# Reflections on racism, civility, and the role of general practice ### **From historic childhood racism to modern-day resurgent intolerance** Growing up in the inner city of Derby during the 1980s was a difficult experience. Overt racism on the streets also manifested as verbal and physical aggression within the classroom. This was a space that should have been a sanctuary of safety and learning. Despite being born in England, I was made to feel like an unwanted, second-class citizen. In recent years, I have found myself re-experiencing those same feelings — this time, as a parent. Fear and uncertainty about the future are amplified when viewed through the eyes of one's children. I have also found myself re-experiencing them as a GP. From the divisive rhetoric of rightwing politics to overt displays of nationalism — such as a nearby house painted entirely with the Union Jack — angry, intolerant discourse has re-entered mainstream public life. What was once confined to private conversations has spilled into the public realm. It feels as though intolerance is now proudly worn as a badge of honour. The 1990s, by contrast, felt like a period of hope. Discrimination seemed to fade, and diversity became 'cool'. British-Asian culture flourished; the optimism surrounding the 1997 Labour victory hinted at a more inclusive society. Yet the events of '9/11' (and '7/7') abruptly halted that progress, ushering in a new era of suspicion, stereotyping, and the re-racialisation of identity.¹ The resurgence of right-wing ideology has been attributed to multiple factors: economic austerity, political alienation, and the populist backlash against perceived 'liberal elitism'. Some argue that performative equality, diversity, and inclusion initiatives — designed to address structural inequality — may have paradoxically fuelled resentment by appearing tokenistic rather than transformative.² When fairness feels procedural rather than authentic, it risks deepening the very divisions it seeks to heal. Symbols such as the Union Jack and the St George's Cross remain, for many, powerful expressions of national pride during sporting events. But when flags are co-opted to signify exclusion, they lose their unifying purpose. Ironically, St George himself was of Middle Eastern heritage — a reminder that British history, too, is intertwined with global and diverse identities.³ I am concerned that these wider societal tensions are now entering the consulting room. From subtle microaggressions to explicit racism and physical threats, GPs and practice staff are exposed to hostility. I find that the NHS policy on zero tolerance, once rarely referenced, now requires frequent citation, even as NHS England changes the language from *'zero tolerance'* to *'violence prevention and reduction'.*⁴ The NHS, like schools, should be a sanctuary — for patients and professionals alike. To have to legislate for basic decency is deeply troubling. When rules are required simply to enforce civility, we must ask: what has happened to our shared humanity? # **Reclaiming compassion** Uninformed nationalism — stoked by fear, economic insecurity, and populist narratives — risks corroding the social contract on which the NHS was founded. The founding principles of universality, equality, and compassion are incompatible with division and hostility. When civility erodes, so too does the moral foundation of care. As clinicians, we are both witnesses to and participants in these societal shifts. Yet we also occupy a position of hope.⁵ Each consultation offers an opportunity to model kindness, understanding, and shared humanity. In a world of fragmentation, the GP consultation remains one of the civic spaces where empathy and trust still hold currency. The NHS must once again become a sanctuary — not only for patients, but also for those who serve within it. Leadership must move beyond performative inclusion to meaningful actions at the national level, in our institutions and practices, and in our dealings with one another. This includes creating psychologically safe workplaces, actively addressing discrimination, and investing in emotional resilience and team wellbeing. The moral crisis facing Britain goes beyond politics; it is existential and it is socially toxic. We must reclaim civility and compassion as clinical and civic duties. Only then can we begin to mend the torn fabric of our society — one consultation, one act of humanity, at a time. **Carter Singh** GP in Nottinghamshire. #### **Email: drcartersingh@gmail.com** This article was first posted on *BJGP Life* on 18 Nov 2025; https://bjgplife.com/civility **DOI: https://doi.org/10.3399/bjgp26X743997** ## **References** - 1. Modood T. *Essays on secularism and multiculturalism*. London: Rowman & Littlefield, 2019. - 2. Ahmed S. *On being included: racism and diversity in institutional life*. Durham, NC: Duke University Press, 2012. - 3. Riches S. *St George: hero, marytyr and myth*. Thrupp: Sutton Publishing, 2000. - 4. NHS England. Violence prevention and reduction. [https://www.england.nhs.uk/](https://www.england.nhs.uk/supporting-our-nhs-people/health-and-wellbeing-programmes/violence-prevention-and-safety) [supporting-our-nhs-people/health-and](https://www.england.nhs.uk/supporting-our-nhs-people/health-and-wellbeing-programmes/violence-prevention-and-safety)[wellbeing-programmes/violence-prevention](https://www.england.nhs.uk/supporting-our-nhs-people/health-and-wellbeing-programmes/violence-prevention-and-safety)[and-safety](https://www.england.nhs.uk/supporting-our-nhs-people/health-and-wellbeing-programmes/violence-prevention-and-safety) (accessed 25 Nov 2025). - 5. Thompson T. Book: I Shall Not Hate. *Br J Gen Pract* 2025; **DOI:** [https://doi.org/10.3399/](https://doi.org/10.3399/bjgp25X743805) [bjgp25X743805](https://doi.org/10.3399/bjgp25X743805)