Closing the ethnicity gap in healthcare disciplinaries: updated briefing

Executive summary

Despite targeted efforts, ethnic disparities in disciplinary actions within the UK healthcare workforce (e.g. nursing, midwifery, medical consultants) persist. Although recent data from the NHS Workforce Race Equality Standard (WRES), the General Medical Council (GMC), and the Nursing and Midwifery Council (NMC) show some improvements, Black, Asian and minority ethnic (BME) staff remain more likely to face formal disciplinary processes. This paper updates the 2022 briefing with new data (2023–2024), policy changes, and academic insights, providing evidence-based recommendations to address these disparities.

Introduction

Ethnic disparities in healthcare disciplinaries are long-standing and well-documented. The 2022 briefing highlighted disproportionate disciplinaries as a manifestation of structural, systemic, operational and process racism. The NHS People Plan (NHS England, 2020) and “A Fair Experience for All” guidance (NHS England, 2019) urged employers to close this gap by 2022. While national targets were not fully achieved, data from 2023 and 2024 show narrowing gaps in some areas. However, persistent inequities remain, particularly in referral rates to regulators and staff perceptions of fairness.

Latest data and trends (2023–2024)

1. NHS Workforce Race Equality Standard (WRES)

WRES data for 2022–2023 reveal that BME staff remain disproportionately subject to formal disciplinary action. At 46% of NHS trusts, BME staff were more than 1.25 times as likely as white staff to enter disciplinary proceedings, only a marginal improvement from the previous year (NHS England, 2023). Disparities correlate with lower staff confidence in equal treatment and increased reports of bullying and harassment (NHS England, 2023).

2. General Medical Council (GMC)

Between 2016 and 2023, the gap in employer referral rates to the GMC for ethnic minority and white doctors decreased from 0.28 to 0.13 percentage points. In 2023, 0.31% of ethnic minority doctors and 0.18% of white doctors were referred (GMC, 2024). The proportion of healthcare organisations with extreme disproportionality fell from 5.6% in 2016 to 3.2% in 2023. However, ethnic minority doctors’ referrals are still more likely to be closed with no further action, suggesting differential thresholds for referral (GMC, 2024). The GMC has been undertaken targeted work to reduce disparities in disciplinaries.

3. Nursing and Midwifery Council (NMC)

Black nurses, who make up approximately 8% of registrants, accounted for nearly 16% of referrals to the NMC, and these cases were more likely to be closed early with no action (NMC, 2022). The NMC’s Ambitious for Change programme has documented significant disproportionality, particularly for Black and male nurses. Although improvements are underway, intersectional disparities remain (NMC, 2022). The NMC has committed to address the disparities through an overhaul of implementing its regulatory duties and assessment of its fitness-to-practice process along with investment in EDI.

4. Impact on workforce and patient care

Disproportionate disciplinaries contribute to BME staff attrition, lower morale, and increased psychological distress (Kobab et al., 2023). Studies show that 1 in 4 BME nurses who go through disciplinaries leave healthcare. Perceived unfairness damages trust, discourages whistleblowing, and undermines patient safety (BMA, 2022; NHS Resolution, 2023).

Policy and practice developments (2022–2025)

1. NHS England

The 2023 NHS Equality, Diversity and Inclusion (EDI) Improvement Plan introduced six High-Impact Actions (HIAs), including leadership accountability for EDI outcomes, tackling bullying, and promoting inclusive recruitment. These build on earlier commitments in the People Plan (NHS England, 2023).

2. Professional regulators

The GMC has set a 2026 target to eliminate referral disproportionality and is monitoring progress annually (GMC, 2024). It has enhanced employer engagement, case examiner training, and transparency. The NMC is similarly reviewing its processes, improving referral guidance, and enhancing cultural awareness training (NMC, 2022).

3. Cultural change and just culture

Widespread adoption of the “Just Culture” approach, championed by NHS Resolution, has promoted learning over blame. The 2023 update, Being Fair 2, encourages pre-disciplinary review processes and compassionate handling of incidents (NHS Resolution, 2023).

Recommendations

1. Data transparency and accountability: Strengthen monitoring of disciplinary disparities at all levels and make WRES data central to trust evaluations.
2. Mandate equality impact assessments: Ensure all staff are competent in the function and methodology of equality impact assessments and a governance audit trail is embedded in changes to policy, process and operations.
3. Standardised disciplinary framework: Mandate pre-formal action reviews using national toolkits to ensure consistency and equity.
4. Bias train the trainer development for decision-makers: Provide mandatory, scenario-based training for management staff involved in disciplinaries. Support them to cascade and update training for their teams. Line managers will take the role of change ambassadors in embedding equity in the DNA of the organisation.
5. Diversify panels: Require diverse disciplinary and HR panels. Regular audits and training of panels by independent observers.
6. Supportive culture: Continue embedding Just Culture principles and ensure managers are trained in informal resolution techniques. Ensure trauma informed practice is available for staff and those going through disciplinaries.
7. Regulator reform: Hold regulators accountable for meeting equity targets and publishing disaggregated data. Ensure there is ongoing support for regulators on their improvement trajectory. This can include vetted consultants with expertise in embedding equity in processes and operations.
8. Pastoral support: Offer dedicated advocacy and counselling services for staff under investigation. This includes trauma informed practice and independent, audited, services aligned with the needs of diverse individuals.
9. Inclusive leadership: Link senior leaders’ performance objectives to progress on equity. This can include training senior leaders in role modelling gold standard equity behaviour and being open to onward learning and development.
10. Ongoing Research: Fund evaluations of interventions and encourage innovation (e.g. anonymised reviews). Ensure thematic analysis is ongoing of qualitiative data.
11. Global reviews: Compare performance against regulators worldwide to improve learning. Healthcare workforce travel and work all over the world, it is important to join up regulatory standards.
12. Approach to discrimination: Ensure discriminatory behaviours, including biased referrals, are addressed promptly with support for learning and development.

Conclusion

While signs of progress are evident, ethnic disparities in healthcare disciplinaries remain an issue. A multi-level approach that combines data transparency, cultural change, inclusive leadership, a robust communication strategy and regulatory reform is essential.

References

BMA. (2022). Delivering Racial Equality in Medicine. British Medical Association.

GMC. (2024). Annual ED&I Progress Report. General Medical Council.

Kobab, R., Halley, J., & Shah, S. (2023). The impact of race and gender discrimination on junior doctors’ psychological distress. MDPI Journal of Healthcare, 11(2), 113–127.

NHS England. (2023). NHS Workforce Race Equality Standard 2023. NHS England.

NHS England. (2020). We Are the NHS: People Plan 2020/21. NHS England.

NHS Resolution. (2023). Being Fair 2: Learning and Improvement Through a Just and Learning Culture. NHS Resolution.

NMC. (2022). Ambitious for Change: Research into NMC’s Fitness to Practise Processes. Nursing and Midwifery Council.