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GPs go forth

Health secretary 'deeply concerned' about implications of GMC court ruling

Health secretary Jeremy Hunt has questioned the GMC for taking its own tribunal's decision to the High Court to be quashed.

Commenting on Twitter, Mr Hunt said he was 'perplexed' that the GMC acted as it did, adding that 'patient safety must be paramount'.

He further told the BBC Radio 4 Today programme that doctors need to be able to express themselves freely about mistakes in order to keep patients safe.

Judges ruled in favour of the GMC yesterday and said Dr Hadiza Bawa-Garba should be struck off the medical register after the death of a youg boy with sepsis in her care.

Mr Hunt said on Twitter: 'Wouldn’t be appropriate for me as Govt Minister to criticise a court ruling, but deeply concerned about possibly unintended implications here for learning and reflective practice in e-journals. Am also totally perplexed that GMC acted as they did: patient safety must be  paramount.'

Concerned doctors - over 800 of which signed a letter to GMC before last month's High Court hearing - have warned that it penalises the doctor for systemic trust failures and criminalises clinical error.

Mr Hunt told the Today programme: 'I do think we need to consider very carefully what may be some of the unintended consequences of this ruling. In particular, doctors have e-journals, in which they reflect on what they do.

'We know that in medicine all over the world there is always going to be mistakes made, and for patients to be safe we need doctors to be able to reflect completely openly and freely about what they have done, to learn from mistakes, spread best practice around the system, to talk openly with their colleagues. 

'And I want to make sure going forward that doctors are able to do that.'

To which he was asked: 'But as a result of this case, nobody will feel free to do that?'

He responded: 'Well we have to make absolute sure that isn't the case, because if we are going to keep patients safe, then we have to make sure that doctors are able to learn from mistakes.'

House of Commons Health Committee chair and former GP Dr Sarah Wollaston also said she was concerned about the ruling, in response to the health secretary's comments: 'I agree there are unintended consequences from this case and whilst ministers cannot intervene in judicial process for this case there will need to be a review not only of system pressures but to make sure clinicians can learn from errors rather than fearful of discussing them.'

The Medical Protection Society, which represented Dr Bawa-Garba, said in light of the appeal decision that it 'may jeopardise an open, learning culture in healthcare at a time when the profession is already marred by low morale and fear'.

They added that they were 'considering all options in the interests of our member and the wider profession'.

The Medical Practitioner Tribunal Service decided in June last year that erasing trainee paediatrician Dr Bawa-Garba from the register would be ‘disproportionate’ and recommended a 12-month suspension instead.

But the GMC disagreed and told the High Court in December that she should be struck off 'to protect the public' after her actions resulted in the death of a six-year-old boy.

Yesterday, Lord Justice Ouseley said: 'I come firmly to the conclusion that the decision of the Tribunal on sanction was wrong, that the GMC appeal must be allowed, and that this Court must substitute the sanction of erasure for the sanction of suspension.'

Mr Hunt has been outspoken throughout his time as health secretary about creating an NHS culture of learning in light of the Francis Report into the failings at the Mid Staffordshire NHS Foundation Trust.

Readers' comments (35)

  • I concur with “too cross to talk”. The GMC should not have over ruled the tribunal- otherwise what is the point of having a tribunal in the first place.

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  • Just shows you can't trust any of our professional organisations.... the people who go into indemnity, politics, management etc all do so because they know they're safer out of day to day medicine, that and they're often just sticking their nose in the trough. Disgraceful all over.

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  • Time to find a new career methinks!! You slog your guts out whilst being harangued from all sides, and with "Big Brother" hovering to destroy you. A truly Orwellian nightmare if ever there was!!

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  • DoH double speak: 'I'm perplexed' (but I set the tone and statutory framework)

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  • I will not be submitting SEA or reflections on my appraisal portfolio. It remains to be seen whether there will now be a lot of doctors not passing their reappraisals.

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  • Just Your Average Joe

    First time I have ever agreed with JH !

    I am perplexed why the GMC even exists in the format it is in - self regulation by your peers is what was intended, but no longer in place.

    Who unilaterally made the decision to challenge this GMC decision not to erase her in the high court? They should resign immediately for putting the profession into disrepute.

    The Jury made a criminal case decision, based on lawyer presented screened evidence, and they in my opinion made an incorrect decision, as they systemic failures which led to the death were outside the control of the poor doctor involved.

    Its like a car shunting you from behind after an driver had a heart attack driving down and steep hill, and you hit and kill a pedestrian crossing in front of you. To prosecute the driver of the car that actually hit the pedestrian is grossly unfair, as they were only in the position they were put into by circumstances outside their control.

    A panel of the GMC who are informed and aware of the full facts in the case made a sound decision that should have been respected as it was the right and fair decision on the ability for her to work again, just like any person who is released from prison has a right to fresh start once a sentence is served, rather than continue to persecute this doctor by taking away their hard work and training, and the profession they have trained their whole life for - which would help many patients in the future - bringing good to the world.

    If the GMC wishes to be a kangaroo court, stop charging doctors and let the government pay for prosecuting doctors, and stop fleecing us as an extra tax when it is no longer self regulation, but the rules from the GMC lead to potential self incrimination and harm to your careers.

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  • Another kick for a struggling profession. Take on extra to help or reflect at your peril. What a sad state of affairs. Where are the managers / trust board in all of this? Hiding away as ever no doubt. The GMC are most definitely not fit for purpose.

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  • Vinci Ho

    No doubt , the culture of the world is changing . The expectations on the ‘guardians’ of the world are radically altered. With the evolution of IT technology, social media and hence, globalisation, the reflection of competing notion of virtues any authority(government) should honour or reward , is subjected to even more open and liberal challenges . One can argue the word ‘transparency’ has got a new meaning . Clearly , our prosecution and judiciary system is under huge pressure to ‘get it right’ time to time. As a strong believer of the old doctrine of independent judicial system , I chose not to comment until this verdict was reached.

    One thing I am not sure is how general public understands the difference between murder and manslaughter, with motive(s) and without intention in homicide. Ian Patterson was struck off the GMC list because he harmed(no necessarily killed)so many patients with motives and clearly would be unsafe to let him practise medicine again in future.
    Gross negligence is an involuntary manslaughter(correct me if I am wrong ) carrying no intention to kill.
    It is difficult to revisit the original indictment in 2016 as her appeal to higher court was already rejected.
    But the action of GMC was extraordinary and questionable:
    (1) If the ‘rules’ stated GMC sanction was immediate erasure whether the indictment was murder , voluntary manslaughter or involuntary manslaughter, why was the doctor not erased immediately after the indictment?
    (2) The answer was perhaps because the power of doing that lied in Medical Practitioner Tribunal Service . And if you remember recent report in here about another case :

    There appears to be a ‘power’ struggle between GMC and tribunal services.
    As I wrote before , GMC has an old fashioned superhero-protector complex to fulfil that it clearly wants to ‘centralise’ all power in itself. This will serve the appetite of this ‘ Right OR Wrong ; Left OR Right; nothing in between’ climate of the world.
    (3) The conclusion of this present verdict is as long as one being found guilty when a patient died , one will be struck off GMC list PERMANENTLY , no matter what .
    (4) Whether the reflection process in appraisals(hence , revalidation)needs modification is only scratching the surface . Like many first generation appraisers(quit 5 years ago) , I lost the belief in the original telos of a genuinely reflective exercise which was replaced by a tick-boxing one anyway. If this case means anything, it simply adds more flaws into an exercise which has already lost people’s faith.
    (5) The system failure involved in this case , also well demonstrated the poor availability and distribution of resources(you should all know my definition of resources by now)in NHS. The fallacy of austerity and efficiency saving (not a lot people want to mention that openly these days) in NHS had a good translation in this case. All authorities ,including the government, ‘understandably’ wanted to distance themselves away .
    As it was written in Analects, ‘’When the higher authority had lost its way , people deserted losing their faith . After discerning all the details from the matter, we should only show sympathy rather than schadenfreude for those who committed a crime under such circumstances and climate.’’
    (上失其道 ,民散久矣。如得其情,則哀矜而勿喜。)Well , the higher authority here is ,of course , GMC .
    I am all for a legal challenge to Supreme Court if that is feasible and decided.

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  • Vinci Ho

    And the sake of the extraordinary irony that we , doctors , are the one funding and subscribing GMC , all of us should give our comments on this case.

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