Avoiding Discrimination

SJT Textbook: Avoiding Discrimination

Avoiding Discrimination MSRA

This guide covers the legal and ethical necessity of Avoiding Discrimination MSRA scenarios. In the Professional Dilemmas paper, you must demonstrate the courage to challenge bias and the knowledge to apply the Equality Act 2010 to protect patients and colleagues.

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🎯 THE CORE PRINCIPLE

Avoiding discrimination means providing safe, fair care without unlawful unfavourable treatment linked to protected characteristics such as age, disability, race, sex, sexual orientation, religion or belief, gender reassignment, pregnancy and maternity, and marriage or civil partnership. In healthcare, discrimination damages access, safety and trust, and can lead to serious harm.

In the SJT, you score highly when you intervene early, stop discriminatory behaviour, support the person affected, and put in place reasonable adjustments to enable equitable access. You should use interpreters, accessible formats and flexible processes to reduce barriers, not simply apply a rigid “one-size-fits-all” approach.

Good options also show that you escalate concerns using local policies, incident reports and senior support, rather than handling things informally or ignoring them. Documentation must be objective and specific, describing what happened, what you did, and what follow-up is planned.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Recognise discriminatory comments, behaviours or patterns and act immediately to stop further harm.
2. Support the patient or colleague affected, check on their welfare, and apologise on behalf of the service where appropriate.
3. Arrange reasonable adjustments such as professional interpreters, accessible information or alternative booking routes to remove barriers.
4. Escalate concerns to a senior, manager or safeguarding lead and follow local equality and dignity at work policies.
5. Report incidents through formal systems (e.g. incident reporting, HR procedures) so learning and monitoring can occur.
6. Document objective facts, protected characteristics involved, actions taken and agreed follow-up in the clinical or incident record.
7. Identify and address indirect discrimination where processes disadvantage certain groups, and raise improvement suggestions.
8. Reflect on your own biases, seek feedback and attend equality, diversity and inclusion training to improve practice.
9. Ensure prioritisation remains based on clinical need, not lifestyle, background or personal beliefs.
10. Share learning from cases through team meetings or governance forums so the wider system improves.

Trap options minimise or ignore discrimination, place the burden on the victim, avoid formal reporting, or maintain exclusionary systems rather than making reasonable adjustments.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I am arranging a professional interpreter and accessible information today so we can provide safe, equitable care.”
* “I have documented exactly what happened, what we did to support the patient, and who I have escalated this to.”
* “Our booking process is excluding some patients; we need an alternative route so everyone can access care.”
* “Thank you for raising this; I will report it through the formal incident process and keep you updated on next steps.”
* “Care must be based on clinical need, not personal views about lifestyle or background.”

F = Find facts
A = Address behaviour
I = Include reasonable adjustments
R = Record and refer

📋 QUICK FAQ

What are the protected characteristics under the Equality Act 2010?
Age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation.

Can I delay or refuse treatment because I disagree with a patient’s lifestyle?
No. GMC guidance is clear that you must not refuse or delay treatment because you believe the patient is responsible for their condition or disagree with their choices. Prioritisation must be based on clinical need.

What is indirect discrimination in a healthcare context?
This occurs when a policy or practice that appears neutral disproportionately disadvantages people with a protected characteristic, without a justified reason. For example, online-only booking may indirectly discriminate against older or disabled patients who cannot easily use digital systems.

Do I always need to provide an interpreter or accessible information?
Where communication needs are identified, you must take reasonable steps to meet them. The Accessible Information Standard requires you to identify, record, flag, meet and review communication needs, which often includes professional interpreters or alternative formats.

How should I respond to discriminatory behaviour from colleagues?
Stop the behaviour if safe to do so, support the affected person, escalate to a senior or manager, report through formal systems, and document an objective account. You should not ignore it or just discuss it informally.

What is the Public Sector Equality Duty (PSED)?
It requires public bodies to have due regard to eliminating discrimination, advancing equality of opportunity and fostering good relations between groups. In practice, this supports you in challenging discriminatory systems and advocating for more equitable processes.

📚 GMC ANCHOR POINTS

* Treat patients fairly and do not discriminate on unjustified grounds (Good medical practice).
* Do not refuse or delay care because of personal views about a patient’s lifestyle or beliefs (Personal beliefs and medical practice).
* Raise and act on concerns about patient safety, including discriminatory behaviour that harms access or care.
* Communicate effectively and meet communication needs, including interpreters and accessible information.
* Maintain clear, accurate and timely records of concerns, decisions and actions taken.
* Work collaboratively to improve systems that disadvantage particular groups.

💡 MINI PRACTICE SCENARIO

A deaf patient attends clinic for new warfarin counselling. Reception staff say, “We do not book interpreters here; bring a family member next time.” The patient looks distressed and has not understood the written leaflet they were given.

Best action: Intervene immediately, arrange a professional interpreter and accessible information today, explain that the service must meet communication needs under the Accessible Information Standard, document what happened and your actions, and escalate the incident through local reporting routes.
Why: Leaving the situation unchallenged risks unsafe anticoagulant use, breaches equality and AIS duties, and allows discriminatory practice to continue. Immediate adjustments, escalation and documentation align with GMC duties and legal requirements.

🎯 KEY TAKEAWAYS

✓ Discrimination harms access, safety and trust; you must act, not ignore it.
✓ Care must be based on clinical need, not lifestyle, background or protected characteristics.
✓ Reasonable adjustments such as interpreters and accessible formats are core to safe, equitable care.
✓ Challenge discriminatory behaviour respectfully but clearly, and support the person affected.
✓ Escalate and report incidents through formal channels so systems and culture can improve.
✓ Document objective facts, actions and outcomes so there is an auditable trail.

🔗 RELATED TOPICS

* → Respecting Cultural and Religious Beliefs
* → Information Access and the Accessible Information Standard
* → Raising and Acting on Concerns
* → Safeguarding and Protected Characteristics
* → Professionalism and Social Media Conduct

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

A 62-year-old woman of Black African heritage attends your respiratory clinic. In the waiting area you overhear a junior doctor say to a colleague, “These people never attend on time; we should stop booking them late slots.” The woman looks uncomfortable. You also learn that the practice only offers online booking, which she struggles to use. She has poorly controlled asthma.

Options:
A. Ignore the comment to avoid creating tension and focus on seeing the patient quickly.
B. Take the junior doctor aside, explain why the remark is discriminatory, ask them to reflect, and ensure the patient is treated respectfully today.
C. Raise the issue with the clinic lead and submit an incident report describing the comment and its potential impact on patient care.
D. Speak to the patient, apologise for what she overheard, and ask what adjustments might help her access appointments more easily.
E. Post anonymously on a staff social media group criticising the junior doctor’s behaviour.
F. Suggest that the practice continues with online-only booking because “everyone must adapt to digital”.
G. Ask admin staff to offer telephone or in-person booking options for patients who struggle with online systems and to flag this for governance review.
H. Tell the patient that the junior doctor “did not really mean it” and change the subject.

Example SJT — Rank 5 (best → worst)

A receptionist tells you that they have told a gay couple seeking fertility advice, “We prioritise traditional families here; you might be better going elsewhere.” The couple have left visibly upset. You are the duty GP for the day.

Options:
A. Speak to the couple, apologise, reassure them that they are entitled to fair care, offer an urgent appointment, and report the receptionist’s behaviour to the practice manager with a written account.
B. Tell the receptionist that the comment was inappropriate, ask them not to repeat it, but take no further action.
C. Arrange an appointment for the couple but do not mention the comment, focusing only on their clinical needs.
D. Email the practice manager saying “there are some issues with reception” without describing what happened.
E. Do nothing; the couple have left and you do not want to upset team relationships.