JS Bamrah, Psychiatrist, Manchester & Chair, BAPIO
Anshoo Dhelaria, Paediatrician, East & North Herts NHS Trust
Cherian George, Radiologist, University Hospital of North Midlands
Geeta Menon, Ophthalmologist & PG Dean, Health Education England, South London
Himanshu Kataria, Emergency Medicine Physician, Manchester
Neeraj Bhala, Gastroenterologist, Birmingham
Nitin Shrotri, Urologist, East Kent Hospitals
Raj Mattu, Cardiologist, University Hospitals of Northamptonshire
Renu Jainer, Paediatrician, West Midlands
Roberta Fida, Psychologist, University of East Anglia
Roshelle Ramkisson, Psychiatrist, Manchester
Sapna Agrawal, General Practitioner, West Midlands
Saraswati Hosdurga, Paediatrician, Bristol
Satheesh Mathew, VP, BAPIO & Rtd Paediatrician, Barts Health, London
Shivani Sharma, Psychologist, University of Hertfordshire
Soumitri Chakraborty, General Practitioner, West Midlands
Tista Chakravarty-Gannon, GMC Outreach Lead
Vijay Jadav, Surgeon, W Midlands
Ananta Dave, Psychiatrist, Lincolnshire Mental Health Trust
Joydeep Grover, Emergency Physician, Bristol
Mahendra Patel, Pharmacist, University of Bradford
Priyanka Nageswaran, Imperial College London
Shevonne Mathiekin, Psychiatrist, Cambridge
Subodh Dave, Psychiatrist & Dean, Royal College of Psychiatry
Role of BAPIO
The British Association of Physicians of Indian Origin (BAPIO) was established over twenty five years ago predominantly for the purposes of representing the interests of migrant doctors who had faced hardship in the NHS. Since then it has evolved to an organisation that promotes teaching, research, policy making, charitable work and collaboration with NHS bodies, regulators, medical royal colleges, nursing fraternities, politicians and international organisations on a variety of health related issues.
In recent years, BAPIO has taken an active stance in ensuring that medicine as a whole is freed from discriminatory practices, and in this context, we have worked closely with the General Medical Council (GMC) to root out the bias that exists within the regulatory system.
Central to how doctors are regulated is the framework that has the purpose of ensuring that we operate at the best possible levels, that we put patients at the heart of what we do, and that we are accountable. The Good medical practice (GMP) guidance (2013) has served a purpose, but it has had its critics and rightly, it is now in the review stages.
BAPIO is an important stakeholder in the consultation so that we can ensure that the renewed guidance is fit for purpose for professionals, especially those that are of a Black, Asian and Minority Ethnic origin, but also for the patients for whom we strive to provide the best standards of care. As doctors, we have been trained to a high standard, and but for a minority, we all strive to provide the best possible and safe care to patients, we treat colleagues with respect and dignity, and even where we are in a highly specialised field, we continue to seek improvements through evidence based teaching and research. Our professionalism has often meant that we put our craft and profession above our own needs.
BAPIO is determined therefore to ensure that changes to GMP reflect the complex needs and values of a diverse workforce, without comprising the high quality care that we deliver to our patients and a firm commitment to work with the regulator and all stakeholders to implement this aspiratio
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.
To discuss the validity and impact of the provisions in the proposed GMP document, especially with regards to
Fairness, equality and social justice,
Ensuring inclusion and diversity intelligence,
Ensuring accountability for doctors in leadership roles and organisations.
To ensure that the recommendations from the Bridging the Gap 2021 report are considered for incorporation in the proposed GMP 2022- particularly on working environment, transparency, fairness, accountability for organisations and their leaders.
The current version of GMP considers four domains to be at the heart of medical professionalism:
Domain 1 - Knowledge skills and performance
Domain 2 - Safety and quality
Domain 3 - Communication partnership and teamwork
Domain 4 - Maintaining trust
The proposal is to retain four categories but alters the context of each of them, and makes them as much applicable to registered medical practitioners as it does physician associates and anaesthesia associates:
The four domains considered in the workshop were;
Theme 1 - Tackling discrimination, and promoting fairness and inclusion
Theme 2 - Working in partnership with patients
Theme 3 - Working effectively with colleagues
Theme 4 - LeadershipInclusive leadership and accountability
The objective of this workshop was to debate and dissect the proposals rather than critique or compare them with the existing guidance.
Tackling Bullying for Minority Doctors
Chakravorty, T. A., Ross, N., George, C., Varadarajan, V., & Mehta, R. (2021). Tackling Workplace Bullying for Minority Ethnic Doctors. Sushruta Journal of Health Policy & Opinion, 15(1), 1-8. https://doi.org/10.38192/15.1.1
DA in Career Progression
BAPIO Institute for Health Research/ Bridging the Gap Project
Differential attainment in career progression in the NHS is a complex issue with many interplaying factors apart from individual protected characteristics. In this paper, we examine the attainment gap, causes for these disparities and some recommendations to reduce the gap.
Our review shows that there is significant DA between groups of doctors on the basis of gender, ethnicity, race and country of primary medical qualification. The likely causes are bias, lack of opportunity, poor supervision, mentorship, sponsorship, dichotomous treatment of doctors based on training or non-training status and cultural exclusion. Data is not monitored or reported and there is little organisational accountability. Solutions are likely to include transparent data on recruitment as well as progression for benchmarking, training support for all doctors, initiatives which are sensitive to gender, parental responsibility, cultural heritage, language and robust supervision including mentorship and sponsorship.
This scoping review forms part of the Alliance for Equality in Healthcare Professions project on Differential Attainment chaired by the British Association of Physicians of Indian Origin (BAPIO) and will be integrated into the Bridging the Gap project undertaken by BAPIO Institute for Health Research (BIHR). This work is part of six domains of doctors' careers in the NHS.
Published on behalf of British Association of Physicians of Indian Origin.Copyright (r) by BAPIO Ltd, UKDisclaimer: The opinions and views expressed by the author in his magazine are not necessarily those of the editor or the publishers. Although, care is taken in preparation of this publication, the editors and the publishers are not responsible for any inaccuracies in the articles. Great care is taken with the regards to artwork supplied, the publishers cannot be held responsible for any loss or damage incurred. The magazine takes its name and inspiration from the ancient father of Indian medicine and surgery 'Sushruta'. www.bapio.co.uk @BAPIOUKCONTACT: firstname.lastname@example.org
The year 2020 will go down in history as the year that never was, the year that brought humanity to the brink and back. A year that many around the world would rather forget and hope it never existed. That it was a bad nightmare. For the UK the double whammy of COVID-19 and BREXIT has really put us to the test. There is hope as we reach the last few weeks of the year that we can take a few moments to look back at what really happened. What can humanity learn from the experiences of the last 12 months?
The first aspect that we learned is how connected we are both physically and digitally. While the physical connectedness, the ease of international travel led to a rapid spread of the novel coronavirus (SARS - CoV-2) across all the continents, making it impossible to contain, quarantine or limit the devastating impact that the COVID-19 caused to each every country in the world. No one was spared. We learned how technology can come to our aid, how like in every previous crisis, calamity led humanity to innovate, speed through multiple cycles of invention, adopt early and diffuse at lightning speed.
We learned how the world is divided along social, political and economic lines, yet connected and collaboration surged across borders with scientists, clinicians, social activists and political pundits helping set the tone of responses from people and organisations to their respective leaders. We learned that racism, discrimination and deprivation are deeply ingrained in all societies. We saw clear evidence of how such systemic inequalities cost lives. We saw the uprising and the sentiments of people across the world protesting against the discrimination evident in the treatment meted out by law enforcement agencies in the USA and how this uprising resonated with people across the world. How in the UK, there was a movement to recognise the unfairness of the wealth accumulated through exploitation in the actions against the legacy of the trade-in humans.
We saw the commitment from frontline healthcare professionals who were willing to sacrifice their own personal lives or their time with their loved ones in order to dedicate themselves to the care of their patients. We saw the inherent selflessness of people of all shapes, sizes, colour, ethnicity, gender and across the world. Many lost their lives in the line of duty. It is perhaps not unusual for humans to choose to face danger, take actions that clearly and incontrovertibly put their own lives at risk as often seen in the times of war, but never in peacetime and from not from people who normally denounce loss of life. We know that healthcare attracts people with certain qualities of selflessness, dedication and caring but never before were these sentiments tested in such extreme circumstances as the first surge of COVID-19 pandemic swept across the world. Thousands of healthcare professionals fell ill, watched their loved ones suffer, lost colleagues and still carried on.
The full impact will only be seen in years to come as the effects of long Covid and moral injury become more apparent
It was probably the first time in decades that the ‘common people’ recognised this dedication and there was much emotion in the period of ritual clapping that was undertaken by many communities in the UK and similar gestures across the world. The term ‘NHS Heroes’ was coined and understood by many. There were millions of acts of kindness from neighbours, organisations and strangers showing the gratitude that the world felt towards the caring professions. This flood of gratitude was not limited to healthcare workers, rapidly there was recognition of ‘key workers’ and the contribution that a multitude of professions made to the running of society and societal systems that are often taken for granted. We heard, read and shed many a tear as we learnt about the acts of courage and kindness shown by many such key workers.
We saw how political decisions are made and how mass communication of messages is disseminated in various countries of the world. We watched individual politicians, leaders make wise decisions (in New Zealand, Germany), controversial choices as in the USA and of much vacillation in the UK, France or Italy. We saw how countries dependent on systems of government rather than charismatic leaders were able to make evidence-based decisions (S Korea, Singapore) often with significantly better outcomes for their citizens. Perhaps political decision making cannot be simplified to a choice between individual personalities versus collaborative, consensus-based modalities of decision - making.
There are the poorly understood reasons behind the variable mortality seen in hugely populous countries such as India or Africa versus European or American nations. Nowhere in the world and at no time, have politicians enjoyed the supreme confidence of the masses, at least not for very long. While healthcare professionals have always been at the top rung of the ‘most trustworthy’ people’s list. The year 2020 has not been any different. Politicians across the globe have grappled with the delicate balance of appearing to listen to scientific and political wisdom while deciding on the timing, content and tone of the messaging to the masses. Have they got the messaging right? Have they managed to strike a balance on fairness and support the idea of a cohesive community, where every citizen is valued? Have they recognised the plurality of voices, yet kept citizens on the primary message? There will be a time and place to review and judge our actions for this year.
It has been a momentous year for the British Association of Physicians of Indian Origin (BAPIO). It has morphed from a national, voluntary organisation supporting its members, representing the views of the vast numbers of immigrant healthcare workforce in the UK to a national body standing up for tackling health inequalities across the spectrum.
BAPIO has stood for equality, diversity and inclusion, in every walk of life, as well as for healthcare professionals. It has matured in its silver jubilee year, as an institution with its many regional divisions, forums and arm’s length bodies.
In spite of lockdowns and restricted mobility BAPIO was able to expand its activities and reach. It was the first organisation to pick up the issue of COVID-19 affecting BME population and staff much worse than the white population. While actively engaging the DH, NHS and public health it also discovered the huge hidden talent of academia and research amongst its membership. It led to the launch of the highly successful BAPIO Institute for Health Research (BIHR) which was established in March 2020. The objective of BIHRis to promote high-quality research and innovation in health and social care by supporting diversity, leadership and engaging in strategic collaboration with partners in the UK and beyond.
BAPIO’s charitable activities required immediate action. Thousands of Indian tourists and students were stranded in the country due to lockdown. BAPIO collaborated with the Indian High Commission and set up an emergency helpline to support them with health advice. There were many stranded people who were on long term medications. For them, BAPIO set up a system of writing prescriptions and dispensing the medication. Another high profile charitable activity was related to supporting almost 250 doctors from 27 nationalities who had come to the UK to take the PLAB test. Due to lock down the test was cancelled but these international doctors got stranded. They were running out of finances and were obviously under considerable stress. The BAPIO PLAB stranded doctors’ project started as a
serendipitous exercise in the third week of March 2020 with first a handful of doctors until it reached a peak of 267 in the group. Under the umbrella of BAPIO, the project team doctors, who previously had barely known each other, took on all the challenges - teaching, pastoral support, career advice, writing CVs, finding food, accommodation and funds for those in need, organising professional support, links with GMC, the High Commission of India and the U.K. Home Office, the lot. The project was concluded on 19 September as previously agreed, with all the doctors either returning home or making a conscious decision to work in the NHS when conditions allowed. The weekly Zoom meetings, the camaraderie, the scale of the project, and most importantly bringing it to a close without any major crisis was only possible through sheer determination, understanding, professionalism, leadership and good communication.
The BAPIO Welsh Team under the leadership of Prof Keshav Singhal developed an App for Risk Assessment tool. This App could find our risk of infection to COVID-19 within 2 minutes. There were separate tools for healthcare staff and for the general population. This App was made available free of charge.
The British Indian Nurses Association (BINA), an arm’s length body of BAPIO, was launched during the annual conference on 20th November 2020. There are 24,000 Indian nurses currently working in the UK and they have not had any national body to support them. BINA will ensure on-going support as well as provide pastoral care to newly arrived nurses.
BAPIO Training Academy (BTA) has been very active in starting several courses locally but more importantly, it has developed an innovative India-UK programme also known as 2+2 programme. The scheme is to deliver a 4-5-year training programme to Indian doctors in medical specialities. The training will be between India and UK thus reducing the UK training cost significantly; while providing much needed trained doctors to both countries. At the same time providing world-class UK postgraduate qualifications and training to Indian doctors. It is expected that following completion of training and obtaining an MBA in healthcare management, these doctors will return to serve in their home country. The scheme involves 2 years training in India followed by 2-3 years in the NHS and named as “Indo-UK PG Training Programme” This is a collaboration between the BTA, Royal College of Physicians of Edinburgh, Health Education England (HEE) Global Engagement and the University of South Wales.
Finally, it is time to recognise those of our colleagues who have fallen in battle against the virus, while dedicating themselves in selfless service of their fellow humans. It is time to recognise the dedication and brilliance of thousands of scientists across the world who have succeeded in designing, developing, testing and delivering a worldwide vaccination programme to protect against the scourge of the SARS-CoV-2. It is time to recognise how the common people of the world have come together overcoming barriers to help each other and aspire to a more equal world. This is the time of the year when multitudes across the world come together to bring hope and joy to everyone, to seek a new tomorrow. Despite the late surge of the pandemic during the dying weeks of 2020, the hope is that 2021 will bring us a fairer, safer and just world for all.
To quote William Shakespeare,
“True hope is swift and flies with swallow’s wings”.
A huge thanks to all who have submitted entries to the International Essay Contest and to our judge Professor Geeta Menon, Postgraduate Dean, Health Education England, South London. The Prize-winning vouchers will be emailed on Friday 10 July. The prize-winning entries will feature in the Sushrutajnl.net