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GPs go forth

After Dr Bawa-Garba – is the GMC fit for purpose?

Dr Kailash Chand

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


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Readers' comments (12)

  • I thank that should read 'formerly respected fellow clinician Sir Terence Stephenson'.
    He is, after all, in charge of this mess, and he after all owns it.

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  • The GMC thinks it’s too big to fail. That’s about to change now the medical profession is starting to wake up. About time too.

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  • Why aren’t we rallying together to stop paying the HMC it’s wages??
    Why are we compelled to pay both defender and prosecutor when something goes wrong?
    Why are we accepting judgement from non peers??
    The GMC wasn’t fit for purpose once the balance of people on the board tipped to non medical majority.

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  • That’s GMC not HMC

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  • Just Your Average Joe

    Professional self regulation is the role the GMC is meant to perform, however it has turned into a dictatorial regime - tormenting and destroying the lives of many innocent and hard working doctors - with sometimes simply scraps of accusations enough to damn the doctor.

    Guilty until proven innocent is the mantra performed out through drawn out investigations and tortuously slow clearance when it is as been proven there is no evidence of wrong doing.

    Financial and professional manslaughter is committed on a daily basis by the GMC panels - leaving doctors on the brink - with the sad figures quoted above of those who fell off the edge.

    There is no self regulation when C Massey - a politically appointed stooge sits on the top of the ivory tower that has been created. The GMC is completely out of touch with the ground, and hence is shocked by support for Dr BG.

    Stop doctors paying for their own torment - as the GMC is no longer peer led regulation. Either sack the entire senior structure and put in place self regulation in the way it was intended, or the DOH needs to fund the GMC forthwith.

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  • There is documented severe ACEI AKI with V+D and ACEI should be stopped in V+D. This is a well known caution.
    What are the biochemical and clinical differences between ACEI AKI with Gastroenteritis and Sepsis that a ' competent junior doctor could easily spot' according to the expert opinion ?
    And if it is so easy to spot and so ' criminally manslaughter bad' not to, then how come Dr BG is condemned for not ' highlighting ' only ' flagging ' to the Consultant the apparently patently obvious Sepsis results. How come you have to high light to a Consultant results that are blindingly obvious to a ' junior doctor'
    How can DR BG be condemned for missing ' obvious deterioration' when Jack was bouncing about ?
    I cannot see anywhere where Jack was getting worse.
    The judgement actually states at 17 and 14 that Jack was clinically better.
    This case seems completely illogical to me, it is full of Contradictions.
    I think Dr BG's diagnosis of dehydration, AKI in a child on ACEI with V+D is absolutely acceptable.

    The CRUX of this case that everyone seems to forget is the ACEI that poor Jack was on pre admission and that severe V+D lasting over 12 hours causes severe metabolic dysfunction.
    I have seen very similar in adults.

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  • I say, do some thing about dr bawa-garba.
    reinstate her. her future is destroyed. looking closely these issues are not going to help her.
    ask her how hard she may have worked in her teens to enter medical school . 5 to 6 years of grinding in medical school. parents paid lot of money.
    her carer was destroyed by one error if it was error.
    if every one who broke speed limit any time in life is banned from driving then no drivers including those who work for police or dvla ,would be left in uk.

    ask all gps if they stopped ace on any one with d and v as routine??

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  • C Massey was an aid of Hunts....I smell a rat. So NHS is being destroyed/privatised. Systemic changes have led to thousands of extra deaths. Better to point the finger at individual clinicians rather let the general public see where the real harm is coming from.

    GMC has been politicised, end of!

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  • Three billboards:-

    GMC out of control
    And still no action or sanctions
    How come, the PSA?

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  • Sign the petition

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  • I do not think that the GMC is functioning as it should. We have no real say as to who is managing what within the GMC. It is not looking after us - paying members. I want GMC to be managed only by senior and experienced doctors and not business men and politicians. GMC is supposingly a registered charity that is looking after the interests of the patients according to what they recently told me themselves (their quality department). The GMC needs to be monitored and it needs to be restructured. At the moment I have lost my faith in it and I feel completely let down. I strongly believe that there should be a vote about Dr G who was taken off the register, and the decision to be re-instated or not should be left with us DOCTORS. All GMC members should be invited to vote and decide whether Dr G should be in the register or not. In addition I would suggest that GMC seriously rethink their function and reason for being. They should not exist just for patient protection but also for doctor protection as these two are intertwined - you cannot have one without the other.

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