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
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
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…
‘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.’
‘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.’
‘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.’