BAPIO (British Association of Physicians of Indian Origin) as an organisation actively promotes the diversity, equality and inclusion of all healthcare professionals. As an organisation which encompasses a majority of ethnic minority members, we hear the unfortunate experiences of bullying, harassment and discrimination that takes place in numerous healthcare settings within the UK. In response to these lived experiences, a committee was appointed to establish a set of standards, to foster dignity within the workplace, using the large body of literature documents available. The ambition of this project is to advocate and advertise for an environment that is free from bullying and harassment and to adopt a zero tolerance policy towards bullying or harassment. We aim to do this by developing, implementing, and evaluating our Dignity@Work Standards. The Standards constitutes of 8 different domains for all healthcare professionals including managerial members to adopt in clinical practice. These domains include: Environment & Culture - ensuring the workplace environment remains a safe place for professionals to raise concerns, be treated fairly and one with dignity for all. Cultural Intelligence - acknowledging and raising awareness of the impacts of culture and diversity on dignity and accounting for intersectionality in the workplace. Organisational Interventions - highlighting the role of the organisation in accommodating the appropriate resources to eradicate behaviours of bullying and harassment. Communication & Interactions - encouraging respectful interactions between staff and creating a safe workplace to communicate any workplace issues. Monitoring & Accountability - adopting a collaborative approach to routinely monitor the standards of behaviour in the workplace and being held accountable for any failures Metrics - collection of data from the workforce to be able to understand the lived experiences of the workplace. Concerns & Grievances - having a transparent process to raise concerns and ensuring the same process is applied to all members of staff. Support - provision of the appropriate support for all staff that are a victim of bullying and harassment. Our preliminary vision of the Standards is to create a document that defines the gold standard for dignity in the workplace. The Standards incorporates the diversity of the workforce and ensures consideration is given to the intersectionality of already known determinants of bullying and harassment within the workplace. The COVID-19 pandemic has created increased pressure on the workforce of the National Health Service and with this pressure has come unacceptable working standards, inappropriate behaviour within staff, increasing reports of bullying and harassment and more staff leaving the NHS than ever before. It is therefore crucial to act now in order to eradicate bullying and harassment within the healthcare setting. We know and appreciate that collaboration is the cornerstone to progress and we encourage working with core leaders within the UK healthcare system to create this change. Together we will deliver.  

Between 2020-21, BAPIO through its arms length Institute for Health Research (BIHR) and partners in the Alliance for Equality for Healthcare Professions, undertook a comprehensive, thematic synthesis of differential attainment as affecting the lifecycle of a health professional from entry to exit in the profession. This was followed by a series of consensus building workshops involving the triumvirate of grassroots professionals, their representative organisations,  stakeholder agencies and academics. The consensus recommendations were published in 2021, as the Bridging the Gap 2021 report.  One of the six domains in this report consisted of recommendations relating to professionalism and fitness to practise for the regulator and employing organisations. The report also provided a deep understanding of the onboarding, acculturation and differential treatment of international medical graduates, who make up approximately  40% of doctors and 1 in 5 of the UK healthcare workforce. The report acknowledged the overwhelming inherent existence of ubiquitous institutional bias and incivility, its impact on the health and wellbeing of the workforce, hindrance of workforce development  from the failure to recognise diversity and ultimate impact on patients that are at the centre of everything that healthcare professionals stand for.  The GMP guidance from the GMC UK aspires to describe and embody the letter and spirit of the values and behaviours that define the professionalism expected from doctors in the UK. The medical professionals (doctors and Physician associates) are required to provide evidence against domains of GMP during yearly appraisals and the five-year revalidation to continue to hold the licence to practise in the UK.  The GMP thereby serves as a framework against which to determine if a regulated professional has deviated significantly from the expected high standards of professionalism. Therefore, GMP is routinely referenced by the public, employing organisations and by the GMC UK, when doctors are referred to the regulator for appropriate investigation and possible sanctions. Although the GMC UK is often at pains to point out that GMP is not a set of rules, however, as any practising doctor will be aware, especially those at the sharp end of the GMC’s disciplining arm, the Medical Practitioners Tribunal Service, GMP is often the standard that determines whether or not a registered doctor has deviated away from what is expected of them. However, there is growing evidence that the GMP, in its current format, fails to properly reflect diversity amongst the medical profession and patients nor demonstrate sensitivity to the interpretation of values or behaviours through the lens of culture or diversity intelligence. The GMP does not take into account the shared responsibility and collaborative healthcare in multi-professional teams. The GMP does not sufficiently reflect that doctors are working in and for large organisations, where those in leadership and management positions must have accountability. The leaders are responsible for developing and creating functioning teams, provide the optimum working environment, with the tools to perform their intended roles (education and training) and be held accountable for delivering on the requirements of equality, diversity, inclusion and fairness for all patients and professionals, as reinforced by the NHS Constitution and the Equality Act 2010.  The resulting unfairness in how healthcare organisations treat regulated professionals, in particular doctors and the differential referral to the regulator is in part due to the format and content of the current GMP, which embodies a set of standards conceived and crafted more than a decade ago, and therefore appears to be significantly outdated in transforming the modern, diverse healthcare landscape.  In this workshop, doctors from across the profession worked with psychologists and academics in reviewing the GMC UK’s redraft of the GMP. In doing so, they suggested amendments and inclusions necessary, so that the proposed GMP 2022, demonstrates progress to a culture of fairness, social justice, diversity and inclusion.  The recommended amendments and inclusions to the GMP from this workshop are presented under three broad themes: 1) working with colleagues, 2) working with patients and for those 3) doctors in leadership or management positions.  The workshop participants reflected the perception that the GMP appeared to overtly support people in authority, and is open to be interpreted pejoratively and utilised for punitive action, to thereby provide grounds for deviating from the aspiration of a ‘blameless culture of learning’ that is the hallmark of a modern organisation.   That the proposed GMP did not reflect the diversity of the medical professionals nor their patients and therefore needed to be more explicit and unequivocal in every section in order to achieve dignity, respect and value to embed equality, diversity and inclusion in the profession and in healthcare.  The workshop recommended that Responsible Officers and the regulator demonstrate robustly and transparently in their processes - fairness,  diversity intelligence, accountability and an independent assessment of the impact of their referrals/decisions on the morale, wellbeing of the regulated professionals.  This paper summarises the extensive discussions and presents the amendments that will aid the architects of the new GMP to truly address the palpable shortcomings of the current GMP. The recommendations take into account modern societal transformation, the healthcare space that doctors function within, reflects the considerable diversity of our communities and professionals. This paper offers an opportunity to capture the wide-ranging views from the profession and academics to help right the many wrongs that have plagued the relationship of the regulator with the medical profession.  The workshop acknowledged the efforts of the GMC UK and its outreach ambassador in actively seeking out contributions from voluntary professional organisations and their vast membership in helping shape the new GMP, which we hope will be fit for a modern, post-pandemic just society in the UK and serve as an exemplar for the standards expected from the profession, across the globe.

Presented on 5 Nov'22

Sexual harassment and gender discrimination overlap affecting people (including children) of all genders, however data shows an overwhelmingly high prevalence of violence or harassment experienced by women in areas of conflict, professional life and in their homes as well as in the healthcare workplace. It is pervasive, persistent and all too common.                   Workplace sexual harassment an discrimination although illegal, is particularly is more common in women who are young, early in their careers, in temporary employment, from under-represented or marginalised groups based on ethnicity, immigrant status, gender non-conformity or disability.   Majority of perpetrators are men, who are older and enjoy the privilege of disproportionate power and in certain toxic male-dominated healthcare environments.                   Two recent stories of sexual harassment in healthcare prompted many women to follow suit and share similar stories referring to flashbacks, post-traumatic stress, damage to careers, pressure to leave their job, self-harm and suicidal thoughts, brought about by their experiences. Yet there are examples of women as role models breaking down historical barriers such as Hilary and Chandi in their polar adventures.                   Tackling such structural inequality requires remedies that go beyond incremental approaches focussed on individuals and include transformation of the organisational and societal climate by interventions, affirmative policies and courageous, compassionate leadership. Workplace sexual harassment and discrimination is unacceptable, not inevitable and needs to be eradicated.

Oral and Poster Presentations at the BAPIO Silver Jubilee Annual Conference 2021 Birmingham, UK 22-24 Oct 21