Dear RCGP Chief Executive Neil Hunt and RCGP Chair of Council Maureen Baker,
I would like to cancel my membership of both the College Council and the college itself. My main reason for leaving is in protest at the way in which the college has handled both the CSA scandal and the valid concerns I have raised as a council member throughout the years I have served on council. There is a clear racial discrepancy between non-white BME UK and white UK candidates in CSA failure rates and between non-white BME and white IMGs (international medical graduates). The four times higher failure rate for non-white UK graduates over white UK graduates can only be explained by unconscious bias, as there are no cultural or language differences, as may be argued with IMGs.
If you are sure that the licensing exam is free of unconscious bias, then it is reasonable to have two examiners present in the CSA, to video the CSA exam using digital CCTV recording and to allow access to CCTV recording to ensure a fair appeal process. This has not happened despite my repeated requests over the years on behalf of members to reduce this disparity.
As both a British born BME and IMG doctor, I can only feel compassion and empathy for my black and minority ethnic UK and IMG GP trainees who feel and see that colour (ie unconscious racial bias) may have played a role in the huge disparity in pass rates of a UK GP licensing exam and affected their livelihood. Their dream and passion was to be a NHS general practitioner and serve their multi-cultural community at a time of national shortage crisis.
As a GP educator, I have never in all my years of teaching the MRCGP seen such a huge racial disparity in exam module pass rates, as I have witnessed with the CSA module post September 2010. Disparity to this degree never existed with the MRCGP video module observing GP trainees treating real life patients, akin to the recent Channel 5 series GPs behind closed doors, and it was a pleasure to see budding GP trainees manage real patient consultations in video submissions, as it is a pleasure for our viewing public to watch BME doctors work side by side with white UK doctors treating diverse patients in a NHS GP surgery.
I was very disappointed to see the reaction of both the RCGP and GMC to the verdict of the High Court Justice on April 10 and to receive an email moments after the judgement, that I as Council Rep would be summoned to a disciplinary hearing for among other things, donating to BAPIO's fight against discrimination appeal (which mind you the BMA also believed and financially supported). Are we Council Reps to be gagged in the name of 'collegiality' or are we elected to speak up on behalf of our college members and challenge decisions made by College that may have detriment on our members?
Had I seen compassion and empathy in my College, I would have believed that the College sincerely wished to address the racial disparity and embrace diversity, but instead I have had to defend against foreign doctor bashing that suddenly appeared in the media not long after the judgement. Instead of insight and reflection, it seems to me as though the RCGP and GMC would much rather say that a whole swathe of potential GP's are not good enough at the end of 3 years of supervised GP training with real patients, rather than consider for a moment whether the actors and examiners consciously or unconsciously react differently when they see candidates from different backgrounds.
I know, first hand that this happens with real patients and the public in real life, fuelled by ignorant views sadly still held by many, (whether consciously or unconsciously), and often fanned in the media, Daily X, etc., so why not consider for a moment that this could happen unconsciously to examiners and actors? And make proper efforts to control for it.
The College's position in my opinion is unjustifiable, and therefore I can no longer be part of an organisation that handles real concerns of potential BME/IMG GP members and elected Council reps in such a way.
I also cannot justify paying to be a member of an organisation that I feel does not understand the needs of BMEs and IMGs and has not itself, demonstrated to me, cum scientia caritas. In my opinion, it does little to advance the careers of black and minority ethnic GPs and instead it has been an uphill battle to achieve equality.
I do not want to be a part of this organisation any more.
Dr. Una Coales BA (Hons) MD FRCSEd FRCS (ENT) DRCOG DFFP PGCertMedEd
Sent May 15, 2014.
A senior MP wrote the RCGP upon learning of my letter of resignation:
'Dear Royal College, May I ask two questions please?
I am aware that Dr Una Coales made a contribution to BAPIO.
Does or did the RCGP have a problem with that?
If so, please let me know what it is.
What is the reason against videoing this test?
It would make it easier to identify the absence or existence of unconscious prejudice?'