Racism, sexism and wider inequalities remain embedded within NHS systems and daily interactions, and the time for denial or delay is over
CREDIT: This is an edited version of an article that originally appeared in BMJ Group
That’s the urgent message from a new report by the BMJ Commission on the Future of the NHS, which lays out stark evidence of discrimination across the health service and what must be done to tackle it.
For practice managers, this report is a call to action. It highlights the ethical, financial and operational reasons why addressing inequality is no longer optional. It’s about patient care, staff wellbeing and the long-term sustainability of general practice.
Discrimination Is Widespread – And Costly
The report finds that discrimination across protected characteristics such as race, ethnicity, sex, gender, age, disability, sexuality, religion and belief is “alarmingly normalised” within the NHS. This affects not just how patients are treated, but also the experiences and wellbeing of NHS staff.
The impact on health outcomes is measurable. Discrimination leads to increased physical and mental health problems, worse experiences of illness, limited access to care and higher mortality rates. The cost to the UK economy is staggering, with health inequities contributing to £31–£33bn in productivity losses, £20–£32bn in lost taxes and increased welfare and £5.5bn in direct NHS costs each year.
What This Means for Primary Care
Discrimination can show up in everything from hiring and promotion practices to how patients are triaged, how staff are treated and how clinical decisions are made. If it’s not actively addressed, it quietly shapes outcomes and creates long-term damage.
The report urges government, regulators, NHS organisations and individual healthcare leaders to take bold action and this includes general practice.
Key Actions Practice Managers Should Prioritise
Audit Culture and Wellbeing in Your Practice
Ensure staff feel safe, respected and empowered. Look at bullying, harassment and discrimination complaints whether informal or formal and consider anonymous feedback tools to assess workplace culture.
Make Equality Data Matter
Track diversity across your team, especially in roles, pay and career progression. Disaggregated data on sex, race and other characteristics isn’t just for compliance, it can reveal where hidden inequities exist. Ensure you are capturing patient experience data as well. Who is not attending? Who feels unheard? This information can help guide targeted improvements in care.
Embed Flexibility and Support
Support equitable working conditions with flexible and remote working opportunities where possible. Ensure workloads are balanced fairly and offer development pathways for all team members. Understand that some staff may face structural barriers others don’t. Equality doesn’t mean treating everyone the same, it means supporting people according to their different needs and experiences.
Systemic Solutions Need Local Leadership
The report outlines several national recommendations, including implementing inclusive leadership standards, strengthening the role of the NHS Race and Health Observatory and ensuring equity standards are baked into all new health technologies and research. But these goals only work if they’re supported by local implementation.
Practice managers are uniquely placed to drive day-to-day change, from recruitment and retention to how care is delivered and how teams interact. It’s a strategic investment in staff morale, patient trust, and operational excellence.
The BMJ Commission concludes that tackling inequality is not just the right thing to do, it’s a legal, ethical and strategic imperative. Failing to act leads to greater harm, higher staff turnover and poorer health outcomes.
For practice managers, the message is clear: now is the time to lead change from within. Review your data. Rethink your policies. Have the conversations. And build a practice that’s not only inclusive in name but in everyday action.
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