GMC case in focus: The ‘promised’ laptop

Every month, the Doctors’ Association UK will look at a GMC case that has implications for the profession that is either topical or from recent history. We kick off the series with a review of the case of Dr Manjula Arora, the GP who was suspended after she claimed she had been promised a laptop

‘We have been very aware of concerns regarding this case.’ So wrote the investigators Professor Iqbal Singh CBE and Martin Forde KC, who were commissioned by the GMC to review missed opportunities for local resolution and the escalation to a full Medical Practitioners Tribunal Service (MPTS) hearing – and a period of suspension – for Dr Manjula Arora.

They said the case ‘generated significant anger and anxiety among the medical profession. The case raised once again the perception of a regulatory process lacking in fairness; of a system in which the stakes seem much higher if you are a black and minority ethnic doctor’.

Dr Arora, an international medical graduate (IMG) of Indian origin, qualified in 1988 and at the time was working for Mastercall, which provided a clinical assessment service for the North West Ambulance Service. She was reported to the GMC by her medical director for allegedly dishonestly telling the IT department that she had been promised a laptop by the MD.

At a MTPS tribunal this allegation was found proven, but not others.

The GMC barrister told the tribunal that Dr Arora ‘brought the medical profession into disrepute’, ‘breached a fundamental tenet of the profession’, and that ‘her integrity could not be relied upon’.

The GMC, however, in unprecedented fashion, withdrew the suspension and issued a public apology. Dr Arora’s MTPS hearing documentation is no longer available on their website.

Charlie Massey, GMC chief executive, said: “It is absolutely right that the GMC’s decisions about a doctor’s ability to practise in the UK are open to scrutiny.

‘I believe that the GMC can be a positive force for improvement, and we will only be able to fulfil that role if we are open to learning from every case that we investigate.’

The commissioned report concluded that the dishonesty allegation against Dr Arora should not have been taken forward. It added that the GMC missed multiple opportunities to avoid this embarrassing episode, including several moments where GMC officers expressed misgivings about the strength of the evidence, and about whether the allegations were sufficiently serious for the GMC to become involved.

From a Freedom of Information enquiry, we know that the GMC’s legal fees for this case were £8,880, with further costs of in-house work not known. While not specific to Dr Arora’s case, the cost of her MPTS hearing was estimated at £22,104 for eight days. 

The money spent by the GMC pursuing this doctor is eye-watering, but the personal cost to Dr Arora was much more. We know that she went through months of high levels of anxiety, stress, worry and fear. Any doctor would recognise this professional assault as being close to unbearable.

Perhaps the greater cost to the GMC, however, may be further loss of trust and it is now in even higher disregard by the medical profession it regulates. While it is said that the GMC wants to promote ‘a culture which encourages local resolution, the need for sanctions to be proportionate, and for every step in the decision making process to be free of racial bias’ it is probably more true that the medical profession views its treatment of Dr Arora as stereotypical, the only difference here is that the Doctors’ Association UK (DAUK) and other organisations generated enough publicity to force a GMC u-turn. 

On a more positive note, the review of Dr Arora’s treatment found no clear or conclusive evidence or data to suggest that biased thinking affected this case. This may be an isolated finding as we know that incontrovertible data, published by the GMC itself, supports the widely held belief that black and minority ethnic doctors are routinely discriminated against by GMC processes. And so, this finding will not reassure, particularly because the authors of the report also found no evidence or data that would definitively dispel the perception that it was affected by bias. 

So, what happened to Dr Arora’s medical director who reported her? Identified only as Dr B, he gave evidence that Dr Arora was not ‘at the top of the list’ for requests for laptops and said his Christmas Eve message was a ‘holding email’. He said he ‘didn’t want to give negative messages ahead of the busiest time of the year’. The medical director seemingly balked at the insinuation that he had broken his promise to Dr Arora since he hadn’t used the ‘P’ word. 

Why did the misunderstanding over this conversation end up with the suspension of a medical licence?

Dr Arora was actually reported by her MD because she had requested for emergency calls coming through to North West Ambulance Service to be suspended or diverted.

She had a high number of unanswered calls to deal with, was struggling with a new IT system, and wanted a pause so she could catch up and make sure those patients already on hold were dealt with. Her concern was that someone with a life-threatening condition might come to harm as a result of her inability to keep up. This action by Dr Arora, while a safe clinical decision, I understand breached Dr B’s organisation’s contract. Or, in other words, had the potential to cost his organisation financially. 

New GMC targets to eliminate disproportionate complaints from employers about ethnic minority doctors seem laudable, with work apparently through ROs seeking to make workplaces more inclusive and supportive. It also aims to support organisations to understand GMC thresholds for fitness-to-practise referrals to help ensure fairer outcomes. Much more needs to be done to make those in medical management answerable for their actions. 

Professor Singh and Mr Forde concluded that the GMC’s policies and processes at every stage of a fitness-to-practise case, up to and including a tribunal hearing, should emphasise that everyone involved is treated with both compassion and respect. It would seem they missed the elephant in the room here. Dr Arora was not treated with compassion or respect.

 Doctors’ Association UK (DAUK) is a non-profit professional association run by volunteer NHS doctors, which advocates for the medical profession and the wider NHS. 

We want a better and fairer process for all, including our patients, and will be reviewing the GMC case of the month for Pulse. Our aim is to generate debate, honest reflection and raise awareness. 

Contact DAUK if you have a case you think should be reviewed.