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Original research
Race-ethnic and gender differences in representation within the English National Health Service: a quantitative analysis
  1. Adrienne Milner1,
  2. Elizabeth Baker2,
  3. Samir Jeraj3,
  4. Jabeer Butt3
  1. 1 Department of Life Sciences, Brunel University London, Uxbridge, UK
  2. 2 Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
  3. 3 Race Equality Foundation, London, UK
  1. Correspondence to Dr Adrienne Milner; adrienne.milner{at}


Objectives To evaluate race-ethnic and gender disparities in National Health Service (NHS) England employment in position, prestige and pay.

Design National study using data from NHS Digital.

Setting Trusts and clinical commissioning groups in England.

Participants 1 105 390 NHS Hospital and Community Health Service staff.

Results Chinese people (42.9%, 95% CI 41.7% to 44.1%) are the most likely to be employed as doctors, followed by Asians (28.6%, 95% CI 28.3% to 28.8%) and people of mixed race/ethnicity (17.9%, 95% CI 17.3% to 18.4%); while white people (6.8%, 95% CI 6.7% to 6.8%) are less likely to be employed as doctors. However, white doctors are the most likely to be in the highest paid positions: 46.0% (95% CI 45.6% to 46.4%) of white doctors are consultants, whereas only 33.4% (95% CI 31.6% to 35.2%) of Chinese doctors are consultants. Black people are under-represented both among doctors and as consultants: 6.5% (95% CI 6.4% to 6.7%) of black employees are doctors and 30.6% (95% CI 29.2% to 32.0%) of black doctors are consultants. We found similar results for nurses and health visitors, where white people are over-represented in the higher pay bands. However, among support staff for doctors, nurses and midwives, we found that Chinese people were over-represented in the higher pay bands. These race-ethnic differences were similar for women and men. Additionally, we found that men were more likely to be employed in higher pay bands than women, and this gender disparity was apparent across race-ethnic groups.

Conclusions Race-ethnic and gender disparities exist in the NHS in position, prestige and pay. To begin to overcome such disparities, the NHS must collect data using consistent race-ethnic categories in order to examine differences over time.

  • doctors
  • gender
  • NHS
  • pay bands
  • race

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  • Contributors AM, EB, SJ and JB were involved in the design of the study. AM and EB carried out the statistical analysis and wrote the first draft of the manuscript with the support of SJ and JB. All authors participated in further drafts and approved the final manuscript. The corresponding author confirms that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. AM is the guarantor.

  • Funding SJ and JB are supported by the Health and Wellbeing Alliance grant, funded by the Department of Health and Social Care. JB was supported by a grant from NHS England during conduct of the study These funding sources had no role in the design or conduct of the study, the collection, management, analysis and interpretation of the data, or preparation, review or approval of the manuscript.

  • Competing interests AM, EB and SJ have no other relationships or activities that could appear to have influenced the submitted work. JB sits on the Workforce Race Equality Standard strategic advisory group. They oversee the implementation of a work programme to deal with racial inequality in the employment of staff in the NHS.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request.

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