Monday, 29 July 2013

High Court Judge grants BAPIO permission for Judicial Review of the GP exam

High Court Judge Hon Mr Jeremy Stuart-Smith

High Court Judge Hon. Mr Jeremy Stuart-Smith rules in favour of BAPIO.

The British Association of Physicians of Indian Origin (BAPIO) were informed that High Court Judge Hon. Mr Jeremy Stuart-Smith has granted BAPIO permission for Judicial Review of the GP exit exam called Clinical Skills Assessment (CSA).
BAPIO spokesperson announced, 'This week BAPIO has heard from the High Court that the Honourable Mr Justice Stuart-Smith has granted permission for a Judicial Review to bring proceedings against the RCGP for adoption and continuing application of the CSA.

The judge has noted that prima facie RCGP has not given due regard to Equality law and continuing CSA is unlawful.

This is an extremely important ruling, now the case will proceed to a full Judicial Review and BAPIO's legal team is very confident of proving it's point in court.

We have reached so far due to an intense battle against injustice and the implications of this case will not only affect the CSA but ALL ROYAL COLLEGE EXAMINATIONS.'

Learning points and reflection for the RCGP

It is imperative that the Royal College of General Practitioners work towards testing and controlling hidden bias in both the CSA actors and examiners or consider reverting back to real patient video assessments which showed negligible difference in white and ethnic minority doctor pass rates in 2007, and to ensure all CSA candidates have access to video evidence for fair appeals. It is vital that Deaneries educate their educational supervisors ie GP trainers on what CSA stands for and how to prepare their GP trainees for this exam. Dr Tessa Hicks conducted a survey of 40 educational supervisors in Severn Deanery School of Primary Care on the CSA exam. Astonishingly '25% of GP educational supervisors did NOT know what CSA stood for, 50% greatly underestimated the cost of the exam and 60% thought that the pass mark was lower than it is, which was reflected in over-optimistic  views about the % of candidatres who pass the exam.'
The RCGP has taken recent steps to remove candidate names from the CSA assessment doors (which was open to foreign name bias) and has replaced this with just GMC number identification. This is good news, as it shows the RCGP is adaptable to change, and now must stop denying there is a problem with CSA and instead work with whistleblowers and complainants to address all concerns to ensure the exam abides by the Equality Act 2000 'it is unlawful for age, religion or belief, gender, race or sexual orientation to be the cause of less favourable treatment in vocational training (or exit exams). Indirect discrimination puts rules or arrangements in place that apply to everyone, but that put someone with a protected characteristic at an unfair disadvantage.'

At a time when the NHS is haemorrhaging doctors at almost a 1000 in one month, the NHS needs all hands on deck and has to ensure it is not releasing competent doctors with years of dedication to the NHS with a 'pretend' exam that has a 65.3% failure rate for ethnic IMGs and a 24.4% failure rate for black UK graduates compared to a 5.8% failure rate for white UK graduates. We cannot blame language and cultural barriers on the huge failure rates of our own born, raised and educated British ethnic minorities!

BAPIO news of exam discrimination attracts global media coverage

Pulse GP news: International Doctors Granted Judicial Review of the MRCGP exam, 26 July 2013.
BBC news  'Foreign Trained Doctors Face GP Exam Discrimination', 10 July 2013.

BBC Asian Network Evening News Broadcast, 10 July 2013. South Asian Doctors Claim Discrimination.

One Carribean Radio, 9 July 2013.

BAPIO renews its fund-raising campaign to support costs of Judicial Review.

BAPIO has begun a renewed worldwide donation campaign to reach its target of £100,000 to cover all potential legal and appeal costs. To date they have received £43,000 in generous donations and need a further £57,000.

NHS doctors of all specialties make contributions to the BAPIO CSA Judicial Review.

'I am neither a GP, nor are any of my family members. I don't have any future intention of being a GP. In spite of this, I have contributed £200 to the BAPIO fund as I support justice in society, irrespective of their origin, race, religion, colour, caste, sex or age. I fully support this fight and urge others to please contribute to be a part of this change in our society! Best wishes,' Dr S.
'Congratulations to BAPIO. I have already donated. Will do again. Regards,' Dr VK.

'I am a Paediatric Registrar, not directly affected by CSA. I, however, would like to see fairness and equality in all Royal College exams including MRCPCH examinations, as well as in various assessments and ARCPs. I have contributed GBP 200 earlier on two occasions, and now, with the good news of permission to go for JR, I have contributed another £100 today. Thanks,' Dr S.
'We (my wife and I) have donated £2,500 to the campaign. Good luck to BAPIO,' Dr AT.
'I have donated £1000.' Dr SR.

More daily testimonials received from black and ethnic minorities failed by CSA:

'I could never really understand this discrimination hue and cry ever before than now, when I have witnessed it myself. I fully and wholeheartedly support BAPIO in this fight against this biased exam. On the RCGP courses organised by them, as well at my Deanery, many IMGs expressed their distress, helplessness and loss of trust in this exam system but we were all advised "not to fight against this exam system because they said that it has been found to be fool proof". I have witnessed it and it's not "fool proof" but to make fools of foreigners.
As advised by senior members of BAPIO, I am in the process of writing to the Chief Examiner although I am not expecting them to accept their wrong doings (given a total mark 6 points less than when marks were added manually) or their faulty biased exam either.' Dr M, an ethnic minority Indian male GP trainee, facing a 4th CSA, weeps in despair.

'I am 31 years old, of Nigerian origin, came to the UK at the age of 10 years old, only child of a single parent mum, who worked her way up the ladder from doing 2 jobs to become a lawyer. I did my primary, secondary (GCSE English Grade B) and college education in London at the City of Westminster College.

My mum then sent me to Ukraine to study medicine, as she thought it would be good for me to break away from Hackney, become independent, and as she also studied in Ukraine, she knew that their universities were good. Have spent 7 years in the Ukraine, did my medical degree in English. It was a challenging but an important life experience for me. Occasionally you may experience discrimination but overall they were nice people and keen to adapt to international student needs even though we were not citizens. However there is no place like home, and I was so happy to return to the UK in 2007 where I am a citizen, expecting to be treated fairly and ready to exhale. Unfortunately 1 month after my graduation, my mum (God bless her soul) died of ovarian cancer. As the only child, I had to pick up the pieces, dealing with funeral arrangements' solicitors, registry office and tax office. The first class care she received from her GP and my natural inter-personal skills made me decide to become a GP.

So like others, I did my PLAB/IELTS and FY1/FY2 training posts in Yorkshire and Hull. I then did my GP entry exam and got my second choice. Having spent 3 years of my life in GP training in Hertfordshire, excited about the future and playing my part within the community and done everything and more that they have asked me to do, to then to be told that I CANNOT communicate or MANAGE a patient and further more, I might be made unemployed in 6 months and referred to the GMC for not passing CSA. It is a miserable situation and outcome.

My trainer is herself a senior GP partner, a white female CSA examiner and TPD, and they had offered me a job which is now on BMJ awaiting another doctor to collect. I had also been offered another job elsewhere after a recommendation by a white OOH doctor, and I had to undergo an interview with a panel of 5 white GP partners and was offered the job the following day.

Only to be stopped in my tracks by the CSA exam and of course with the financial, psychological and social meltdown. It is like watching my life sip away from you, heart-breaking. I am the only black doctor in my training scheme and the only one that did not finish this August. Yet I along with a chinese doctor did a 3-hour CSA teaching session to ST1s which was supervised by two TPDs who only had positive comments and recommended I become a trainer in the future.'

A black ethnic minority GP trainee writes his heart out, in despair, after the actor CSA exam fails him.

Judical Review Update


Update January 1, 2014: Judicial Review has been scheduled for April 8, 2014 and is expected to last for 3 days.