DAUK were disappointed to learn that following the successful employment tribunal of Mr Omer Karim, a renowned robotic surgeon, the General Medical Council (GMC) is appealing against the verdict of institutional racism for which it was held responsible.
In 2014, Mr Karim – a consultant urologist of Sudanese and Irish heritage – blew the whistle on unsafe surgical practice at Frimley Health NHS Foundation Trust. Citing apparent ‘intimidation’ and ‘threatening behaviour’, he was then accused of lacking fitness to practice by his Trust, who reported him to the GMC. All these allegations were found to be unproven at his employment tribunal. By contrast, a white colleague Marc Laniado, who was the recipient of similar allegations, had his case dropped much sooner than Mr Karim.
Dr Duranka Perera, DAUK spokesperson said: “Lessons have not been learned from the infamous case of Dr Hadiza Bawa-Garba. She was initially convicted of gross negligence manslaughter but the sanction of erasure at the MPTS was rightly not accepted. She has now been reinstated without restriction. Subsequent analysis of events – as put in the Hamilton review – spoke of a ‘toxic fear of reprisal’ by the regulator if doctors were to ever make mistakes. By appealing this verdict and pursuing the same punitive measures they took against Dr Bawa-Garba, the GMC is doing nothing to repudiate these assumptions – they are only further entrenching them in truth.”
“The verdict in favour of Mr Karim has been seen as vindication for the Black and Minority Ethnic doctors who are more than twice as likely as their white colleagues to face referrals regarding their fitness to practice. For the GMC to appeal is for them to misunderstand just how much accountability and restorative justice for institutional racism matters, not just for the nearly 60,000 strong BAME workforce in the NHS, but for the organisation in general.”DAUK have written to the Health Secretary, the Rt. Hon. Sajid Javid and Dame Clare Marx, the head of the GMC, to address these important concerns.
Dear Health Secretary and Dame Clare Marx
We write with great concern regarding the General Medical Council’s decision to appeal against the employment tribunal decision earlier this month which ruled in favour of renowned Consultant Urologist Mr Omer Karim.
The results of this tribunal have held that Mr Karim, of Sudanese and Irish heritage, was treated differently from a white colleague Marc Laniado – who had similar complaints surrounding intimidating and threatening behaviour put to him – on the grounds of his race. All allegations were found not proved and Mr Karim was adjudged not to have committed misconduct. As such, there was no question of his fitness to practice.
This is a landmark ruling within the medical profession. It is the first time that the GMC has been found to be legally responsible for structural racism and discrimination within the NHS. This was a decision 7 years in the making after Mr Karim blew the whistle on poor surgical practice at his Trust. He had to restructure his entire life – to the cost of £300,000 – to face up to the GMC, prior to the recent decision that ruled in his favour. However, that the GMC appears willing to spend its members’ money on a retributive appeal, rather than investigating and adjusting the local and systemic issues through which a case such as this could ever have arisen, comes across as deeply disappointing. As a campaigning grass-roots organisation for doctors, we at DAUK are very concerned at this decision and its wider impact on the profession.
These decisions are not made in a vacuum. We know of at least one other case, currently under investigation, where a Trust did not follow disciplinary due process for a BAME doctor; we have strong reason to believe a white doctor would not have been dealt with in the same manner. We will write to you confidentially concerning this.
The echo of Dr Hadiza Bawa-Garba resounds in these cases. She was initially convicted of gross negligence manslaughter but the sanction of erasure at the MPTS was rightly not recommended. It is of note that Ivan Hare QC, who was instructed by the GMC to strike Dr Bawa-Garba off the medical register, has been once again instructed in the Karim case. We find this decision extraordinary given his role in an unwise appeal which caused such an extraordinary backlash for the GMC.
The GMC is largely funded by the mandatory subscriptions of doctors. As paying subscribers, we have concerns that once again, our money is being spent in a way which seeks to absolve the GMC of any fault, rather than to understand the many barriers facing Black and Minority Ethnic healthcare staff. We wish to understand what actual learning has taken place at the GMC since the Bawa-Garba case given that in the Karim case, they have simply chosen to repeat their previous actions.
NHS Improvement’s Just Culture guide expressly states:
“Action singling out the individual is unlikely to be appropriate; the patient safety incident investigation should indicate the wider actions needed to improve safety for future patients. These actions may include, but not be limited to, the individual.”
With external support, including that of us at the Doctors’ Association UK, justice was served in the case of Dr Bawa-Garba. The many systemic failures which let her down are testament to these flaws. However, instead of following the Just Culture principles and adopting a Learn not Blame approach to promote reflection and progress surrounding these failures – much like aviation does – it seems instead that Trusts and regulators remain committed to singling out and destroying the individual, no matter the cost.
That this pattern of decision-making has a racial element attached is no surprise.
By the GMC’s own documentation, Black and Minority Ethnic group doctors and non-UK graduate doctors are more than twice as likely as their white colleagues to be referred to the GMC over fitness to practice issues. These are stark figures indeed, compounded by the fact that as recently as 2012, if one were under investigation by the GMC, they would be 20 times more likely to die by suicide. These recent events speak to a calcification of principle at the top of the profession that simply isn’t willing to shift its views from its position of comfortable, self-serving inertia.
The simple fact is, given the evolving perspectives surrounding racism within the zeitgeist, whether it be through footballers taking the knee or Black Lives Matter setting precedents for genuine social change across the world, the GMC’s position on this matter comes across as woefully dated and out of touch. With up to 46% of the medical workforce being non-white per government records – a number in the range of 58,200 people – the GMC’s actions will have ramifications and resonance for many. Worse still, their actions will only serve to entrench the distrust many in the profession have of the regulator, especially since the Bawa-Garba case and the subsequent Hamilton review exposed a ‘toxic fear’ of reprisal should a doctor ever make a mistake.
Referring to Dame Clare Marx’s email from May 2021, it is clear the GMC is aware that progress on the matter of race and discrimination should be made. We make reference to two key points she mentioned, regarding the GMC’s individual goals on the subjects:
· To eliminate disproportionate fitness to practise referrals from employers, in relation to ethnicity and primary medical qualifications, by 2026.
· To eliminate discrimination, disadvantage and unfairness in undergraduate and postgraduate medical education and training by 2031.
Appealing this recent case, to our minds, means that these targets will not be met.
We still haven’t reached a point in the medical profession, or indeed society, where the discrepancies between the way people of different races (or genders or religions or sexual orientations) experience life are negligible. With this case being the latest in a long line, this means that education and sincere systemic restructuring surrounding micro and macro expressions of racism and discrimination within the GMC has never been more important.
As such, we recommend that the GMC choose to land on the right side of history. We recommend it takes lasting and restorative action beyond the short-sighted punitive measures that it is currently pursuing, even though it has previously stated it would adopt recommendations for the better after the Bawa-Garba case.
Justice is not limited to grand gestures, complaints procedures and formal inquiries. It can rectify problems through the active choice of understanding and transmuting individual or organisational power and privilege for the betterment of those with less. In this case, to achieve that justice, we recommend the GMC:
- Start sincere conversations about race within the profession.
2. Offer a microphone for the medical workforce’s lived experiences of racism.
3. Seek to make these experiences public, instead of seeking to penalise and self-justify at the first opportunity.
4. Commit to a diverse, but just as importantly inclusive, GMC hierarchy from the top down and even down to Trust level, so lived experience and understanding of the nuances of race and discrimination can ensure more robust countermeasures against both are in place.
5. Encourage the presence of BAME staff guardians on a Trust level upwards, so BAME staff might feel better supported in general, and safer when speaking out.
6. Normalise the process of reverse mentoring, where younger BAME staff share their experience and understanding of modern nuance surrounding race and discrimination with older members of the workforce, much as firms such as Clifford Chance do in the Private Sector.
7. Improve implementation of the Just Culture recommendations beyond lip service, setting in concrete a commitment to diminishing local blame cultures.
8. Improve and enforce systems of accountability for racism and discrimination at Trust level, such that complaints are robustly assessed in an unbiased manner per the GMC’s published criteria and recommendations. This needs to affect patients, clinical and non-clinical staff equally, such that nobody can ever be preferentially targeted due to protected characteristics.
We request that the GMC reconsider its position in due course.
Dr Kaveri Jalundhwala
Mr Dolin BhagawatiDr Matt Kneale
Co-Vice Chairs – Doctors’ Association UK