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It’s not just cricket






You don’t have to be a cricket fan to have seen the fallout out of the racism scandal at Yorkshire County Cricket Club. It was tearjerking watching an incredibly brave testimony in the Commons from Azeem Rafiq, the cricketer who had his whole career taken away from him due to racism.I strongly believe that it is wrong to say cricket, a sport I love, is reflective of society in this instance. What was happening at that club and others was far worse than the vast majority of workplaces (at least since the 1970s).

But, just like following the fallout from Harvey Weinstein’s crimes, I think it would be remiss not to take this chance to ask whether general practice has anything to learn.

This is a subject close to my heart. In my three years as editor, we have done two cover features on systemic racism, including my very first issue. Before then, my biggest story was on the differentials in performance between white and non-white candidates in the RCGP exam.

So, is there a problem with racism in general practice? The first thing to say is that from Thursday three of the four most powerful positions in general practice will be filled by non-white individuals – health secretary, director of primary care and chair of GPC. There remains a problem with the lack of black people in positions of power in the profession, however.

But I feel the ethnicity of the leadership doesn’t preclude systemic racism. As we have pointed out in previous cover features, non-white GPs have worse outcomes in all areas of general practice, including GMC complaints and investigations, exit exams and CQC inspections. This is equally true when only looking at British-born individuals. There is still no explanation as to why this is the case.

We can also look at policies. Take the new NHS England plan. As RCGP chair Professor Martin Marshall pointed out, the draconian measures in the plan will target single-handed GPs, a disproportionate amount of whom are old, male and of Asian heritage. Of course, you may say that the rules are the same for everyone. But this is the point of systemic racism. Why were these metrics around face-to-face appointments and access? If there was a policy decision to look at overall patient satisfaction and continuity of care – which would be equally valid metrics as those chosen – then the practices Professor Marshall speaks of would score highly.

This is not saying that there is a vendetta against doctors of Asian heritage – far from it. But single handers seem to be seen as collateral damage in the overarching policy in England. Ageism is probably a bigger factor in allowing these GPs to be collateral damage; if they were male and of Asian heritage, but also young, I strongly suspect they would reconsider this policy. But also – and I have no way of proving this – I wonder if more attention would be paid to this collateral damage if single handers comprised predominantly old, male and white GPs.

Take also the RCGP’s response to the row over its clinical skills assessment exam. While their actions were nowhere near as bad as those of Yorkshire CCC, the responses were identical – a refusal to even countenance there was a problem. This is not about individuals making the decisions, and it is not even about NHS England or the RCGP, both of which have many good people working in them. But non-white GPs are still affected disproportionately.

Yet the thing that most resonated with me watching the Rafiq hearing was the micro-aggressions, and this is something I have experience of (albeit nowhere near what he went through). It’s the ‘but where are you really from?’ questions, getting funny looks after an Islamist terror attack, feeling self-conscious about supporting England, people joking about not attempting to get your name right. The recipient of these micro-aggressions laughing again awkwardly because they know no harm is meant, but it is a reinforcement that you don’t belong.

This is absolutely a societal issue, but even with the high proportion of non-white GPs, this still exists in general practice and medicine – something which Nabi has written about beautifully.

I suspect many readers would not agree with what I have written, and I understand that. Systemic racism is complex and you don’t need to be racist (or white) to contribute to it. I am sure I am guilty of contributing to it, and I also don’t think I am anywhere near understanding it. On the whole, I think we can say general practice is better than most professions in combatting it. But the more we think about it, the more just a society we can help establish.

Jaimie Kaffash is editor of Pulse. Follow him on Twitter @jkaffash or email him at editor@pulsetoday.co.uk

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