Intended for healthcare professionals

Opinion

An independent, root and branch review and reform of GMC processes is needed to ensure fairness in medical regulation

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1346 (Published 27 May 2022) Cite this as: BMJ 2022;377:o1346
  1. Chaand Nagpaul, BMA council chair
  1. The BMA

Many in the medical profession have rightly reacted with outrage at hearing that the Medical Practitioners Tribunal Service has suspended Manjula Arora, a GP in Manchester, relating to her request in December 2019 for a work laptop for the purpose of triaging patients.1 Astonishingly, Arora was suspended for “dishonesty” in using the single word “promised” in a phone call to her IT department, based on her understanding of an earlier email that a laptop would be provided when available. This was in spite of the fact that Arora had stated that the IT department should confirm her understanding of what she had been told.

This case epitomises the systemic flaws in the entire referral pathway to the medical profession’s regulator the General Medical Council (GMC)—ranging from the decision by an employer to refer, through to the decision to investigate, the process of investigation and finally the tribunal hearing.

Being notified and being investigated by the GMC can be one of the most traumatic experiences in a doctor’s life. A past survey by the Medical Protection Society highlighted that 72% of respondents felt that their GMC investigation had a detrimental impact on their mental and/or physical health, and, tragically, between Jan 2019 - Dec 2020, 29 doctors died while under investigation, of which five deaths were confirmed as death by suicide.23 There is therefore a moral imperative that the GMC as a regulator needs to be used proportionately, appropriately, and only when necessary.

However, problems can begin at the very onset of a decision to refer, with concerns about inconsistency and unfairness of referrals from employers. Ethnic minority doctors are already referred at twice the rate of white doctors, and international medical graduates are referred at three times the rate as UK trained doctors.4 The GMC itself recognises this inequality and has set a deadline for this to be eradicated by 2026.5

Further, the existence of inherent bias against ethnic minority doctors has been demonstrated by a recent study which showed that anonymised case details and scrutiny by an independent panel before a formal referral to the GMC eliminates the disproportionality in referrals between ethnic minority doctors and white doctors.6

Upon receipt of a referral there are further concerns about the objectivity and fairness in the GMC’s decision to investigate. In the recent landmark employment tribunal ruling against the GMC for race discrimination, brought by Omer Karim, a consultant urological surgeon, it was found that the GMC was looking for material to support allegations “however trivial, however old, and however much they contradicted accounts from those who actually knew about the claimant’s conduct and competence […] rather than fairly assessing the matters presented.”7 In Arora’s case, the decision to investigate seems entirely disproportionate given that to any reasonable person the allegations made against Arora should have been handled locally with understanding and compassion.

As a result, the BMA has called for the immediate safeguard of an external scrutiny panel to assess each potential employer referral to ensure that it is fair and objective, and consider whether the issue could be more appropriately dealt with locally and swiftly.8 This is especially important given the mental turmoil and uncertainty resulting from a GMC referral. It is not uncommon that these cases stretch on for years, and in this case, Arora waited an inordinate two years and three months, much longer than the GMC’s own standard of 12 months.

The final stage in the pathway is the MPTS tribunal, where this case raises further concerns about objectivity and fairness in reaching decisions. Reading the Tribunal’s determination, the inherent adversarial process of hearings appears to be driven by the GMC’s focus on winning the case as opposed to a sensitive approach to assessing an allegation based upon evidence.

For Arora, this involved being subjected to a cross examination by a barrister on the semantics of her use of the single word “promised.” For this simple miscommunication, in the hearing the GMC extraordinarily accused her of bringing “the medical profession into disrepute.”

The Tribunal itself admitted that “Dr Arora’s misconduct was a single incident in relation to the use of a single word, with no evidence of any other similar episodes of dishonesty before or after.” It further stated that “Dr Arora had not set out to be dishonest, and that she had not set out to mislead.” The GMC representative “acknowledged Dr Arora was a person of good character.”

It is therefore all the more perplexing that the tribunal ultimately ruled that Arora’s fitness to practice was “impaired by purpose of her misconduct” and suspended her on the basis that it “would send an appropriate message to the medical profession and the wider public.” In arriving at this conclusion, the tribunal stated that an informed member of the public would consider this suspension “reasonable.”

It is incomprehensible how preventing Arora from providing care to patients for a month at a time of exceptional NHS pressures, over a semantic disagreement on the use of a single word, would be considered “reasonable” to members of the public.

Ultimately, far from having any positive impact on the public’s confidence in doctors, this determination has exacerbated fear and distrust among the medical profession, already afraid that the regulatory process is inherently stacked against them.

This entire case demonstrates how the current system is structurally disproportionate, lacks timeliness, with insufficient checks and balances, and is manifestly unjust. The GMC has since indicated that it will seek to understand whether there are lessons to learn from this case. However, this falls well short of what is needed. The catalogue of concerns from the point of referral, GMC investigation to a tribunal hearing further supports the BMA’s call for a root-and-branch, independent review with radical reform of the entire pathway.9 Nothing short of this can secure justice and fairness in medical regulation.

Footnotes

  • Competing interests: none declared.

  • Provenance and peer reviewed: not commissioned, not peer reviewed.

References

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