Discrimination in the discretionary points award scheme: comparison of white with non-white consultants and men with women

Esmail, Aneez

doi:10.1136/bmj.326.7391.687

Cited by 22 publications

(17 citation statements)

References 3 publications

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“…[5][6][7][8] At the same time, concerns persist about the effect of racism and discrimination in medicine at many levels. [9][10][11][12][13][14][15] The General Medical Council (GMC) regulates doctors in the UK. Its governing body is made up of both doctors and members of the public.…”

Section: Introductionmentioning

confidence: 99%

Place of medical qualification and outcomes of UK General Medical Council "fitness to practise" process: cohort study

Humphrey

Hickman

Gulliford

2011

BMJ

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Objectives To evaluate whether country of medical qualification is associated with "higher impact" decisions at different stages of the UK General Medical Council's (GMC's) "fitness to practise" process after allowing for other characteristics of doctors and inquiries. Design Retrospective cohort study. Setting Medical practice in the United Kingdom. Participants 7526 inquiries to the GMC concerning 6954 doctors. Main outcome measures Proportion of inquiries referred for further investigation at initial triage by the GMC, proportion of inquiries investigated that were subsequently referred for adjudication, and proportion of inquiries resulting in doctors being erased or suspended from the medical register; relative odds of higher impact decisions, by country of qualification, adjusted for doctors' sex, years since primary medical qualification, medical specialty, source and type of inquiry, and nature of allegations. Results Of 7526 inquiries, 4702 concerned doctors who qualified in the UK, 624 concerned doctors who qualified elsewhere in the European Union (EU), and 2190 concerned doctors who qualified outside the EU. At the initial triage, 30% (n=1398) of inquiries concerning doctors who qualified in the UK had a high impact decision, compared with 43% (267) for doctors who qualified elsewhere in the EU and 46% (998) for those who qualified outside the EU. The adjusted relative odds of an inquiry being referred for further investigation were 1.67 (95% confidence interval 1.28 to 2.17) for doctors who qualified elsewhere in the EU and 1.61 (1.38 to 1.88) for those who qualified outside the EU, compared with doctors who qualified in the UK. At the investigation stage, 5% (228) of inquiries received concerning UK qualified doctors were referred for adjudication, compared with 10% for EU (63) or non-EU (221) qualified doctors. The adjusted relative odds of referral for adjudication were 2.14 (1.46 to 3.16) for doctors who qualified elsewhere in the EU and 1.68 (1.31 to 2.16) for those who qualified outside the EU. At the adjudication stage, 1% (69) of inquiries received concerning UK qualified doctors led to erasure or suspension, compared with 4% (24) for doctors who qualified elsewhere in the EU and 3% (71) for non-EU qualified doctors. The adjusted relative odds of erasure or suspension were 2.16 (1.22 to 3.80) for doctors who qualified elsewhere in the EU and 1.48 (1.00 to 2.19) for those who qualified outside the EU. Conclusions Inquiries to the GMC concerning doctors qualified outside the UK are more likely to be associated with higher impact decisions at each stage of the fitness to practice process. These associations were not explained by measured inquiry related and doctor related characteristics, but residual confounding cannot be excluded.

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Section: Introductionmentioning

confidence: 99%

Place of medical qualification and outcomes of UK General Medical Council "fitness to practise" process: cohort study

Humphrey

Hickman

Gulliford

2011

BMJ

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“…Using previously unpublished data, Esmail and colleagues 34 showed that 56% of white consultants had been awarded discretionary points whilst only 41% of non-white consultants had such awards. For female consultants compared to male consultants the figures were 44% and 55%.…”

Section: Prp Schemes and The Problems Of Discrimination And Biasmentioning

confidence: 99%

Performance Pay Remuneration for Consultants in the NHS: is the Current System Fair and Fit for Purpose?

Abel

Esmail

2006

J R Soc Med

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Despite reforms to the performance pay review system for NHS consultants, little has changed since the original Distinction Awards Scheme was conceived in 1948. Inherent weaknesses and biases in the scheme persist and result in discrimination against women and ethnic minority consultants in the allocation of awards. The literature on performance-related pay suggests that such schemes can be inappropriate in a public sector health service. The continued focus on rewarding individuals in performancerelated pay schemes can seem out of place in the modern era where there is an increasing focus on the performance of teams.

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“…They are more likely to be disciplined by the General Medical Council 6. Ethnic minority staff in the NHS are paid less and disadvantaged in the allocation of discretionary payments 7 8. They are more likely to face bullying and harassment from both patients and staff, and they are overwhelmingly over-represented in the more junior ranks of staff in the NHS 9 10.…”

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confidence: 99%

The prejudices of good people

Esmail¹

2004

BMJ

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Discrimination in the discretionary points award scheme: comparison of white with non-white consultants and men with women

Cited by 22 publications

References 3 publications

Place of medical qualification and outcomes of UK General Medical Council "fitness to practise" process: cohort study

Place of medical qualification and outcomes of UK General Medical Council "fitness to practise" process: cohort study

Performance Pay Remuneration for Consultants in the NHS: is the Current System Fair and Fit for Purpose?

The prejudices of good people

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