RCGP is cleared of ethnic discrimination in clinical skills assessment

A High Court judge has ruled that the clinical skills assessment required to become a GP in the United Kingdom does not unlawfully discriminate against ethnic minority candidates.

The ruling is a blow for the British Association of Physicians of Indian Origin (BAPIO), which brought a legal challenge against the Royal College of General Practitioners and the General Medical Council over the assessment.1

But Mr Justice Mitting said that the association had won “if not a legal victory, then a moral success” and called on the college to act over the disparity in success rates between white UK graduates and those from ethnic minorities who qualified in the UK or abroad.

The judge cleared the college of unlawful racial discrimination and of breaching its public sector equality duty. He also rejected a claim that the GMC, which did not face accusations of unlawful discrimination in the legal action, had breached its equality duty.

He said that the college had carried out many reviews that had identified the disparity between different groups and must now take action. “If it does not act, and its failure to act is the subject of a further challenge in the future, it may well be that it will be held to have breached its duty,” he said.

The judge accepted that the assessment, which involves role play in which actors pose as patients and is taken at the end of three years’ training, put trainees of south Asian origin—whether they qualified in the UK or overseas—at a disadvantage. But he ruled that the assessment was “proportionate” and designed to achieve “legitimate ends.”

BAPIO’s president, the consultant paediatrician Ramesh Mehta, said, “We are naturally extremely disappointed in the decision and still believe that the clinical skills assessment racially discriminates against both international medical graduates and UK graduates with ethnic minority backgrounds.” The association’s solicitor, William O’Neill, said that it would consider an appeal.

The royal college’s chairwoman, Maureen Baker, said that the college had “commissioned and supported extensive research to understand what is happening and to try to identify what the causes may be.”

She said the college agreed that further action was needed and would be working with BAPIO, the British International Doctors’ Association, and the BMA, as well as with the GMC and the training deaneries or local education and training boards with responsibility for trainees.

Niall Dickson, chief executive of the GMC, said that his organisation had commissioned an independent review of the examination for membership of the RCGP and the clinical skills assessment by Aneez Esmail of Manchester University, published in the BMJ.2 Dickson said, “His report raised some important issues, and we are already working to take forward his recommendations. In addition, we are leading a review, working with the Academy of Medical Royal Colleges and others, on a project to understand and bring together the data in this area.”

He added, “The UK benefits from the diversity of the medical profession. We will work to make sure that diversity and high standards go hand in hand.”