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Editor's Choice

The GMC has lost the profession’s trust and respect

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1374 (Published 01 June 2022) Cite this as: BMJ 2022;377:o1374
  1. Kamran Abbasi, editor in chief
  1. The BMJ
  1. kabbasi{at}bmj.com
    Follow Kamran on Twitter @KamranAbbasi

The stated role of the UK’s General Medical Council is to protect patients and improve medical education and practice.1 It is hard to see how these ambitions are furthered by the case of Manjula Arora, a general practitioner suspended for overstating her employer’s offer of a new work laptop (doi:10.1136/bmj.o1324).2 Doctors and medical organisations are angry (doi:10.1136/bmj.o1350)3; the GMC is a regulator that has lost the profession’s trust in its ability to regulate (doi:10.1136/bmj.o1353).4

The GMC has also lost all sense of perspective. The tribunal transcript reveals how the GMC, through its lawyer, pursued the case without an ounce of compassion, and how the tribunal’s nine days of deliberations essentially centred on whether letting an employee know about a future roll-out of laptops amounted to a “promise.”5 Whether it did or not should not be a matter for the GMC.

The more serious charge against Arora, of suspending a clinical service without authority, was dismissed quickly by the tribunal, but more thorough local vetting would have reached the same conclusion earlier. A concern is that once the GMC decides to take a case to tribunal there is a perverse incentive to deliver a guilty verdict in order to justify its decision making.

In May 2021 Charlie Massey, chief executive of the GMC, identified inappropriate referral as one of several areas that required improvement (doi:10.1136/bmj.n1269).6 Yet the Arora case shows that the GMC has failed to prevent inappropriate referrals and may have no understanding of what is or is not an appropriate referral. What are we to make now of Massey’s “promise” from 2021?

The GMC is also custodian of Good Medical Practice, important guidance on what it means to be a good doctor.7 But the words are chosen carefully: there is no such thing as “perfect medical practice.” Perfection is an unattainable goal in healthcare and for all humans (doi:10.1136/bmj.o1327).8 It serves no purpose to punish people for misunderstandings or minor performance issues.

Perhaps the GMC should ask itself what it means to be a good regulator? Is being a good regulator compatible with tolerating a climate of fear and blame in the health service when a better way is to move towards a no blame culture? Is it compatible with an appalling record on discriminating against ethnic minorities and overseas graduates? Arora is both, being a medical graduate from Delhi. Is it compatible with failing to learn the lessons of past failures, such as the case of Hadiza Bawa-Garba (www.bmj.com/bawa-garba)?9 Is it compatible with outlining a reform plan that inspires little confidence and sets targets that are too far into the future (doi:10.1136/bmj.o1346)?10

The GMC is further damaging workforce morale and wellbeing at a time when our new investigation reveals that violent incidents at general practices have almost doubled in the past five years (doi:10.1136/bmj.o1333),11 the workforce crisis means that solutions to clearing the backlog in elective care are hard to implement (doi:10.1136/bmj.o1337),12 and a new model is required for primary care (doi:10.1136/bmj.o1342).13 The Arora case is an embarrassment for the GMC, showing its systemic failures and its bankrupt promises on tackling inappropriate referral and ending discrimination in its processes. The question for the GMC is whether its current leadership can realistically win back the profession’s trust. The GMC does not need to be loved by doctors, but it does need to be respected.

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