GMC admits failings that left Shipman's patients unprotected
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7426.1248 (Published 27 November 2003) Cite this as: BMJ 2003;327:1248All rapid responses
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I would like to respond to the points raised by Oliver Dearlove in
turn:
I am confused by Oliver Dearlove’s assertion that the GMC is “run by
a secretariat of appointed civil servants on secondment”. If he is
referring to the staff of the GMC, I can confirm that at present there is
one member of staff who is seconded from the Department of Health. He is
the IT manager. If Mr Dearlove is referring to the lay members of
Council, his assertion is untrue. There are no seconded civil servants on
Council.
A tribunal held by the NHS is concerned with the employment of a
doctor. The General Medical Council, as the medical regulator, is
concerned with the doctor’s overall fitness to practise. As such, the
hearing process that each employs is by necessity different, although one
can inform the other. There is no role for the GMC in overseeing an NHS
tribunal.
If the evidence of an NHS tribunal is used during a GMC investigation
or Professional Conduct Committee hearing, and the doctor believes the
tribunal to have been unfair, they are able to make this argument to the
GMC and support it with any evidence they may have.
Elected medical members make up the largest proportion of Council.
Lay members, who are appointed by the Privy Council, have an important
role to play in ensuring the medical profession Is a partnership between
the profession and the public. This is necessary to ensure that the
framework of standards, ethics and values adopted by the profession
reflect the views and expectations of the public.
New regulations are due to come into effect shortly which will enable
Council to remove members from office if they feel the person is not
performing their duties properly. A person outside of Council can
instigate a complaint about a member of Council which may result in a
removal if appropriate.
Competing interests:
GMC Staff
Competing interests: No competing interests
I was surprised to read that the GMC admitted to the Shipman Inquiry
chaired by Dame Janet Smith that the GMC has been less than perspicacious
in following up or monitoring trust complaints. Who is accountable for
these obvious deficiencies? The GMC is run by a secretariat of appointed
civil servants on seondment. No prospect for change, then at the next
election of Councillors: the appointed secretariat will still be there.
It surprised me even more, because I had earlier this month written
to the GMC to suggest that they appoint observers to trust inquiries, to
over see, check but perhaps not control these activities. A bureaucrat at
the GMC summarily turned down this innovative suggestion of mine,
presumably unmindful of the difficulties that would be admitted by another
GMC functionary at the tribunal later on in the week. And yet if this had
been done, and officers did supervise inquiries, then the evidence given
to the Dame Janet Smith’s tribunal might have limped instead of being
completely lame. The reason the bureaucrat gave me was that she “was sorry
she could not be more positive about my suggestion.”
I have to say the intention to have a supervising GMC official was
not to check whether the inquiry had been carried out but in fact to
forestall unfairness, bias or lack of openness on behalf of the Trust,
which no-one will be surprised to hear is rife in the new look Stalinist
health service. Bear in mind that inquiries may lead to dismissal of the
practitioner. Trust inquiries since they are conducted under oath, are
admissible in GMC proceedings. It strikes me as very obvious that the GMC
has a role in quality control of things it admits in evidence, as the
quality of an inquiry may be very poor indeed.
-
Clearly the secretariat that runs the GMC was unaware what the GMC would
be saying in public evidence. Who is in control at the GMC, the president
or the civil servants on secondment for the D O H?
We, patients practitioners and all and sundry, could do well with a
change. However there is a difficulty with the 2001 changes with a
reduction in the number of elected council members. It means that duties
carried out by those who were elected are now carried out by appointees.
Previously an elected member could be turned out of office at the next
election, if they disappoint, go crazy or run amok. Appointed
functionaries cannot be turned out by an electorate, and seem to lead a
charmed existence. The GMC is suffering from exactly the fault that this
change was said to forestall – the GMC becomes isolated, out of touch and
unaccountable. The GMC is responsible for the quality of justice it
dispenses and clearly the quality of justice needs to be improved.
Unfortunately there seems to be no way of enforcing this.
I think self regulation of the profession is a wonderful idea, and
much better than the system we have been lumbered with. When do we start
doing it?
Oliver Dearlove
Competing and conflicting interests: the author stood unsuccessfully
for both the old and the new GMC. He appeared as a witness in a Hospital
Inquiry which was later admitted as evidence in GMC proceedings. He is a
councillor of the Royal College of Anaesthetists. These views are his own.
Competing interests:
as script
Competing interests: No competing interests
The General Medical Council (GMC) should hypocritically save all it's
'Flimsy Public Apologies' for 'Oprah'.
The main reason why Dr Harold Shipman suavely got away with his
countless 'Alleged Crimes' was because he was a 'White Medical Doctor',
with 'Strong Professional Connections' to Senior GMC Figures.
If Dr Shipman had been a 'Black Medical Doctor' ; he would have long
been 'Summarily Struck Off' the 'British Medical Register'...within
seconds of the very first suspicion of 'Unproven Olfactory Intent'.
I therefore unrepentantly call upon the destitute families of all of
the alleged victims of Dr Harold Shipman , to unequivocally unleash a
'Firebrand Torrent' of 'Mass Legal Action' ; in a desperate bid to
comprehensively unravel the full extent of the GMC's 'Shameful
Involvement' in this exceedingly tragic case.
Competing interests:
Dr Joseph Chikelue Obi MBBS MD MPH DSc FRIPH FACAM is also the Chairman of the General Wellness Assembly (GWA); an International Professional Body for Independent Wellness Consultants.
Competing interests: No competing interests
We all got to learn lessons
Blaming the GMC is not the solution. GMC is in a very difficult
position. It is damned if it supports the doctors and damned if it
supports only the patients. One has to just read the publicity surrounding
the recent case of two doctors, who are charged with the manslaughter,
both are juniors from ethnic minority background. The judge has criticised
their care (or lack of it) and the media as well as the relatives have
criticised the GMC for allowing these doctors to continue to work.
I do not think there is any evidence to say that the GMC is
institutionally racist, but the GMC has to look at the reasons as to 'why
52% of doctors appearing in front of its disciplinary committees are from
ethnic minority and must learn lessons from them. The one simple solution
may be for the GMC to take anonymised referral so that at the screening
stage the screeners and advisers are not aware of any demographic details
but just the incidence and allegation. This should take away any racial
bias on the part of investigating officer or the adviser. It is not the
institutions that are racist but in each and every institution there are
few individuals who hold racist views and there must be systems in place
to reduce the risk of any form of bias.
It is not just the GMC who has to learn lessons from Shipman but the
NHS as a whole should learn lessons not just from Shipman but all recent
tragic cases like Ledward, Bristol cardiac babies and many others. Shipman
was a criminal and NHS must have systems in place to identify people like
him early not only to protect poor patients but also for the sake of our
profession. Rodney Ledward, Richard Neale and Bristol cardiac babies are
examples of decades of poor practice, which was unchecked and clear
evidence of lack of accountability. Even though individuals were blamed
and punished, let us not forget the system failures in all these
tragedies. NHS must have systems in place to identify and deal with these
early.
But NHS is about good doctors and nurses trying to do a good job.
Vast majority doctors and nurses work very hard trying to provide a good
quality care but some of them end up making mistakes because of the system
failures and simple human errors. Charging these doctors or nurses with
'manslaughter' is not the answer. This will result in low morale,
defensive medical practice, lack of innovation and cover up even when
there are genuine mistakes. Doctors, managers, NHS, politicians, patients
and public must join together and make sure that there are systems in
place to report errors and learn from them. Doctors and nurses who make
genuine mistakes should be supported and system failures must be
addressed. Of course there are some mistakes, which are due to negligence
and recklessness. When this happens the person must be held accountable
for his/her action but no doctor or nurse should be punished for system
failures.
Competing interests:
None declared
Competing interests: No competing interests