sharing their experiences so openly and candidly. We recognise that sharing their experiences may have been difficult for practitioners and are grateful that they gave their time and effort to this work.

NHS Resolution is very thankful to Opinion Research Services for conducting this valuable piece of research and in particular, Liz Phillips, Senior Researcher and Kelly Lock, Head of Qualitative Research.

2. NHS Resolution working group members

  • Neil Armstrong, Casework Systems and Guidance Manager
  • Alison Budd, Specialist Adviser
  • Hanna Gillespie-Gallery, Evaluation and Research Lead
  • Anwar Khan, Senior Clinical Advisor
  • Kelly Lock, Head of Qualitative Research (Opinion Research Services)
  • Liz Phillips, Senior Researcher (Opinion Research Services)
  • Rineke Schram, Lead Assessment and Remediation Adviser
  • Sanjay Sekhri, Deputy Director of Advice and Appeals

3. Authorship of the Insight and supporting materials

  • Neil Armstrong, Casework Systems and Guidance Manager
  • Hanna Gillespie-Gallery, Evaluation and Research Lead
  • Daniel Knight, Communication and Engagement Lead

4. Input into the Insight and communication

We have held workshops and briefings with employers, practitioner groups, defence organisations and national bodies, including regulators. We would like to thank those individuals and organisations who gave their time to help us consider the findings of the research and our approach to communications to maximise learning across the healthcare system. This engagement included representatives from primary and secondary care providers across England, Wales and Northern Ireland, as well as:

  • British Medical Association
  • British Association of Physicians of Indian Origin
  • Care Quality Commission
  • General Medical Council
  • King’s Fund
  • Maraz Healthcare UK
  • Medical Defence Union
  • Medical Protection Society
  • NHS Employers
  • NHS England

5. Communication

  • Ian Adams, Director of Policy, Strategy and Communications
  • Daniel Knight, Communication and Engagement Lead

6. Administrative support

  • Sandra Middlehurst, Personal Assistant
  • Emma Yanatchkov, Specialist Support Officer

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Footnotes:

1. Fair to Refer?, GMC, 2019
2. Medical Workforce Race Equality Standard (MWRES) WRES indicators for the medical workforce 2020, NHS England/Improvement, 2021
3. Who are the practitioners we advise on and are there any patterns of concerns?, NHS Resolution, 2022
4. Insights from 10 years of supporting the management of exclusions in England, NHS Resolution, 2022

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