Intended for healthcare professionals


Will human factors restore faith in the GMC?

BMJ 2019; 364 doi: (Published 22 March 2019) Cite this as: BMJ 2019;364:l1037
  1. Lauren Morgan, human factors lecturer,
  2. Dawn Benson, sociologist,
  3. Peter McCulloch, co-director
  1. Patient Safety Academy, John Radcliffe Hospital, Oxford OX3 9DU, UK
  1. Correspondence to: P McCulloch Peter.mcculloch{at}

The General Medical Council’s decision to incorporate human factors into their process for evaluating fitness to practise is an important step in advancing patient safety in the UK, say Lauren Morgan and colleagues

The relation between the General Medical Council (GMC) and the profession it regulates could fairly be described as in crisis. The case of junior doctor Hadiza Bawa-Garba placed the fitness to practise functions of the GMC in the media limelight and fuelled feelings of injustice within the medical profession.1 The Crown Court verdict of gross negligence manslaughter, combined with the GMC’s statutory duty to “maintain public confidence in the medical profession” put the GMC in a difficult position in this complex case, but a profession already at odds with its regulator focused on the GMC’s role.

The key questions raised were about how the context in which doctors work is considered when evaluating their performance. The catalogue of adverse factors Bawa-Garba faced included unfamiliarity with her environment, excessive workload and time pressure, lack of appropriate support, technology failures, and miscommunications—none of which could reasonably be attributed to her. The reaction of many frontline doctors familiar with the pressures of modern NHS practice was, “There but for the grace of God go I.” The depth of feeling against the GMC openly expressed by doctors, and the condemnation by respected publications such as the Guardian and The BMJ, suggested a profound breakdown of confidence in the regulator. The views of patients and the public may be different, as much less has been heard about their perspective on this case. How did we end up here, and what can we do about it?

How the GMC has evolved

The GMC was established under the Medical Act of 1858 to “take charge of registration and medical education across the UK and the publication of …

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