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Monitoring in all fairness

Done well, ‘ethnic monitoring’ could improve access to care and highlight unmet need, says Katy Gardner

Is ethnic monitoring essential to ensure fair uptake of health services? Ethnic monitoring is now compulsory in NHS trusts. More and more organisations are introducing it but how is it being done and is it being used?

Last week I referred a patient to social services for a home help. The person on the other end of the phone asked me what the patient’s ethnic group was. ‘Why do you want to know?’ I asked. ‘It’s routine,’ I was told.

Of course primary care is the place where ethnic monitoring can be carried out because people are almost always registered with a GP. But it would not necessarily be easy and exactly what type of information would be collected is also open to debate.

It is not enough to look at the census categories because some groups will be left out. We are one of several practices in the UK carrying out ethnic monitoring and contributing to the debate going on inside the NHS Executive. We have devised a questionnaire, which asks a person’s self-defined ethnic group, allowing a space for ‘other’, their family origins, language and religion. In our surgery we have many Yemenis and Somalis with their own particular health needs.

So it is possible to answer the question I was asked fairly accurately for most of our patients. But unless we work across boundaries, social services will soon have their own lists of people of different ethnic groups, and if it is the result of a quick phone call to a GP it will be meaningless. Joined-up work is urgently needed.

The information we are getting from the questionnaires is exciting: 8% of our white British patients over 35 have angina, (self-defined by questionnaire), whereas 24% of our Somalis and 20% of Yemenis have it. Although numbers are small, there are potential implications for our primary care group. One single-handed doctor has 500 Yemenis on his list. Although he is an Arabic speaker he told me recently how long it took to sort out one Yemeni family who became ill after travelling to the Yemen. Ethnic monitoring linked to disease register could enable him to seek extra resources.

Our experience is that patients do not object to being monitored as long as they can understand its potential benefits. It is perhaps more difficult to convince overworked GPs and their clerical staff of the benefits. Universal introduction is feasible but will consume resources. Customising computer systems in primary care is another crucial area and with NHSNet coming and universal computerisation in sight, now is the time to think about it.

Many recent research papers have looked at unequal consumption of health services, in which ethnicity has played a crucial role. The best way to extend meaningful monitoring into health and social care is through primary care. Mechanisms and systems to use this information must be created from the start and PCGs could be the ones to do it. But they will need resources and help.