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Have you ever been put in an impossible position? Where there were too few hours in the day? That you’d done patients a disservice; were unable to offer the care you wanted to give. Made a mistake but feared admitting it?
They’ll all be rhetorical questions, of course, for doctors at work in the NHS today, where the expectation of yet another day at work, under pressure again, is increasingly commonplace.
What most haven’t expected, until very recently, is the threat of criminal prosecution for their errors and being struck off as a result, as happened for real to Hadiza Bawa-Garba, in an infamous case.
For doctors at the BMA’s annual representatives meeting this week, this infamy belongs to the GMC, its chief executive Charlie Massey and chair Professor Sir Terence Stephenson, for their handling of this trainee paediatrician’s case.
‘We can all relate to working in an environment where there is simply not enough hours in the day to do justice to all of our patients,’ Humberside GP Krishna Kasaraneni told the BMA’s annual representative meeting. ‘Yet, when a difficult set of circumstances led to the tragic death of a child, one single doctor in training was singled out and her career was ended. When faced with what seems like impossible situation, what doctors, particularly junior doctors need, is a helping hand not the threat of criminal prosecution.’
Such is the infamy lacquered onto the GMC’s name by its handling of the Dr Bawa-Garba case, doctors were considering calling on Mr Massey and Sir Terence to resign. To make it BMA policy that both should go and that there should be a public inquiry into their conduct.
As has been widely reported, Dr Bawa-Garba was convicted in 2014 of gross negligence manslaughter for failings in the care of Jack Adcock, who died, aged six, in 2011. Following that judgment, the MPTS (Medical Practitioners Tribunal Service) decided to suspend Dr Bawa-Garba for a year. But the GMC wanted her struck off instead and appealed to the High Court. The judge, hearing the appeal, agreed, described the failure’s in Jack’s care as ‘truly exceptionally bad’.
Echoing the term used by that High Court judge to describe the failures in Jack’s care, Birmingham consultant neurologist David Nicholl said the GMC had been ‘truly exceptionally bad in the way they’ve moved towards blame rather than learn’.
But he stopped short of calling for resignations. ‘If Terence Stephenson and Charlie Massey resigned, all that will happen is that you’ll someone else in, a potentially worse regulator,’ he added.
London-based neurology consultant Jenny Vaughan described the decision to erase Dr Bawa-Garba as ‘wrong’ and served ‘no useful purpose for public protection’. But she too rejected the suggestion that the chair and chief executive should resign. ‘They should sort out the mess they have created.’
Merseyside ST1 in obs and gynae James Warwick pointed out that doctors have officially lacked faith in the GMC for almost two decades through policy agreed at previous ARMs. ‘We haven’t had faith in them for longer than many of us have actually been working. That is truly horrific. What professional confidence do we have right now? I can’t see it getting any lower.’
Buckinghamshire associate specialist general surgeon Farid Ahmed said there were increasing concerns about bias in the GMC that it treated ‘black and minority ethnic doctors differently and harshly’.
BMA’s GMC working party chair Peter Maguire spoke just before the vote on whether to support the calls for resignations. ‘I don’t know that calling for resignations of specific individuals is very helpful because we do need to continue to work with senior officials at the organisation,’ he said.
BMA council chair Chaand Nagpaul said the move away from a ‘climate of blame’ in the NHS required fixed for ‘a multiplicity of factors’.
Mr Massey himself was at the Brighton Centre, where the ARM was held, fielding and answering questions from doctors in a packed breakfast meeting on the morning of the debate.
He told BMA News, in an earlier interview, that he had stuck by his decision – one the GMC will be defending at the Court of Appeal next month – and had been ‘listening very carefully’ to doctors’ legitimate concerns about the case. He’s commissioned several reviews, including one into evidence of racial bias in referrals from outside the GMC to its handling of those within it.
He believes ‘actions speak louder than words’ and hoped doctors would give him the chance to prove it.
And they did. But only just. Just over half – 51 per cent – of doctors against the motion calling for the resignations.
Most however backed a declaration of no confidence in the GMC and called for a public inquiry into its conduct. They demanded ‘radical reforms’ of the GMC’s structures, and reviews of high referral numbers of doctors from black and minority ethnic doctors and the high suicide rate of all those under investigation.
The GMC will have its work cut out in the year ahead, it seems, a point Mr Massey already appears to have conceded. ‘We have always been clear that this is going to be a journey,’ he told us.
Keith Cooper is a senior staff writer at the BMA
The BMA’s response to the Bawa-Garba case, and resources to support doctors
One of the speakers against the part of the motion calling for resignations made the case that the current incumbents should be made to sort things out, and not allowed to disappear quietly. I suspect that may be a large part of the reason more delegates did not call for their resignations.
I am still appalled that Mr Massey claims he was motivated to refer Dr Bawa-Garba's case to the High Court in order to satisfy public confidence.
He claims he acted on 'legal advice' - but he was not obliged to seek that advice. He could have accepted the MPTS determination.
Mr Massey has carried out no survey of public opinion, no Likert analysis of whether the public at large would fear being treated by Hadiza , taken no note of her many colleagues who would have no such concern and seems in thrall to the readers of popular broadsheets.
When doctors conduct such non-evidence based practice we are rightly held to account.
Mr Massey should examine his own conscience more closely.
A 51% rejection of a call for him to resign is not an endorsement for him to continue - it simply exemplifies the consolation RB members feel towards those in distress, as Mr Massey must surely be (unless he is inordinately arrogant).
Yes, his successor (who will come along sooner or later) might be 'worse' (by whatever criteria) , but at least we will be able to start afresh after Mr Massey's departure.
We are facing the end of the medical profession, to be replaced by the profession of 'healthcare worker (medical)' - subservient to state control.
As a patient I want a proper independent medical profession I can trust - regulated by regulators I can trust, and respect.
I enquired, yet again, why a junior doctor was in the dock and not the consultant or consultant advisors and was once more fobbed off with a feeble excuse; in the latest case that the consultant was no longer registered. I am in the fortunate case of being now retired and in my 70s so am able to cancell my direct debit. Interestingly I had a letter from the “retention “ department. Perhaps they did not read my letter or I had been too careful in my language for them to get the message. Our problem is that there is now an industry feeding the “must be someone’s fault” mantra. “Shit happens”, as they say, sick children die, sick adults die, but for some reason, (could it be unemployed solicitors since they lost the conveyancing monopoly?), no one, especially the GMC, seems to be brave enough to say so. Any doctor in the accute specialities will have their own personl graveyard to wander arround in the bleak hours of patients who might have not died if only they had...... the retrospectosccope is a cruel instrument to look down without guidance and strict adherance to the “at the time given what you knew, or what was availble” analysis.
Reporters, rather than spending time finding out the truth about anything, jump on the bandwagon of “there must be blood!” A doctor must be the best to sacrifice, no headlines in a manager, the politicians who cut funding to the bone and promise the earth or the taxpayers who vote them in.
Actions do indeed speak louder than words. Doctors will remember for a very long time that the GMC found a suitable scapegoat and threw her to the wolves.
I hope expert witness for the child's family finds him or herself under investigation some time soon...
I agree with the comments of other readers that 51% is not an absolute endorsement. One of the weaknesses of this kind of voting system is that the statistical significance is not stated. The majority is not necessarily right. I wonder what actions would have ensued had the vote been 50%. Indeed, the same could be said of the Brexit referendum.
As for the GMC, this is probably not the first time that appeasement of public opinion has resulted in a blinkered reaction. The introduction of appraisals was done on the back of the Shipman saga. Whilst the concept of appraisal is laudable, the systems introduced are tortuous and time consuming and has generated an industry in itself. It has not prevented other Shipman-like incidents and in addition rendered the majority of practitioners vulnerable as their written records can now be used against them. This could have been foreseen. Has the GMC ever thought to practice its own preaching and audited and appraised itself?
It is not only the GMC that needs to look into its conduct. We as a group of professionals have just as much responsibility to ourselves to not accept dictats blindly but to have the patience and foresight to examine possible inadvertent consequences of systems prior to their introduction.For this we need a good dose of old fashioned wisdom which is sadly lacking today.
Otherwise, we run the risk of a tyrannical relationship with our regulator which, I hope neither of us wants.
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