Wednesday, 19 December 2012

Doctors fundraise worldwide to take the RCGP to Judicial Review

According to a BIDA (British International Doctors Association) representative and BAPIO, 200+ young doctors (mostly Asian male) were expelled from UK GP training; many of these families face debt, destitution, and despair this Christmas since the change to the marking system of the new CSA GP exit exam Sept 2010-2012.
On Saturday, December 15, 2012, BAPIO (British Association of Physicians of Indian Origin) held an emergency conference meeting over the CSA (Clinical Skills Assessment) GP exit exam. Doctors travelled from all over Great Britain to attend. Each of the expelled doctors stood up and recounted their CSA experience, how they felt it had been discriminatory and how expulsion over repeated fails at an actor exam had affected both themselves and their families. One Indian male GP at the conference announced that GP trainees who were expelled now faced a GMC referral as to fail an actor exam repeatedly, implied they were 'dangerous doctors' to actual patients and he knew 2 GP trainees in this position; yet real patients of theirs had given them excellent patient satisfaction surveys when treating their real medical and psychological conditions in each of their respective GP surgeries in Great Britain. And indeed one GP trainee contacted me since, after receiving his GMC letter in the post, referred by his training Deanery and faces a GMC Interim Order Panel Meeting in the New Year.

I looked into the faces of so many young Asian wives, female and male GP trainees (residents in training) who had been expelled or face expulsion. They all conversed in fluent English, as they were relaxed at this meeting and not under extreme psychological duress facing a CSA exam with a 36% pass rate for Asians, a 66% pass rate for Black British and a 96% pass rate for White British GP trainees; an exam with up to 13 white British actors whose role-plays would affect their entire medical career in just one 1/2 day assessment and a need to score on average 6/9 in all 13 stations to meet the pass mark of 73-77/117, an almost impossible target. Yet the anomaly was they had all passed their workplace based assessment which included a Consultation Observation Tool (videos of real patient-GP consultations) and 40 random patient satisfaction surveys from their real patients.

Jimmy Stewart in 'It's a wonderful life' depicts what I saw - human pain and suffering multiplied several times over by the sheer numbers who attended, families stricken by poverty and stress this Christmas and one had attended with a young child. They had all maxed out their credit cards, were in debt, many jobless, shamed, unable to face their young families; one young doctor with MRCP who had given up his job as a NHS hospital medical registrar (specialising in cardiology and diabetes) to become a GP, drove 180 miles to attend. Deep down he was driving away from his young family (his wife is also a GP trainee and ex-medical registrar who has resigned her GP training number in protest despite passing the AKT with a high score in the 80%ile), a broken man unable to face his wife and 2-year-old child.  He scored 92% in his GP entry exam, 86% in AKT (the written applied knowledge test of general practice) and failed the actor CSA exam 5 times yet the Royal College of GPs alleges those who fail CSA are also underperforming in the written AKT exam? There were 2 asian female doctors present who had both resigned from their respective Deaneries, protesting to the way the CSA was treating their male colleagues. One female GP trainee had scored in the 80%ile in AKT and her Dean wanted her to stay in the programme, but she was adamant she could not stand by and watch this injustice. She announced to the conference that she would rather work in Tescos than be shamed by CSA. She could keep her dignity. Another GP stood up and shared how his wife and children had left him to go back to India. He was now alone in the UK, jobless and a broken man. The Conference voted unanimously to take the Royal College of General Practitioners to the High Courts for a Judicial Review of the CSA exam.

Please help the real life Jimmy (one of the many expelled and future 'Jimmy's') by coming together as a global medical community to ensure all exit medical exams are fair and equal for all doctor trainees, with videotaping for fair appeals, and with an alternative assessment with real patients and not actors, i.e. consideration of a video submission of real patient consultations  (as is used in the American Board of Family Medicine board certification .  Spring 2012 & their pass rates - US medical graduates 86.7%, Canada medical graduates 83.9% and IMGs (International Medical Graduates) 77.2%...1462 IMGs took the US exam. The MRCGP CSA pass rates for August 2010-July 2011 - UK medical graduates 91.8%, female UK graduates 95.8% and IMGs 40%...1305 IMGs took the UK exam).

An argument to go back to video submission of real patient consultations

Video submission of real patient consultations was used prior to 2007 by the Deaneries as part of Summative Assessment alongside their written exam (no charge to the trainees) and had an extremely high pass rate for both UK and IMG graduates to progress GPs to certification and was also used as one of the old MRCGP exam modules (at a cost of only £190 to submit a dvd/VHS tape of 7 taped real GP consultations to the RCGP) to award MRCGP prior to October 2007. Perhaps time to reinstitute a tried and proven cost-effective method of GP assessment, video recording of the doctor consulting with real patients? GP trainees do not want more attempts at an actor CSA exam but one attempt at a video submission seeing his real patients in a real surgery in Great Britain, authentic not simulated surgeries. Are not 40 real patients better judges of their GP than 13 actors?
One affected wife wrote to BAPIO: 'It is really sad to see how many of us are suffering behind closed doors with our dreams shattered. It is absolutely disgusting what these institutions are doing to such talented people.

He saw a glimpse of hope after we contacted BAPIO. Just knowing that people are fighting for this made us feel better. We are most grateful to BAPIO and even if we don't win anything with the RCGP, we had the opportunity to meet people like you fighting for justice and that is enough.

As you know my husband is a broken man and our lives are ruined in every aspect. With no confidence or hope, he cannot build up his life here again in this country. He is considering going back home and living with no discrimination like this. I can't wait to see my husband back the way he was- a person with dignity.

God bless.'

Doctors worldwide unite in solidarity over this injustice to young doctors.

A NHS consultant and College Examiner in Emergency Medicine has been so struck by the BAPIO vs RCGP battle over the CSA (Clinical Skills Assessment) exit exam employing predominantly white British actors and white British examiners for GP trainees to obtain their Certificate of Completion of Specialist Training (medical license to practice as a GP) that he has written this appeal and circulated to all his hospital friends and non-medical colleagues also.

NHS Consultant appeal to donate:

'Dear Friends,

Our friends and colleagues need help. They have been struggling against this exam, spending tens of thousands of pounds on exams and courses, and being kicked out of training with no qualifications. All this despite having no patient concerns, no serious untoward incidents, satisfactory WPBAs and PSQs.

The exam is marked subjectively and based heavily in favour of 'perception' of actors and/or examiners.

This remains the only exam where candidates have been referred to the GMC for 'safety reasons', while dealing with non-patients! I could go on, but that is not the real issue.

The issue is that we need to focus on raising funds to take the RCGP to court, and let the law of the land decide on the future of our colleagues.

I am not a GP, all the same I have made a small contribution of £200 today to the BAPIO CSA Fund.

Please think of it as a small, but very valuable contribution to a just cause and give our colleagues a chance to fight for their careers and against perceived injustice.

They need our help, now is a time to give generously, whatever you can afford to help in this cause.

Make your transfers to BAPIO, reference CSA, Account number: 00066608, Sort Code: 30-90-66
Please show your support on this if you can contribute

Doctors and members of the public worldwide respond to BAPIO's appeal for donations for their legal challenge as they take the RCGP to the High Court for judicial review of the CSA exam.

New Headquarters of the Royal College of General Practitioners in Euston Square, London.
To prepare for legal action, BAPIO has started  fund-raising. Required amount £100,000. Deadline January 15, 2013. Prof Rajan Madhok, Chair of BAPIO and NHS Consultant in Public Health, “It is important that we stand up for fairness and justice. Please donate generously.”
Payable to: BAPIO
BANK: Lloyds TSB A/c No: 00066608
Sort Code: 30-90-66
IBAN: GB86 LOYD 3090 6600 0666 08
By post: BAPIO Office, 178 Ampthill Road, Bedford MK42 9PU

NHS Psychiatrist: 'I am a psychiatrist, and I have just transferred £100 to the BAPIO account for the CSA Battle. I feel we all should contribute as its a battle against the system. Thank you.'

NHS Consultant Paediatrician: 'I will be contributing £500 to the fight and will send the money today even though I am not affected by this at all. It really saddens me that so many IMGs are affected.'

NHS Consultant GI Surgeon'I contributed £100. If South Asian doctors are not failing similarly in FRCS examinations, why should they fail in MRCGP?'

GP in the UK 'I have transferred £400 today. My total contribution £1700 since the issue started last year. Thank you everyone in the BAPIO CSA team.'

GP in Australia: 'I have just now transferred 1000.00 Aus $ ( roughly 600 Pounds ) to Bapio's Account. It should take couple of days to reach UK. Kindly confirm once you get the fund. I will also try to convince my friends & colleagues in Australia to contribute. I have friends in other specialities in the UK who may be able to contribute.'

Another GP in Australia has donated by international bank transfer: 'Done.'
GP with FRCGP: '..all so tragic. We will pray about it. I have just made the contribution (£100). God bless.'
German GP in Bristol: 'I am so glad someone is taking on the CSA..will contribute to the fund...I do seriously fear that someone may harm themselves due to all this.'

Female Black GP: 'Have donated now.'

GP in Manchester and CCG lead: 'I will donate tonight and will ask my friends to do so.'

Another Manchester GP writes: 'Have made a donation of £100 to this good cause...will be following the case.'

Newly qualified female GP in London: 'done. Satyamev Jayate. Truth shall win.'

Newly qualified local UK graduate GP: 'Just donated £50.'

Newly qualified Asian GP: 'I will contribute another 500 pounds. I felt the same injustice as you are all facing. Don't lose hope friends; we have a strong case here. Good luck.'
White British ST2 GP in Training: 'Just given £100. Good luck!'
GP in Kirby: 'I am donating £1000 today and all doctors should donate as much as they can as it could easily have been one of us.'
KSS Deanery GP Trainer and Partner: 'I have already transferred £200. I am a trainer as well and I understand the difficulties these guys are going through. Someone had to take this further. I must admit that not once during my training did I feel that I was being discriminated. I am also a partner in a white area and have outstanding white partners and staff who support me. This fight must never turn W against BME. Some bad elements need to be rooted out.'
GP trainee facing his 5th and final CSA before expulsion and a GMC referral by his Deanery: 'I am in deep debt from my previous CSA exams and have been using credit cards, and have had an offer of a 5th attempt which I have painfully accepted, that has put me in an additional £1500 in debt...I will send a donation of £100.'

Expelled GP trainee: 'I have transferred £500 today and will transfer another £500 in the 1st week of Jan. I have also contacted my friends who are software engineers to contribute. Hope we reach the target soon.'

Expelled GP trainee and her husband: 'Just letting you know that I have transferred £500.00 from my account. I am also spreading the word amongst my friends and colleagues.'

A GP writes, 'Dear Friends, please welcome Dr TA, a practicing GP. He has contributed £250 to this cause; Dr KM, a practicing GP. He has contributed £800 to date; Dr Chris W, a practicing GP, who is passionate about the cause and has pledged money to this cause.'

A GP writes, 'I am a GP and feel this issue quite close to my heart. I have made a small contribution of £200 towards the funds.'

A GP ST3 trainee writes, 'Just to let you know I have transferred £250 towards the cause of this legal battle.'

A Malaysian UK grad GP ST3 trainee writes, 'I have just put £100 towards the cause.'

Asian male GP Trainee: 'I have contributed £200. My non-GP friends have come forward to donate. I will make sure I contribute £1000 through friends and family. Hats off to all our seniors for standing up for us.'

Member of the public: 'I have wired £200 today as a member of the public and for fairness and justice.'

A GP writes, 'I have donated £500 and pledge £100 each month.'

A salaried female GP writes, 'I have transferred £500 to the BAPIO account. Hope we get justice.'

A big-hearted GP trainee donates on Xmas Day, 'I have just contributed £500 to the CSA campaign. I shall also forward the details to friends of mine in other GP training schemes in the UK.'

The Society of Emergency Medicine India: 'planning to send some funds soon for this challenge.'

The President of BAPIO has sent a letter to the Chief Executive of UK's Equality and Human Rights Commission.

International News Pakistan

The British Pakistani Doctors Forum (inaugurated as the All British Pakistani Physicians Association) express a wish to work with BAPIO to challenge the CSA exam.

British Medical Association Deputy Chair and Retired GP Kailash Chand OBE has helped the BMA GP Trainee Subcommittee draft a response to the RCGP on behalf of all the complaints they have received from GP trainees over the CSA exam. The BMA GP Trainee Subcommittee is composed 1/3 of IMGs (International Medical Graduates).

18 GP Trainers sign a letter to the RCGP of their concerns over CSA failing high numbers of International Medical Graduates 'it is of concern that the significant differences in the success rates of this examination appears to be based on ethnicity, and it has to be acknowledged that this puts pressure not just on the candidates but also on their families.'

On January 10, 2013, BAPIO, BIDA and BPDF issued a joint public statement.
'BAPIO, BPDF and BIDA would like to confirm that the progress towards the Judicial Review (JR) is progressing well.

As previously indicated we are also pursuing redress through the Employment Tribunal (ET) route and this will be offered to all affected trainees who are part of the JR group action on a `no-win, no-fee' basis. We have already acquired the services of the most respected QC in the country to advise us on both these matters.

In addition we have received communication from the GMC that it has sought data from the RCGP in order to begin its own investigation into the conduct of the CSA.

We are also in contact with the EHRC to seek their advice on this issue.

All this time we are in constant dialogue with the RCGP to ensure we can achieve justice for our trainees in a constructive manner, but if this were not to be fruitful we will be ready to take this matter to its justified conclusion. We are determined to leave no stone unturned and no avenue unexplored in this quest.

Please follow our website and Indi_go for further details and updates
Ramesh Mehta, BAPIO
M Akmal, BPDF
Dr S Sarkar, BIDA'

If this one assessment tool, the CSA, continues to cull large numbers of IMG GP trainees as they complete a 3-year GP training programme, I predict a national shortage of NHS GPs in this country which may impact heavily on NHS patient access and care as many areas of Great Britain have a shortage of home-bred GPs!