INTERVIEW

AMICUS HEALTH WORLD | February 2005 |

Making a difference

Dr Aneez Esmail is the former president of the Medical Practitioners Union (MPU). Here, he talks to Amicus Health World about his career, his union activities- including his campaign against racial discrimination - and the Harold Shipman inquiry

AHW: Tell us about your role in the MPU.
AE: I've been involved with the MPU since I was a student, which was at the time the NHS was in crisis. We all wanted to know more about this and to get-involved. Around this time, the Conservative party came into power and much of my early MPU career was spent firefighting against Tory policies, so it was useful to be part of a group of like-minded individuals.
I became president in 1998 and held this position for four years. Although I am no longer president, l have always played an active role in the union and continue to do so. On a day-to-day basis, I am a council member and I work alongside other members to raise the profile of the union.

Shipman and beyond
AHW: You were involved in the Shipman inquiry – tell us about this.
AE: I was asked to join the inquiry by Alan Milburn, the Health Secretary at that time, just after Harold Shipman was convicted. Initially it was meant to be a small scale private inquiry but the families of the victims wanted a public inquiry I worked alongside the Chairman of the inquiry, Dame Janet Smith, to advise her on all aspects related to primary care and public health. We looked very closely at the issues of drug death certification, prescribing, and methods of validating a doctor's fitness to practice.

AHW: Do you think the Shipman case has caused any lasting damage to the medical community, particularly GPs?
AE: No, not at that level. I don't think people lost trust in their doctors, but it raised issues about patients' expectations and how doctors are regulated.

AHW: There have been suggestions that the Shipman inquiry has left GPs constantly looking over their shoulders. Do you think that's true?
AE: No, I don't think that's the case, and if it is, then that's very sad. I think people need to understand that Shipman was not just a serial killer who happened to be a GP, but that he was able to commit mass murder because he was a GP.
If doctors are looking over their shoulder, then I think it's the wrong attitude. They should focus on doing what they do best and that is treating their patients. However, GPs are in a very unique position - they have a huge amount of power and look after people when they are very vulnerable. It is critical that the public can trust doctors and therefore issues related to how they are monitored and regulated are legitimate areas of public concern. That is what the inquiry concerned itself with and I would argue that doctors have little to fear from the inquiry's recommendations for change. Paradoxically, I think that if the recommendations are implemented then they will strengthen the trust between the public and doctors.

A question of race
AHW: You've had an active role in campaigning against racial discrimination in the medical profession - what has that involved?
AE: I am an academic general practitioner so I do research in various areas, such as public health, patient safety and some aspects of clinical care. One of the areas that I am particularly interested in, and this is directly related to my trade union activities, is racism in medicine.

I came from Uganda with my family in 1972 and attended medical school in the UK in 1979. I found that at medical school only about 10% of students were from an ethnic background and when I qualified I found it much more difficult than my white colleagues to get a hospital job. On average I found that I had to apply for at least 100 jobs while my white colleagues only had to apply for about 10 jobs before they were successful. Admittedly, part of the problem was that there were job cuts – there were unemployed doctors at that time if you can believe that. I found that the only way I could get an interview was if I picked up the phone and asked to go and see the consultants so, that they could put a face to the application.

When I eventually got one of the jobs that I had applied for, I asked the consultant which method they used to recruit junior doctors. I remember him saying, "It's simple, Aneez. When we get applications, we put all the foreign names on one side and all the white names on the other" El was pretty shocked.

Several years later, I decided to do a little experiment, along with a fellow MPU member, Sam Everington. We both applied for the same job, with one of us using a white name and the other an Asian name. We discovered that if you had a white name you were twice as likely to be called for an interview as someone with an Asian name.
We were about to embark on the second phase of our study when we were arrested by the police. We think that someone must have found out about what we were doing and complained about us. We were accused of fraud because we were applying for jobs pretending to be people we weren't, and were told that we were preventing real applicants from getting jobs. It was ridiculous.

AHW: What did you do with your findings?
AE: The General Medical Council decided that what we had done had brought them into disrepute, so they came down on us. All of this just made us even more determined and committed to fighting racial discrimination. It is here that the union was critical as it supported us and helped us in pursuing this agenda.
Shortly before the Labour Party came into power, Sam began working with Robin Cook, and this opened many doors - especially in being able to access information. We were able to publish reports on admission to medical school, how consultants are paid and the issue of discretionary awards. after one of these reports Alan Milburn asked to see us and, soon after, many changes took place in the methods of allocation of discretionary points and distinction awards.

AHW: Do you believe there is still racial discrimination among doctors?
AE: I believe it is still a major problem. I think Trevor Phillips, Chair of the Commission for Racial Equality, was right when he described the NHS as a snow-capped institution. One third of doctors are from ethnic minorities, which is quite a significant amount, yet if you look at the top positions in the NHS, such as the Chief Executives, there isn't any ethnic representation. Why is this? Ethnic groups are the backbone of the NHS, yet we are never visible at the top.
I do believe that the situation is getting better though, but probably improvements are reflected as a better recognition of the problem, more than anything else. I'll see a change when the top of the organisation reflects the base; however, I must give credit to the NHS and the Labour government for addressing the problem and trying to make changes.

Back to the future
AHW: What has been the highlight of your career so far?
AE: That's a difficult one. My career has been a rollercoaster, but then I am a trade unionist and I love that. There are many things that I look back upon as great achievements, such as winning an industrial tribunal case and being a part of reform in the NHS. I remember I was working in the US when I heard on the BBC World Service that reform was under way in the merit award system and it was amazing to think I probably played a part in that.

AHW: Any regrets?
AE: Oh, I don't know If you have a high profile you are always in the limelight and sometimes you wish you could have a normal life, but I wouldn't have changed things.

AHW: So, what's next for you?
AE: Well, I've finished the Shipman inquiry and now I'm enjoying life as a professor and spending more time with my family There is still a huge task ahead though, so of course I will carry on.

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