Anna Foster: We began the programme talking about angry doctors, and particularly the case of Dr Hadiza Bawa-Garba. She is a junior doctor and she was convicted of manslaughter and she was struck off for what was termed in court – and this is important – ‘truly exceptionally bad care’.
Six-year-old Jack Adcock died on her watch because, among other things, she missed signs of how ill he was, she took too long to prescribe him drugs and she failed to keep detailed notes.
This case has brought together many doctors who say that she is being blamed when in fact there were many wider problems at play that were maybe beyond her control – the hospital was understaffed, the computer systems didn’t work.
The editor of the GPs’ magazine Pulse, Nigel Praities, told me about the scale of doctors’ anger.
Nigel Praities: ‘It’s immense, it’s definitely taken us by surprise in terms of the concern and anger among doctors regarding this particular case.’
AF: Have you ever seen this level of anger?
NP ‘No, it’s touched on something very deep in the medical profession, I think.’
AF: The doctors’ anger is focused in the main on their regulator, the GMC. They are the body that ultimately had Dr Bawa-Garba struck off. There have been protests outside their building, and on Friday a group of GPs voted for a motion of no confidence in the GMC. So can the NHS work properly if the doctors don’t trust their regulator.
Professor Terence Stephenson is the chair of the GMC. It’s important to say, you’re also a doctor yourself so you see this from two points of view.
Professor Terence Stephenson: I’m a practising doctor on the front line, I work every day, I work with trainees, and I completely acknowledge the pressure they are under and I completely acknowledge the sense of distress in the profession that this case has caused.
I am extremely sorry for the effects on the profession and the kind of fear and anguish it has provoked – I completely understand that.
AF: Is this a greater anger than you’ve ever seen?
TS: The NHS is under huge pressure at the moment. I’ve worked in it all my life and I have never seen it so pressed. It is underresourced, understaffed and it is creaking. Doctors have been angry at that for some time, as has the GMC. We’ve spoken out repeastedly, describing the state of unease and the crunch point. And we’re very concerned that doctors are being asked to work in almost intolerable circumstances.
This anger has been growing since the industrial dispute in England and onwards and this has been a lightning rod. But it is a deep-seated dissatisfaction with the environment that doctors are being asked to work in.
AF: Given that, is it fair, as doctors have suggested, to hold one individual responsible for the failings of the system, and to strike her off?
TS: There are no winners in this case. Jack died, his parents lost a son. Dr Bawa-Garba, who is as far as I can gather, is a very committed doctor, has lost her career. It has affected the profession badly. It has made them feel anxious.
And it has affected our relationship with the profession and set back what we wanted to do, which was to move forward towards being a regulator who would rather doctors didn’t get into trouble in the first place, we would rather support them. We’ve done a lot to do that.
We have asked Louis Appleby, a psychiatrist, to give us advice on how we deal with doctors with mental health problems, and we have accepted all his recommendations. We asked a retired judge, Anthony Hooper, for advice on how to handle whistleblowers and we’ve accepted all his recommendations.
So we wanted to try and change our relationship as we think safe doctors make for safe patients and we think the worst thing in the world is to be at the end of the road when a doctor’s career is in tatters and they are being struck off. That isn’t where we’d want to go.
AF: Given that, was it the right thing to strike her off? Would you take that decision again?
TS: We take these decisions with a very heavy heart. There is no pleasure for me – I’ve been training doctors for 35 years – in seeing a young, idealistic doctor have their career ruined.
We would wish to never have to take this decision again. We, as with most people, think that the use of gross negligent manslaughter in an environment where people die when things go wrong – you have alluded to the systems failures – we think that we would not want to take that decision again if it could be avoided.
That is why we have asked Dame Clare Marx to have an independent review on how the charge of GNM is applied to a setting where it is very stressful, things unravel quickly. I haven’t thought that criminalising individual doctors makes patients safer.