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Dear Editor,

Some of the findings of the article Can we implement ethnic monitoring in primary health care and use the data?1 reflected my experience from training staff in improving, or in some cases establishing, the collection of ethnicity data.

The suggestion by practices that patients need to be educated in advance about the process reflects my experience of staff being fearful of personally approaching patients about their ethnic origin. In my experience, and almost exclusively with respect to white members of staff, there appears to be a fear that asking the question asking will automatically be perceived as discriminatory / racist by the (minority ethnic) patient. This shows a misunderstanding by staff of what constitutes discrimination and this fear has been seen to diminish significantly during training after explanations of ethnicity and of discrimination as defined by the Race Relations Act.

Whilst I agree that patients need information as to why the information is being collected, I suggest that explanations are better delivered on a one-to-one basis rather than through a broad awareness campaign. The explanations can then be tailored to the concerns of the patient, whether these are around anticipated discrimination, fears about confidentiality, difficulties in self-categorisation, or confusion of the concept of ethnicity with race or nationality.

The quality of the data collected, relies so heavily upon the attitude and actions of the frontline staff, that their understanding of and support for the process is crucial if the data collected is going to be accurate. I suggest that it is staff ignorance; misconception and misplaced fear, which are the barriers to accurate data collection and to which greatest attention should be paid in the implementation of ethnicity data collection

Training resources on ethnicity data collection, devised the Department of Health and myself, are downloadable from wwwww.doh.gov.uk/ethnicity2001guidance/index.htm

1. Olatokunbo Sangowawa, Raj Bhopal. Can we implement ethnic monitoring in primary health care and use the data? A feasibility study and staff attitudes in North East England. Public Health Medicine 2000; 2(3):106-108.