Equality, diversity and inclusion

• Supporting equality, diversity and inclusion involves respecting the ways in which others are different from us and valuing each other as individuals, despite those differences and whether or not we disagree with each other in any of these areas. Respecting each other helps create a cohesive community and working culture, for the benefit of the organisation and individuals working in it.
• The law protects people from discrimination, prohibits victimisation and promotes equality of opportunity and treatment for people from all backgrounds. It is unlawful to discriminate against someone due to any protected characteristics.
• We must be aware of our own internal judgements and biases and reflect on how our practice could encourage or discourage equality or inclusion, particularly with respect to people who are different from us.
• It is important to be able to raise issues and to challenge colleagues should any behaviour be discriminatory.

Working in the NHS, we have the potential to influence fellow colleagues and patients, and it is important to recognise the impact we have on those around us. This is especially important when considering our duty not to discriminate against our patients or colleagues and to acknowledge equality and respect diversity¹.

Discrimination is defined as the unfair treatment of individuals from one group in a different manner to those from other groups The law protects people from discrimination on the basis of nine ‘protected characteristics’:

• Age
• Disability: both physical and mental
• Gender: at any stage of reassignment, including before any physical treatment is begun
• Marriage, civil partnerships and singleness
• Pregnancy and maternity: this includes breastfeeding
• Race: this includes colour, nationality, ethnic and national origins
• Religion or belief: this includes a lack of religion or belief
• Sex
• Sexual orientation: this includes lesbian, gay, bisexual, transgender (LGBT) and non-binary.

In Northern Ireland, political opinion is also protected under law.

Equality law affects all staff of a healthcare or social care organisation that provides services to the public. Services must not treat one individual differently from another, particularly if they have one or more protected characteristics. For example, it must not be made more difficult for someone with a protected characteristic to access the services, such as there not being a lift for wheelchair users.

Other characteristics to consider (which are not among the nine protected characteristics) include any that increase the likelihood of difficulties for individuals or groups accessing care. These include:

• socio-economic factors (such as being homeless)
• being a carer or a dependant
• having a diagnosis of a potentially stigmatising condition (such as mental illness)
• lifestyle-related conditions (such as obesity or those caused by smoking, alcohol or drug misuse).

It is against the General Medical Council (GMC) Good medical practice guidance to refuse or delay treatment if a patient’s actions or lifestyle have contributed to their condition².

Further aspects of equality, diversity and inclusion can be considered from the following three areas:

1. The practitioner
2. The patient (or carer where appropriate)
3. As part of a team.

1. The practitioner

The GMC’s Good medical practice states that you must not unfairly discriminate against patients or colleagues by allowing your personal views to affect your professional relationships or the treatment you provide or arrange. Should you feel this may occur, it is important to inform patients about their right to see another doctor and to ensure they have enough information to exercise that right without implying or expressing disapproval of the patient’s lifestyle, choices or beliefs^3,4.

It is also unacceptable to allow discrimination from a patient to go unchallenged should they refuse treatment from a clinician because of a personal or protected characteristic.

2. The patient

Patients need to be respected whatever their own beliefs and values, irrespective of the religion or beliefs of the healthcare professional, although there are some areas where practitioners can consciously opt out of certain provisions. Patients must also receive care that meets their communication needs – both mental and physical. All organisations in England that provide NHS care are legally required to follow the Accessible Information Standard⁵, which aims to ensure that people who have difficulties are provided with information that they can easily read and understand and receive appropriate support to help them communicate.

Organisations must consider in advance, as well as in response to, the needs of patients with disabilities so reasonable adjustments can be made for them. This could include:

• how people enter and navigate around buildings
• what information and signs are provided
• how people communicate with staff
• adjustments to appointment times and length.

3. The team

A positive attitude to equality and diversity also promotes inclusion. This is an element of employment rights. It is important to be able to raise issues and challenge colleagues should any behaviour lead to discrimination or bullying.

Regarding the team, some areas to consider include attitudes towards colleagues who:

• are at different positions in the health organisation (for example junior doctor, salaried or partner)
• work varying shifts (such as locum doctors, portfolio, limited sessions or taking career breaks)
• are proportionally under-represented (for example, there are fewer doctors from lower socio-economic backgrounds)
• are from groups that have lower pass rates in examinations and assessments
• have underlying health problems or disabilities.

Employers must treat their staff fairly and with dignity and respect. Clear equality policies should be available and staff appropriately trained. Equality and diversity data on recruitment processes and the workforce should be collected to ensure transparency.

elearning for healthcare offers eLearning resources relating to equality, diversity and inclusion through its cultural competence and cultural safety programme.

Learning with other healthcare professionals

Primary care teams are highly sophisticated multiprofessional groups. The opportunities for you to participate in shared learning with colleagues have expanded, particularly following the extension of non-medical prescribing and extensive collaborative working on long-term conditions and integrated care.

Are there any health support groups or outreach programmes for patients from different cultures in your area, to help gain insight into how different cultures can affect patient management?

You will have many opportunities in primary care to discuss equality and diversity with nurses, allied health professionals and managers, all of whom should be engaged in the practice’s education and clinical governance programmes.

Applied Knowledge Test (AKT)

• Disease patterns in different populations
• Awareness of protected characteristics of equality legislation
• Health checks in patients with a learning disability

Simulated Consultation Assessment (SCA)

• A woman with raised blood pressure (BP) in late pregnancy lives in a travelling community and cannot return to you for follow-up as she is due to move on again
• A Muslim man with insulin-dependent diabetes wishes to fast during Ramadan
• A young man who is a wheelchair user wants your written support in his claim of discrimination at work

Workplace-based Assessment (WPBA)

• Consultation Observation Tool (COT) on a patient with a learning disability who is not turning up for her blood tests
• Learning log on the challenges of using a sign language interpreter in a consultation with a patient with impaired hearing
• Case-based Discussion (CbD) about a patient who requested a termination after the doctor she initially consulted declined to refer her.

References

1. For example, www.gov.uk/government/publications/the-nhs-constitution-for-england
2. General Medical Council, Good medical practice, 2024. www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice
3. Good Medical Practice, General Medical Council, Good medical practice, 2024. www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice
4. General Medical Council, Equality and diversity strategy 2018–20. www.gmc-uk.org/-/media/documents/edi-strategy-2018-20_pdf-74456445.pdf
5. NHS England, Accessible Information Standard. www.england.nhs.uk/about/equality/equality-hub/patient-equalities-programme/equality-frameworks-and-information-standards/accessibleinfo/