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GPs go forth

Is the GMC serious about mending relations with doctors?

The regulator wants doctors to know it supports them, but it will take more than words to heal the rift caused by its actions during the Bawa-Garba case. Anviksha Patel reports

The GMC seems to be trying to make itself more doctor friendly. Following its controversial handling of the case of Dr Hadiza Bawa-Garba, which served to fan simmering mistrust among the profession, the regulator now says it wants to ‘spend the bulk of our resources supporting doctors’ rather than investigating them.

The relationship between the GMC and doctors reached its nadir during the Bawa-Garba case, which encapsulated many of the issues doctors have had with the regulator, such as an aggressive approach to punishing doctors and a focus on individual errors rather than systemic failures.

The case also seemed to support the regulator’s previous conclusion – that a ‘disproportionate’ number of black and minority ethnic doctors are subjected to GMC investigation.

Our strategic direction and ambition is [to] spend the bulk of our resources supporting doctors

Charlie Massey

GMC chief executive Charlie Massey says he is keen to change this relationship with the profession. 

At the height of the tensions around Bawa-Garba last year, he appeared at both Pulse LIVE in London and the British Association of Physicians of Indian Origin (BAPIO) conference in Birmingham – a sign he is taking the problems seriously.

Speaking at the Pulse LIVE conference in Liverpool last month, he continued this effort. He told delegates: ‘Our strategic direction and ambition is [to] spend the bulk of our resources supporting doctors and that’s because I believe the best way to protect patients, which is our statutory objective, is to support doctors.’

At the event, Mr Massey said he recognises the pressures doctors are under. He described Pulse’s recent snapshot survey of GP workload – which revealed more than 50% of GPs were dealing with unsafe levels of work – as ‘startling and worrying’ and referred to comments he made last year that the profession was at ‘breaking point’.

The GMC had already started its efforts. Last year, in the wake of Bawa-Garba, three independent reviews were launched, to ‘reinforce’ the GMC’s new supportive stance. All three are due to report soon.

They include reviews on: gross negligence manslaughter; the treatment of black and minority ethnic doctors; and mental health and wellbeing in the profession (see box).

The GMC reviews

Gross negligence manslaughter

Led by former consultant Dr Leslie Hamilton and due in the ‘coming weeks’, this considers, among other things, the difference between ‘errors and exceptionally bad failings’ and ‘the role of expert witnesses. It was commissioned after Dr Hadiza Bawa-Garba’s conviction.

Treatment of black and minority ethnic doctors

GMC chief executive Charlie Massey told delegates at Pulse LIVE in Liverpool that BME doctors are ‘twice as likely to be referred by an employer to the GMC’ than white doctors. Roger Kline, an expert on workplace discrimination, is leading the review, which is expected ‘soon’, Mr Massey says.

Doctors’ mental health and wellbeing

This looks at the wider profession to address ‘the symptoms of ill health in terms of the provisional service doctors may need’. It is led by senior King’s Fund fellow Professor Michael West, and will report in the autumn.

The fact the GMC is conducting reviews into these issues is a positive. Mr Massey said the GMC is already addressing one of the most pressing issues for the profession – whether doctors will be blamed for systemic errors.

He said: ‘We made a very significant investment to bring in “human factors” training. We want to understand where an individual is failing in the context of the system and how we then balance that understanding of the system with individual accountability.’

We think we can probably avoid up to 500 investigations a year

Charlie Massey

And the GMC has taken steps in advance of the publication of Dr Leslie Hamilton’s report on gross negligence manslaughter.

It recently announced that GPs who make one-off mistakes will have additional enquiries made about them at an earlier stage, thereby reducing the chance of unnecessary full investigations. ‘We think we can probably avoid up to 500 investigations a year through that process,’ said Mr Massey.

But will all this be enough to rebuild the GMC’s relationship with GPs and the wider medical profession? For Dr Peter Swinyard, Family Doctor Association chair and a GP in Swindon, a lot more will be needed to regain doctors’ trust. He says: ‘The old mission statement “supporting doctors, protecting patients” seems like a generation ago.

‘The GMC has to get its head round what it is. If it is to be a self-regulating professional body as it used to be, it needs to have a majority of doctors on its main board and then we would not object to paying for it.

At present, we seem to be paying the hangman and hoping for an easy death

Dr Peter Swinyard

‘At present, we seem to be paying the hangman and hoping for an easy death.’

Even some of these reviews seem to be shifting the responsibility away from the GMC. For example, the focus on employers’ complaints about BME doctors fails to take into account BAPIO’s criticism that the regulator itself treats BME doctors ‘differently and harshly’.

Meanwhile, the GMC has said it reserves the right to pursue erasure from the performers list for doctors, like Dr Bawa-Garba, who have been charged with gross negligence manslaughter, pending changes to legislation promised by the Government.

Its latest announcement on revalidation last month seems to epitomise the disconnect between GPs and the regulator. It unveiled a consultation on new proposals to require GPs to collect patient feedback each year instead of every five years as they do now – and claimed this would reduce the burden on doctors.

The GMC said more regular patient feedback would allow doctors to ‘pick up any issues to address in a timely way’, claiming it does not want to ‘increase the administrative burden’ of feedback collection.

I think the wounds caused to the profession have now become deep sores that will never heal

Dr Anu Rao

Professor Azeem Majeed, head of primary care at Imperial College London, says this will in fact increase the burden: ‘I can’t see any rationale for annual feedback as this would create extra work. In any case, the system for obtaining patient feedback is scientifically flawed – small, unrepresentative samples selected by doctors – and therefore the results are largely meaningless.’

Leicestershire and Rutland LMC vice-chair Dr Anu Rao questions whether GPs’ faith in the GMC can be restored.

‘The problem with reviews is that, once they are done, no action seems to happen afterwards.

‘And while they are happening, more and more of my GP colleagues are either leaving the profession or the country, or are under immense pressure and stress to the detriment of their mental health.

‘I think the wounds caused to the profession have now become deep sores that will unfortunately never heal.’

Despite these warnings, there does seem to be some kind of culture change under way at the GMC. Mr Massey’s appearances at the Pulse LIVE and BAPIO conferences suggest there is a real desire to repair relations with the profession.

However, until there are tangible changes, any new initiatives are likely to be greeted with scepticism.

Charlie Massey on…

Supporting doctors

‘Our strategic direction and ambition is [to] spend the bulk of our resources supporting doctors and that’s because I believe the best way to protect patients, which is our statutory objective, is to support doctors.’

Dr Bawa-Garba

‘If anything, that case reinforces the strategy of our direction, about going upstream, about providing more support for doctors.’

Helping trainee doctors

‘In the last couple of years we’ve added questions to our national training survey around burnout, and this year we’ve added questions around rest facilities and to shine a light in terms of the pressure that trainees are under.’

Unsafe GP workloads

‘If a doctor is complained about and they’ve been working in an environment which has been unsafe or has been under so much pressure, we will always take that context into account. A doctor who has been doing their best in a tough environment is not going to end up being suspended by the GMC.’

GMC investigations

‘Where there’s been a single incident, even if it meets the statutory threshold for investigation, we don’t want to start the process until we’ve done some preliminary inquiries. We think we can probably avoid up to 500 investigations a year.’

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Readers' comments (13)

  • Supporting Doctors is inconsistent with continuing Appraisal and Revalidation; a process that has demonstrable harms to Doctors and no benefits to those subjected to the process without their consent.

    By their deeds you will know them....

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  • That’s like suggesting friendship to someone you have seriously assaulted and injured and who your likely to repeatedly assault again.

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  • Will never ever trust this organisation.A branch of government,therefore will not tackle the elephant in the room.Under training, under staffing and under resourcing.They need to call out the government before spouting platitudes,actions speak louder than word Mr Massey.The relationship between the state and the profession is broke,hence the relationship with the GMC is broken.

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  • It makes too much money to be successfully reformed. None of this would ever have happened if it wasn't churning so many doctors through it's meat grinder but it's impossible to wind the clock back because there are too many vested interests. The GMC is run by lawyers and accountants who have almost zero interest in a safer NHS because this would conflict with their interests.

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  • It probably thinks it is but practically it won't . Both the GMC and the CQC strayed from the path of common sense to one of massive over-regulation without any idea at all of the well recognised drawbacks of such a swerve. The disastrous leadership of both have gone but the damage they have inflicted can not be undone.
    The GMC needs to write to every doctor offering a formal apology and there needs to be a profession wide discussion and agreement about its future.

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  • Cobblers

    I see no future in a GMC as current. It is irredeemably tarnished by its ongoing treatment of doctors. Charlie the Lush is a government apparatchik with his nose in the trough and spouting the mantra of "Support". At the same time his organisation charges the doctors for the bullet in the back of the head.

    No. The GMC as it is funded by the profession needs to go. The Government can set up whatever it likes to regulate but at least it will be viewed as what it is, a state funded control mechanism.

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  • I agree with all the above. Her case has been the proverbial straw that broke the camel's back. And to expand on Stelvio's point, would I have retired at 55? No. I did mainly because I found it demeaning to go through a meaningless second revalidation, being constantly afraid of complaints , being tired etc. and, yes, I, bitterly, miss caring for patients and being of some use.

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  • "1. CQC inspections too demanding in the context of funding cuts.

    2. Annual appraisals sold as a chat over tea and now extremely onerous and time-consuming endless unpaid paperwork with unpredictable appraisers from overly OCD to supportive if you are lucky.

    3. 5 yearly career ending revalidation, multiple the bureaucracy of appraisals by 5. As in 5 times complete audit cycles, 5 times multiple source feedbacks, 5 times patient surveys, clinical cases, CPD etc. When do GPs have time to see patients?

    4. Lack of GP workforce means no holidays, working overtime, no locums, burnout.

    5. CCGs now delegating what used to be outpatient clinical care onto GP’s laps so many feel out of their clinical expertise and fearful of the GMC if they make a mistake with treating a patient who should be under hospital consultant care but this is now called community care.

    6. 10 minute appointments when in Europe and abroad GPS get 20+ minutes to safely treat a patient. Interruptions and phone consults added in between 10 minute slots or added at the end of an exhaustive list,

    7. Seeing colleagues enjoy the best of both worlds emigrating to Canada or Australia to work safely as a GP.

    8. Pressure from CCGs to reduce hospital referrals, to cut expenditure on prescriptions, to deliver safe care without a minimum practice income guarantee, having to fire staff to make ends meet and watching single mums in tears as they lose their jobs working for practices.

    9. Fear of a GMC referral as investigations may take up to a year during which time the GP may be treated as guilty until proven innocent and God forbid the DM gets ahold of any investigation and publicly shamed a GP before he has had his right to a fair trial.

    10. Students are reconsidering whether medicine is a viable profession when other professions pay double, with free weekends and evenings to enjoy a life and are able to repay student loans. Training is so many years to be a GP. They ask is it worth it?

    11. When you know a GP colleague who has ended his or her life, you start to question whether it is time to retire early, emigrate or change paths.

    12. When you are fearful and anxious, as you may be referred to the gmc for a domestic squabble, raising a voice to a train conductor, drink driving, depression, a jealous colleague, an angry patient who does not get what he or she demands, and think if I were in any other job, I would not be treated like a criminal.

    13. When you decide you need to put yourself and your family’s well being first above the needs of overworking as a GP to an early grave."

    A company founded on the principle of goodwill/charity from its workforce refuses to compensate hard work....

    Unfortunately until people stop seeing medicine as some sort of calling from the heavens above (the sort Noah had) the NHS will continue to take advantage of hard working employees expecting them to bend down further and take it deeper instead of questioning why their hard work isn't being compensated.

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  • Its like this Charlie.
    I simply don't trust you or your organisation.
    Nothing you say I will believe, only what you do is what matters.

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  • charlie's photo makes him look like a man who is hitting the sauce hard

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