GMC’s supposedly independent training review included secret meetings with politiciansBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2400 (Published 07 May 2015) Cite this as: BMJ 2015;350:h2400
- Benjamin J F Dean, research fellow and orthopaedic registrar, musculoskeletal sciences, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, Institute of Musculoskeletal Sciences, Nuffield Orthopaedic Centre, Oxford OX3 7LD, UK
The General Medical Council (GMC) sponsored and provided administrative support for an “independent” review of UK postgraduate medical training named the Shape of Training review, which formally began in 2012. The review’s steering group—including representatives of the four UK health departments, as well as Health Education England, National Education for Scotland, the Academy of Medical Royal Colleges, the GMC, the Medical Schools Council, and the Conference of Postgraduate Medical Deans—appointed David Greenaway, professor of economics at the University of Nottingham, as its “independent chair.” Although the review has been repeatedly described as independent, it remains unclear exactly what it was supposed to be independent from.
In his final Shape of Training report, released in October 2013, Greenaway recommended shortening the training time for hospital consultants and bringing the point of full GMC registration forward, to the end of medical school.1 Several professional bodies, including the BMA and the Royal College of Physicians, and trainee groups including the Association of Surgeons in Training and the British Orthopaedic Trainees Association, have repeatedly voiced concerns about patient safety related to these recommendations.2 3
Senior politicians and civil servants
In July 2013 I used the Freedom of Information Act to force the GMC to disclose that Greenaway had had secret meetings with senior politicians and civil servants throughout the review—calling into question his, and the review’s, true independence. For example, he met with Paul Bate, health and social care adviser in the Number 10 Policy Unit; Charlie Massey, Jamie Rentoul, and Alan Robson of the Department of Health; Dan Poulter, the Conservative MP; Sally Davies, England’s chief medical officer; and the health ministers of the devolved nations, including Edwin Poots.
First the GMC and then the Information Commissioner’s Office refused my request for documentation of these meetings, arguing that disclosure would be likely to inhibit the free and frank exchange of views, but my appeal to the General Regulatory Chamber in December 2014 was successful. This court stated that it was “strongly in the public interest that [the review’s] proposals are made on the basis of sound criteria and any political influence or otherwise needs to be transparent.”4
The court also stated that, although the GMC had said that the initial purpose of the meetings was to “inform the thinking of the review,” it “had control of the notes and they continue to use them for their own purposes in order to inform their response to the review.” The court judged that these meetings had the potential to influence policy that the GMC formed in response to the review.
When the GMC published the withheld notes from the meetings this was picked up by the national media.5 6 Not only had the secret meetings not been formally minuted but they were not reflected in the evidence summaries of the review,1 4 demonstrating a lack of transparency.
The review would provide “an opportunity for ministers to be radical,” said the notes from one meeting between Greenaway and a Department of Health representative. Notes from another meeting with other senior civil servants from the department read, “Ministers [are] setting strategic direction and feeling happy.” Greenaway’s final report did not mention either of these meetings, which occurred during a call for evidence in 2013.
The Department of Health later described their meetings with Greenaway as “routine engagement.”5
Off-record lobbying on policy
The GMC spent more than £4000 on legal fees in resisting my freedom of information request. The court also commented on information obtained from the GMC’s internal correspondence that did not relate to the Shape of Training review: “The evidence was that at one meeting an individual sought an assurance that the minutes would not be published and his willingness to discuss matters freely was contingent upon getting this assurance.” This shows the general way that the GMC effectively allows lobbying on policy off the record, despite supposedly being an independent organisation.
Rebecca Turner, the GMC’s information governance manager, discussed the GMC’s position in an email to its information policy manager, Andrew Ledgard, on 14 February 2014, which was released under a separate freedom of information request for internal correspondence related to the original request.
“Disclosure would undoubtedly impact on future relationships with both these individuals and the departments they represent,” Turner wrote. “We rely on candid discussion with these key stakeholders (and their departments) in a number of areas, including upcoming work on the Law Commission review of the UK law relating to the regulation of health care professionals and a review of the equivalence of application routes in registration.
“These discussions inform the creation and development of policy by the GMC in such areas and allow issues to be fully considered and debated before decisions are made.”
Transparency and accountability
This leads to some interesting questions related to transparency in healthcare regulation. Firstly, is it best practice for an independent review to be subject to the potential influence of government throughout the review process and off the public record? Secondly, is it best practice for meetings involving senior public servants, about key matters relating to patient safety, not to be formally minuted? Thirdly, is it best practice for an independent regulator to give assurances to individual people that they can influence policy off the public record? And, fourthly, is the public interest best served by an independent regulator relying on “candid discussions,” hidden from public view, to create, develop, and formulate policy?
Without transparency there can be no accountability. A reliance on secret discussions may, therefore, erode accountability, potentially leading to policy that better serves the interests of government than those of anyone else. Why key matters relating to patient safety cannot be “fully considered and debated” in a transparent manner before decisions are made is incomprehensible to me.
Cite this as: BMJ 2015;350:h2400
Competing interests: I have read and understood BMJ’s policy on declaration of interests and have no relevant interests to declare.
The released meeting notes and the GMC’s internal correspondence mentioned are available on request.
Provenance and peer review: Not commissioned; not externally peer reviewed.