A case involving a GP’s ‘exaggerated’ statement to her IT department has set back the regulator’s attempts to rebuild relations with doctors. Rachel Carter reports
The dreaded GMC referral remains a constant fear for GPs and other doctors, with the perception that anyone could find themselves facing an investigation, regardless of their professional record. This has been especially true for minority ethnic doctors, who face more complaints, referrals, investigations and tribunals than their white counterparts.
The case of Dr Hadiza Bawa-Garba in 2018 left the relationship between the regulator and the profession at arguably its lowest ebb. Following the case, the GMC has been on a mission to rebuild trust with the medical profession. It has undertaken several initiatives to soften its image, including making improvements to the fitness-to-practise process and working to address disparities in outcomes for different ethnic groups.
Just as it seemed there had been an improvement in its relations with the profession, a case involving a GP and a laptop has threatened to undo any strides made by the regulator. Dr Manjula Arora was found to have exaggerated a ‘promise’ made by her medical director about a new laptop. As a result, the Medical Practitioners Tribunal Service (MPTS) decided she should be suspended for a month.
The case of Dr Manjula Arora
Dr Arora’s case centres around two incidents in December 2019. The first was found not to be proved – an allegation that while working a shift for her employer, the out-of-hours provider Mastercall, she requested that its Clinical Assessment Service be switched off without first seeking permission.
The second incident involved Dr Arora telling the IT department at Mastercall that she had been ‘promised’ a laptop. However, the MPTS found that she had been told by the medical director and former CEO of Mastercall, referred to in the papers as Dr B, that ‘we don’t have any laptops at present, but I will note your interest when the next roll out happens’.
The MPTS concluded that Dr Arora had therefore been ‘dishonest’ and that while she had not set out to mislead the IT department, she had ‘exaggerated the position in her use of one inappropriate word’ – ie, ‘promised’. It said that as a result, her fitness to practise was impaired and suspended her for one month.
The GMC representative on the case also went as far to say that she had ‘brought the medical profession into disrepute’ and that her ‘integrity could not be relied upon’.
The RCGP: ‘We are deeply concerned about Dr Arora’s case and while we welcome the decision by the GMC to review the ruling, we will be asking for answers as to why the case was allowed to get through their screening processes and end in a fitness-to-practise hearing and receiving a sanction.
‘GPs are working in an increasingly punitive and litigious environment and any referral to the GMC causes enormous stress and distress for the doctor being investigated, their colleagues and families. As well as being devastating for Dr Arora, cases such as this only make it harder to retain existing GPs and persuade new ones to go into general practice, and particularly to work in out-of-hours [services].’
The BMA: ‘This ruling will add to many doctors’ fears about the GMC’s disproportionate and unfair approach to their regulatory system as it applies to the medical profession…
‘This case also raises serious questions about the processes and judgements of MPTS hearings. By its own admission, the tribunal’s determination is based on the interpretation of a single word relating to the provision of a laptop, in an otherwise unblemished career of a doctor. It is incomprehensible that suspending this doctor from caring for patients for a month, at a time of unprecedented NHS pressures, is in the public’s interest. Neither will this have any bearing on the public’s confidence in doctors, but it will have dramatically eroded the medical profession’s confidence in its regulator and exacerbated doctors’ fear of unfair treatment by the GMC.’
British Association of Physicians of Indian Origin: ‘The case demonstrates how the GMC has once again failed its ethnic doctors. This will blight the doctor’s life for the rest of her professional career. One word, one occasion, in a career of 30 years devoted and unblemished practice in the NHS.
‘It beggars belief that a doctor can be suspended for apparently misusing the word “promise”. The GMC lately has been making progress in acting with more compassion and being proportionate in dealing with BAME doctors compared to their white counterparts, but we seem to be taking one step forward and two backwards.’
Despite the GMC itself not having taken this decision – the tribunal service is independent of it – the regulator took the decision to send the case to tribunal. The subsequent ruling has forced it into yet another PR offensive. Here, we look at what it is doing to untangle a mess partially (but not entirely) of its own making, and what this means for its continued rocky relationship with the profession.
Attempts to rebuild trust
The GMC was never going to win any popularity awards among doctors. But the case of Dr Bawa-Garba caused a crisis for the regulator – a review it commissioned by Dr Leslie Hamilton following the case found that the relationship with doctors was ‘severely damaged’, and that it led to a loss of confidence from the profession.
Dr Bawa-Garba was found guilty of gross negligence manslaughter after the death of a six-year-old boy on the paediatric ward where she was a junior doctor. The MPTS later suspended her, but the GMC took the tribunal to court, successfully arguing she should be struck off – a decision later overturned. The GMC’s action saw an unprecedented backlash from the whole medical profession – including a vote of no confidence from the BMA.
To its credit, the GMC wasted no time in starting work to rebuild relations and took steps immediately and subsequently (see box, below).
Its first progress update, shared on 10 March, reported slight improvements in narrowing the discrepancies in fitness-to-practise referrals between white and non-white doctors.
In a statement alongside this update, GMC Chief Executive Charlie Massey said: ‘The early indications are good, but we are not complacent. Much more needs to be done. The issues are longstanding, and the incremental changes that are being made may take time to work through the data.’ He announced there would be annual updates on progress made.
The GMC’s measures to restore confidence from doctors
Following the Dr Hadiza Bawa-Garba case, the GMC announced measures to restore confidence, including:
- Training all staff involved in its fitness-to-practise (FTP) processes to recognise the role of ‘human factors’, including wider systems issues.
- Commissioning a review by Dr Leslie Hamilton into gross negligence manslaughter in 2019, which recommended the GMC acknowledge that the relationship with doctors had been ‘severely damaged’ and examine the processes and policies that had contributed to doctors’ loss of confidence.
- Commissioning the ‘Fair to refer?’ report in 2019 on why black, Asian and minority ethnic doctors are subject to disproportionate FTP referrals. This highlighted several factors, including inadequate induction, poor employer support, and managers avoiding difficult conversations with such doctors.
- Setting targets in 2021 to eliminate the disproportionate rate of FTP complaints about ethnic minority doctors by 2026, and eradicate disadvantages and discrimination in medical education and training by 2031.
- Announcing, at the end of 2021, that it had added three questions to referral forms for fitness-to-practise complaints: if referrers had considered environmental pressures or systemic issues already; if overseas-trained doctors had been offered any induction and support on how to respond to concerns; and what impartial checks had been made to ensure the referral was fair and inclusive.
Backlash from the Dr Arora case
But while the GMC’s steps have been welcomed, the MPTS decision on the Dr Arora case has sparked outrage and brought the GMC’s methods into question once again.
The BMA said the ruling was ‘incomprehensible’. BAPIO described it as a ‘travesty of justice’ that would have a demoralising impact on doctors and the wider medical profession. Doctors’ Association UK said it was ‘shocked and saddened’ that the case had even made it to tribunal.
GP commenters on Pulse coverage of the case also reacted with complete disbelief, describing the case as ‘staggering’ and ‘bizarre’. ‘Shame on the GMC,’ one reader commented.
Again, the GMC was in crisis-management mode. Almost immediately, it announced a review into the decision to see what lessons could be learned. Mr Massey told delegates at the NHS Confederation Expo conference in Liverpool in June that he ‘completely understands’ concerns that the ruling in Dr Arora’s case was ‘disproportionate and over the top’. The review will consider questions such as what happened when the referral was made, how the GMC engaged with the referrer about the allegations, and how does the GMC decide what cases to take to the tribunal. It is set to report in September.
While the GMC isn’t appealing the ruling (Dr Arora is), this does represent one of the first incidences of the regulator questioning an MPTS decision for being too severe against a doctor. However, just to demonstrate that the GMC does still carry a threat for doctors, recent figures obtained by the Medical Protection Society under the Freedom of Information Act show the regulator has appealed a further 23 MPTS cases since June 2018 – in most cases seeking stronger measures against the doctor. Its power to intervene in this way was supposed to have been stripped four years ago following the Bawa-Garba case, after a government-commissioned review concluded that this would help ‘address mistrust that has emerged between the GMC and the doctors that it regulates’ – but this legislation has not been enacted.
Confidence remains low
The profession now awaits the outcome of the GMC’s review – and the outcome of Dr Arora’s appeal, which the Medical Defence Union announced in May that it would be assisting her with. But the case does raise questions about just how much progress has been made at the GMC.
Dr Chandra Kanneganti, national chairman of the British International Doctors Association (BIDA), says one important thing that has come out of the case is that it has ‘unified all the doctors associations and the BMA together as one voice’. But it has certainly dented confidence further.
‘The GMC has done a lot of reviews but unfortunately confidence in the profession [with regard to the GMC] is still very low and this particular case – although they have taken some action – has made confidence much, much lower,’ Dr Kanneganti says.
He adds: ‘The Arora case is a classic example of how the GMC can get it wrong. Okay, they are reviewing it but it should never have happened at all. If you’ve done so much research, investigations and reviews, then this should not have happened.’