The Doctors’ Association UK committee met with Charlie Massey, Chief Executive and Registrar of the GMC and Dr Colin Melville, Medical Director and Director of Education and Standards last week. We were clear to convey the anger and distrust the profession feel towards the GMC. During the meeting we covered a variety of subjects including issues raised by the Bawa-Garba case, continued appeal of MPTS decisions, weaponisation of GMC referrals, accountability of NHS managers, and mental health and wellbeing of doctors under investigation.
The Bawa-Garba Case
Although both Mr Massey and Dr Melville seemed to acknowledge the feelings of doctors following the case of Dr Bawa-Garba, they seemed to suggest that the fear and anger has been misplaced. Citing that the majority of fitness to practice sanctions were for conduct issues rather than mistakes made by doctors, they suggested doctors who make simple mistakes generally do not face fitness to practice panels.
They acknowledged that system pressures exist in the NHS and that doctors are subject to these pressures now, more so than ever. Their stated commitment to ensure that their case examiners and staff undergo human factors training , whilst welcome, provides little comfort when behind the doors of a court room they argued in the Court of Appeal that system pressures had already been adequately covered in Dr Bawa-Garba’s original criminal case.
Moreover, we were alarmed to hear that – despite the Court of Appeal decision in August – the GMC still believed that the onus remains on a trainee to request help from their seniors, rather than expect a proactive approach, causing our Chair Dr Samantha Batt-Rawden to interject and say that, with respect, she profoundly disagreed. When this suggestion was made in court, many doctors felt that it was so far removed from everyday clinical practice that the hashtag #armchairconsultant was coined. It was worrying to hear that those in senior positions in the GMC still felt that trainees could still be regarded at fault in this regard.
Appealing MPTS decisions in the wake of Bawa-Garba and Raychaudhuri
Charlie Massey re-iterated that the decision to appeal Dr Bawa-Garba’s MPTS decision was his, based upon the legal advice received which suggested that the MPTS decision had erred in law when considering the Gross Negligence Manslaughter conviction, not on the basis of clinical competence. We have invited him to publish this legal advice he received so that the profession can fully understand the basis of the GMC’s actions.
Our Chair, Dr Samantha Batt-Rawden, pressed the GMC on their continued desire to use their right of appeal of MPTS decisions in light of criticism from the Health and Social Care Select Committee and the Williams Review recommendation that it be removed. Mr Massey argued that the GMC has a legal obligation to use its appeal if it deems the MPTS decision is wrong. We asked him whether the GMC could defer the appeal decision to the Professional Standards Authority (PSA) in line with other regulators who do not have the right of appeal. He confirmed that the GMC are in talks with the PSA about such an arrangement and they are exploring whether it would work. DAUK welcome this and look forward to an update on Massey on this positive step. Mr Massey suggested that following the August Court of Appeal judgement the bar is set higher for him to appeal a MPTS decision and that since the verdict he has not appealed any further tribunal decisions. Mr Massey also confirmed that when clinical context is required in deciding to appeal a case that Dr Melville’s input is always sought.
The weaponisation of the GMC
I questioned Charlie Massey on the increasing weaponisation of the GMC. Recently we have seen threats of referral to the GMC used by Senior Managers and Trusts to silence the concerns of doctors. In the case of Dr Edwin Jesudason, an eminent Paediatric Surgeon, senior clinicians and managers discussed how their best weapon against him would be to refer him to the GMC. They acknowledged that there are at times vexatious complaints made about doctors by fellow doctors and managers, but would look to take action if there was evidence that these complaints were to prevent doctors speaking out for patient safety. They welcomed any doctor contacting the GMC directly or their responsible officer where they felt that pressure was being applied to prevent whistleblowing, a duty of candour or patient safety. It is this culture in the NHS that we desperately need to change, ensuring a safe environment for patients where healthcare staff feel safe and empowered to speak up and suggest improvements to practice. And when things do go wrong, that an atmosphere of openness and willingness to reflect for positive change is prevalent. This is the focus of DAUK’s Learn Not Blame campaign.
They acknowledged that there must be a mechanism whereby managers are accountable for the decisions they make that result in increased system pressure (low staffing etc) and a means by which the conduct of medical directors should be scrutinised. We expressed our deep concerns that the pressures caused by rota gaps, staff shortages, etc, leave doctors vulnerable to increased risk of clinical misjudgements and indeed error, whilst those in management allowing and presiding over unsafe staffing continue working without any accountability. Their ability to move from one Trust to another apparently unhindered despite poor decision making and adverse consequences for patients and staff.
The regulation and issues surrounding medical expert witnesses was also briefly discussed. The conduct of expert witnesses forms a part of the GMC commissioned review of Gross Negligence Manslaughter which is due to report early next year. It is welcome that the GMC have committed to working with Dr Jenny Vaughan, DAUK’s Law and Policy lead on this topic over the next few months. Dr Vaughan had a follow up meeting with the GMC on this subject today.
Doctor mental health and wellbeing
DAUK’s GP and Public Health Lead, Dr Alan Woodall challenged the GMC over their responsibility towards Doctors’ mental health and wellbeing. Dr Woodall highlighted chilling statistics that a doctor under investigation by the GMC is nearly 20 times more likely to commit suicide than the general public. Using 2014 data Dr Woodall stressed that the suicide rate of doctors under investigation was 227/100,000, compared to 11.6/100,000 in the general population and 65.5/100,000 amongst prisoners. Charlie Massey acknowledged that the GMC recognises that there may be vulnerable doctors who are subject to GMC processes and others who become vulnerable as a result of GMC processes. We stressed that the GMC had a responsibility to publish data as the only organisation that has oversight into doctor deaths through their register. We have secured a commitment from the GMC that they will be publishing data on the deaths of doctors from 2019, as well as a commitment to look further at extracting suicide data where possible from this. We have offered to work with the GMC on this.
We have emphasised that DAUK will also work with the GMC on issues that are vitally important to doctors, including mental health and wellbeing. The GMC acknowledged that they are aware DAUK will remain committed to being constructive critics and holding the GMC to account, but have offered further meetings with us. The meeting served as the opening of what we hope will be a valuable dialogue, which will allow DAUK to push for the vital GMC reform that the profession wishes to see.
Dr Rinesh Parmar
DAUK Vice-Chair & Treasurer