After Dr Bawa-Garba – is the GMC fit for purpose?
Dr Kailash Chand
Pulse and the GP community are to be applauded for highlighting the plight of the paediatric trainee, Dr Hadiza Bawa-Garba. The powerful visual image of this issue’s front page will have touched a chord with many a doctor, not just among GPs.
The GMC’s actions against Dr Bawa-Garba were purely punitive against a trainee who was simply juggling too many balls in an under-resourced department. The GMC has been found severely wanting.
There are no winners in a system which blames tragic outcomes from systemic failures on one or two individuals. I accept that there were errors in this case, but patient safety will never be improved unless everyone promotes an open learning culture.
Much has happened that needs changing – how NHS doctors work, how we are regulated, and how we raise concerns. The GMC and the health secretary, Jeremy Hunt, have both announced reviews of how gross negligence manslaughter is applied to medical practice, but the horse has already bolted it seems – and Dr Bawa-Garba has paid a heavy penalty.
The GMC must surely have a duty to act justly, and its failure to do so has now put it in a precarious position
Medical errors can often be a source of serious distress amongst doctors. Over the past decade (between 2005 and 2015) there have been over 100 deaths - including 28 deaths by suicide - among doctors under fitness-to-practice investigation, without a fact being proven against them.
There’s been much talk about a report but none has emerged – just more consultations about what the GMC should do next.
Many senior colleagues may remember the huge public and professional impact of the Bristol inquiry in 2001, the work of Donald Irvine and other pioneers at the GMC at the turn of the century, and the further painful lessons of the Shipman inquiry in 2004. This was followed by legislative reforms to professional regulation in 2008. Since then there have been two inquiries led by Robert Francis QC into Mid Staffordshire NHS hospital trust and a host of other inquiries, reports, and investigations into aspects of patient safety.
The track record of the GMC on regulation as seen in the Bawa-Garba case suggests the GMC has ambitions to be a punitive body based on ‘maintaining public confidence’, whilst the regulatory process may harm doctors and patient care in the longer term.
Successive generations of leaders at the GMC since Irvine inherited the jurisdiction without understanding the origins of its rules and particularly its flaws and dysfunctions. The GMC seeks to investigate and/or impose sanctions without accounting for the personal consequences for doctors. I would argue the GMC in its regulatory role acts as an arm of the state, yet wants to act without regard to the impact of their investigations and sanctions on individuals.
The GMC is aware of data showing significant increases in depression, anxiety and suicidal ideation amongst doctors subjected to actions by them and other bodies.Surely the GMC and doctors on their panels have a duty of care to individuals they are investigating, particularly from vulnerable groups with mental illness.
The GMC proceedings are at odds with natural justice. Its decision to appeal against the MPTS decision, arguing for Dr Bawa-Garba to be erased from the medical register, fundamentally impacted on an individual’s rights to practice as a doctor.
The GMC must surely have a duty to act justly, and its failure to do so has now put it in a precarious position. It cannot command public or professional confidence in its current state. I suggest a clean sheet and a searching review of its performance by someone with some experience. Dr Bawa-Garba's tragic saga raises wider issues about the GMC’s approach to such cases – why did it appeal a judgment reached by its own MPTS, without taking adequate consideration of systemic failings, or about concerns regarding gross negligence manslaughter law as it affects doctors or the impact of using personal reflective learning material as evidence against doctors?
There is a just way to regulate doctors based on trust, transparency and professionalism. The GMC headed by a respectable fellow clinician, Sir Terence Stephenson, needs a radical rethink, a root and branch reform, as otherwise the medical profession will lose complete faith not just in its regulatory procedures but also the many other functions that it discharges. Doctors are demanding a better performance from its own regulator and it must deliver sooner rather than later.
Dr Kailash Chand is a retired GP from Tameside