Expert urges doctors to report themselves to GMC

A prominent campaigner for transparency in medicine has asked the GMC to remove him from its register and for his clinical practice to be scrutinised, after admitting to clinical errors that are likely to have led to deaths of patients. He has called on other doctors who have made similar mistakes to also report themselves to the GMC.

Consultant cardiologist Peter Wilmshurst made the case for his clinical practice to be investigated after the erasure from the UK medical register of the trainee paediatrician Hadiza Bawa-Garba.

Bawa-Garba was struck off after being convicted of gross negligence manslaughter over the death of a 6 year old boy. A medical practitioners tribunal had previously decided to suspend her for 12 months, after taking account of system failures that contributed to Jack Adcock’s death. But that decision was overturned in the High Court last week after the GMC appealed the suspension.1

The GMC’s actions have been widely condemned for what critics say is scapegoating of a trainee for mistakes made amid multiple system failures.2

In a rapid response to The BMJ the Wilmshurst has asked the GMC to investigate whether he is “fit to practise” (bmj.com/content/360/bmj.k417/rr-5).

Over four decades of practice, Wilmshurst said, he has made clinical mistakes, including delayed diagnosis and errors in treatment.

He wrote, “Some sick patients died. I am sure that many would have died anyway, but in some cases my errors are likely to have contributed to poor outcomes and some patient deaths. Therefore I have asked the GMC to investigate my clinical practice over the last 40 years to see whether I am fit to practise. Other doctors who have made similar clinical errors may also feel obliged to report themselves to the GMC.”

Wilmshurst pointed out that the High Court agreed with the GMC that honest errors should be career ending mistakes and that judges in the case thought that the three members of the Medical Practitioners Tribunal Service’s fitness to practise panel had made a mistake. “Will the GMC be asking the MPTS to remove those three individuals from the list of panel members, so that they cannot make a mistake at a future tribunal?” he asked.

In another protest at the court’s ruling, doctors have said that they will cut up their registration certificates outside the GMC headquarters in London on Saturday 3 February.

The case has drawn attention overseas. Holger Wahl, a German paediatrician who trained in the UK, has asked the GMC to remove him from the register. “The GMC’s role in the Dr Hadiza Bawa-Garba case is extremely concerning and has also drawn international attention,” he wrote in an email seen by The BMJ. He added that he could not justify cooperating with GMC “in any circumstance.”

David Nicholl, a consultant neurologist at Sandwell and West Birmingham Hospitals NHS Trust, has written to the House of Commons Health Committee and the Professional Standards Authority to say that there were now “sufficient concerns regarding the GMC” and its ability to function, “given that they have lost the confidence of the medical profession.”

Nicholl pointed out that the GMC was among signatories to a 2001 declaration recognising that “honest failure should not be responded to primarily by blame and retribution, but by learning and by a drive to reduce risk for future patients.” He argued that there were inconsistencies in the regulator’s decisions, with some cases of willful harm resulting only in suspension.

“The GMC needs to be a much more transparent organization,” he wrote.

Responding to the situation, Charlie Massey, the GMC’s chief executive, said that doctors’ concerns about the Bawa-Garba case had been noted and that the GMC would be meeting people and organisations to discuss some of the wider issues it has raised.

Terence Stephenson, GMC chair, said that this would include “how gross negligence manslaughter is applied to medical practice, in situations where the risk of death is a constant and in the context of systemic pressure.”

Stephenson added, “We are not blind to the challenging conditions in which doctors have to work. We recognise that any doctor, no matter how experienced, can make a mistake, particularly when working under pressure. We know that we cannot immediately resolve all of the profession’s concerns, but we are determined to do everything possible to bring positive improvements out of this issue.”