The petty cruelty of the GMC

Doctors make mistakes. We mess up, have lapses in judgment, do stupid or downright wrong things. Some break the law, some violate trust. Patients place their wellbeing, and sometimes their lives, in our hands. So it’s only right that we are held to account. All good doctors want scrutiny.

Our regulator, the General Medical Council (GMC), is supposed to be there to uphold the standards of the medical profession. It’s meant to help maintain the trust that the public places in us. This, of course, gives it an extraordinary amount of power: it can take away livelihoods.

But the GMC has lost our trust. Many doctors feel that the organisation is now out of control, hellbent on pursuing petty indiscretions above all else. Increasingly, it looks like a vindictive, sclerotic and overly bureaucratic embarrassment that assumes a degree of guilt from the start and aggressively pursues doctors as a result. After a number of appallingly misguided cases, the doctor’s union, the British Medical Association (BMA), has called for a complete overhaul of how the GMC operates.

The impact of a GMC investigation, which is often deeply adversarial, cannot be overestimated. Decisions can take months, sometimes years, meaning that doctors are left in limbo for significant periods of time, frequently over bewildering, vexatious or inappropriate referrals.

Most doctors who have been referred talk about the tremendous toll an investigation takes on their mental health. In fact, I know this from personal experience: I was referred by a patient who made an incredibly serious allegation that I had assaulted them while assessing them in A&E. Despite two police officers being present throughout the assessment, and two other members of staff also accompanying me – and there being CCTV of the entire encounter which showed I didn’t even touch the patient, let alone assault them – the process took 11 months.

During that time I felt a cloud was constantly hanging over me. My sleep suffered and I lost so much weight that colleagues thought I was ill. A survey by the Medical Protection Society highlighted that 72 per cent of respondents felt their GMC investigation had a detrimental impact on their mental and/or physical health and, tragically, between January 2018 and December 2020, 29 doctors died while under investigation or being monitored. Five of these deaths were confirmed as suicides.

The BMA’s call for a full review of the GMC follows a recent case which attracted the ire of virtually the entire medical profession. Dr Manjula Arora, a Manchester GP who trained in India before moving to the UK in the early 1990s, was referred to the GMC over ‘dishonesty’ relating to a laptop. The incident in question took place in 2019 and 2020 while she was working for Mastercall, which provided a clinical assessment service for the North West Ambulance Service.

Dr Arora had emailed her medical director to ask about getting a new work laptop and had been told that, while none was currently available: ‘I will note your interest when the next rollout happens.’ She later told the IT department over the phone that she had been ‘promised’ a laptop by the medical director. The GMC representative, Carl Hargan, accused her of lying about being promised one because the medical director’s email was ‘entirely unambiguous’.

Because of this misunderstanding, Dr Arora had ‘brought the medical profession into disrepute’. The tribunal (at which the GMC is represented against doctors by a team of its own lawyers) concluded that although ‘Arora had not set out to be dishonest, and that she had not set out to mislead IT… she had exaggerated her position in her use of one inappropriate word’. The entire case, therefore, rested on the use of the word ‘promised’ and it was deemed she had been dishonest. After a nine-day trial, she was suspended for a month.

In an editorial earlier this year, the doctor’s in-house journal, the BMJ, branded the case an ‘embarrassment’ for the GMC, one that had been pursued ‘without an ounce of compassion’. It argued that the organisation has lost all sense of perspective. After a backlash, the GMC said it would not challenge Dr Arora’s appeal and called for her suspension to be dropped by the High Court. But many doctors have seen this as yet one more example of the GMC fundamentally failing to assess what is and what isn’t an appropriate referral.

Four years ago the profession was profoundly shocked by the case of Dr Hadiza Bawa-Garba, a junior doctor working in paediatrics, who was struck off the medical register after the death of a six-year-old boy. A tribunal had originally recommended that she be suspended for a year but the GMC appealed the decision and she was struck off. The case later went to the Court of Appeal and she was reinstated. That the junior doctor should have been held accountable and lose her livelihood in this way was awful; she was made a scapegoat.

Few others were blamed. The consultant in charge on the day, and who was medically responsible for the young boy’s care, received no formal consequences. The case was complex but there was a widespread sense that the GMC had failed to take into account the extenuating circumstances of the case: that the pursued doctor was the most junior member of medical staff; that she had just returned from an extended maternity leave; that three medical colleagues were absent for much of her shift; that she had had no break; that there had been an IT failure at a crucial moment; and that the issue was related to safety in the NHS, not the failure of a single junior doctor.

The strength of feeling about the case was unprecedented. A BMJ-backed study looking into its impact summarised the concern: ‘Many doctors felt that a distinction should be drawn between unintentional error and egregious violations, with an onus on systems as opposed to individuals, and that moral intention, as opposed to clinical outcome, should influence decisions on doctors’ culpability in cases of harm to patients.’

It was argued that the GMC’s approach led to a culture of blaming individuals without judging the system they are part of. Elsewhere, there were concerns that Bawa-Garba had been unfairly pursued and if she had been white (she is black, from Nigeria) the results would have been different.

Certainly the official statistics appear to suggest that something is going on. The GMC itself notes that doctors from ethnic minorities are twice as likely as white doctors to be referred by their employers for fitness-to-practice concerns, while the referral rate for doctors who qualified outside the UK is three times higher than that for British doctors. Indeed, the racial bias of the GMC is one of the main issues that the BMA have raised in their complaint.

In another troubling case which caused widespread anger, a consultant urologist, Omer Karim, faced ‘years of turmoil’ after being racially discriminated against by the GMC. He had been referred to the organisation by the trust he worked for after he blew the whistle on bullying, discrimination and poor practice. He underwent a fitness-to-practice investigation by the GMC that lasted more than four years and in the end was found to have done nothing wrong. But in the meantime Mr Karim, a leading authority on robotic surgery in kidney and prostate cancer, lost his private practice. He felt he had no choice but to leave the trust too, after a settlement that enabled him to work elsewhere in the NHS. He also sold his family home of 20 years and, in order to help with costs, his daughter left her private school.

In 2018 he brought claims against the GMC and it was found the GMC was ‘looking for material to support allegations against Mr Karim, rather than fairly assessing matters presented’. Here was a body pursuing a case to make a point and avoid embarrassment for an NHS trust. The case also showed once again how GMC investigations can take years, leaving doctors – their lives and their livelihoods – hanging in the balance.

The BMA has argued that the GMC is imposing fitness-to-practise sanctions ‘on vulnerable doctors in order to send a message to the wider medical profession’. Far from protecting the public and upholding standards, the GMC appears to be increasingly damaging workforce morale. Doctors now doubt that if they are referred they will be treated in a just and consistent manner.

We no longer trust that the GMC will treat us fairly and protect us from malicious or false accusations. And as any good doctor will tell you, once trust is lost, it’s incredibly hard to win back.