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The case of Hadiza Bawa-Garba has raised many profound issues, not least about the conduct of the GMC, and whether it treats doctors from black and ethnic minorities fairly in its investigations. Dr Bawa-Garba, a paediatric trainee, has been singled out and paid a heavy price for what also involved wider systemic failures at her hospital over the tragic death of a six-year-old child.
It will undeniably be remembered as a crisis of confidence in our professional regulator. The question now is whether it will also be remembered as a turning point. Meaningful, positive and demonstrable change is urgently required.
BME doctors make up around a third of our workforce. BME staff in the NHS workforce as a whole are more likely to experience bullying, harassment or abuse from other staff. And a survey in 2014 found only 29 per cent of BME doctors believed all doctors were treated fairly by the GMC registration process. There have also been significant concerns about differential attainment in exams. This case has only served to heighten the insecurity many feel.
The first step in tackling a problem is to acknowledge that a problem exists. Last week, I attended a special meeting of the GMC’s BME (Black and Minority Ethnic) Doctors Forum, called in the wake of the Bawa-Garba case.
The forum, whose members include the BMA and several organisations representing doctors from ethnic minorities, was left in no doubt as to the intensity of the profession’s concerns.
Members expressed concerns about the possible racial bias in how Dr Bawa-Garba’s case was handled, and raised wider issues in how BME doctors were over-represented in complaints to the GMC, in fitness-to-practise investigations, and in sanctions. BME doctors are twice as likely to be given sanctions or warnings by the GMC.
The discussions at the GMC meeting also focused on concerns around the perceived impact of the case on reflective practice, consideration of system pressures, and the use of gross negligence manslaughter investigations and prosecutions in cases of medical error.
Some of these issues are longstanding, especially around the high proportion of BME doctors facing GMC action. They have been causing great concern for at least as long as I have been a doctor, and were amongst the spurs for the GMC to establish a BME doctors’ forum. But they have been put in an unprecedented spotlight by the Bawa-Garba case.
The forum exists, partly, I quote, to ‘help to ensure that the GMC’s regulatory activities and policies consider the views of, and impact on, BME doctors and international medical graduates practising in the UK’.
Healthcare, nationally and locally, is full of forums and working groups. Our profession is represented on hundreds of them, but what now counts is not whether our views are ‘considered’ or merely aired but how action will be taken to put right these wrongs.
The GMC has acknowledged that the case has caused the profession a great deal of anxiety. Furthermore, the BMA has met with the GMC in the aftermath of the ruling and obtained a number of commitments, including that the regulator would never ask a doctor to provide their reflective statements if investigating a concern about them, and standardising the implementation of exception reporting in England.
This is a positive start, but much more needs to be done to convince doctors that the GMC applies its own principles of fairness and transparency when dealing with regulatory issues.
For many years, and especially since the Francis report, there has been increasing recognition and calls to create a no-blame culture in the NHS, in which doctors and other healthcare staff can speak out about concerns, for the public good, without fear of personal recrimination.
At the same time, we have seen a growing acknowledgement from the GMC that ethnicity is a feature in doctors’ career progress and that staff and associate specialist doctors, a group with a particularly high representation of BME doctors, have not been treated fairly. Last year, we acknowledged the significance of the GMC’s chief executive Charlie Massey coming to a BMA SAS doctors conference and recognising that these doctors made a vital contribution but were often overlooked.
It is no exaggeration to say that this tragic case has threatened years of progress in both of these areas. We cannot and will not let this continue. It is vital that the GMC listens and acts.
Chaand Nagpaul is BMA council chair
How about the other issue - that discussing patients with seniors is no longer enough. O'riordan shoved BG under the bus, claiming she had not "conveyed the urgency of the situation". THAT is the issue that should really chill the blood of any junior. Even a witnessed conversation = no protection. Everything must be in writing.
What is the GMC doing apart from lip service and fudging numbers about BME representation!
Why can’t the BMA take this up with the PSA
Do we need another survey . Close to 100% would say that the GMC is unfair
A current survey will show that a much higher percentage of BME doctors would not trust GMC to be fair
All true, but what is the BMA, the GMC, the DOH, and the lawmakers going to do about it? We need action. We need fairness.
Is the GMC listening. If not is the BMA doing something about it?
Is the BMA fair to BME group
All of this is lip service and I strongly feel the GMC has let us medics down. Would the BMA carry out a survey about the fairness and if it is fit for purpose?
BME doctors are over-represented in fitness-to-practice investigations, and in sanctions by GMC that is TRUE. To start on the path to remedy this should be called what it is: Institutional Racism.
The Bawa-Garba case is not only about that. It affects ALL doctors. It is about scapegoating doctors for the day-to-day problems of the NHS, trial by media, GMC confusing its role and responsibilities, politicisation of the GMC…etc.
The Profession and the BMA have so far been offered meaningless sweeteners which go nowhere toward addressing the core issues.
To say that BME drs are over-represented in fitness to practice investigations is not proof of bias in itself- it could be argued that drs trained outside the UK or who speak English as a second language have to overcome these disadvantages compared to native and locally trained drs.
To reduce this case to one of racism, ignores the real problem: What is chilling is how Dr BG has been blamed and victimised for multiple failings of the system, an under-resourced NHS trying and failing to keep patients safe, total lack of support for junior staff (where is the censure of her seniors, and hospital administration who allowed her to be on her own in such trying circumstances?), the trial by media and populist stance taken by the profession's regulator. It is only when Dr BG's medical license is reinstated that drs will begin to have any faith in this system.
As a British Asian what worries me most about this case are the issues that affect all doctors about how we handle reflective learning and how far our own professional body will go to gain points from the general public rather than looking at the bigger picture and acknowledging that these actions can do more harm than good to patients in the long run.
As a medical student, this entire case has been absolutely frightening to witness! If Dr BG doesn’t get her license back, I can see even higher numbers of Jr Drs leaving to work elsewhere in the world, leaving the NHS in an even more dire situation.
So why do we not have the same system as in Scotland. That is much fairer and in that system Dr Bawa-Garba would not have been convicted in the same way and would still be able to continue to provide care. The extraordinary fact that she continued to practice for 4 further years after the death of the child without any problems. It reflects that the entire judicial system and the GMC are unfair and because of the issues surrounding what happened she was one small cog in a failing system. All doctors should be fearful about being blamed when things go wrong because of system failures, under resourcing, understaffing, inadequate support of junior doctors by their seniors and inexperience. Doctors are human and can make mistakes and should be forgiven where there was no deliberat act of neglect or intention to cause death, not hounded as the GMC have done this poor junior dr.
Sorry but the results of that so called ‘ survey ‘simply don’t ring true . Virtually every ethnic minority doctor I’ve ever spoken to has absolutely NO confidence in the GMC . I have personally had dealing with the GMC and I doubt my true opinion of them is printable .