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GMC must fundamentally reform its approach to re-gain trust of the profession

The GMC has lost the trust of the medical profession and must fundamentally reform its approach.

These are the hard-hitting conclusions of an independent review of gross negligence manslaughter and culpable homicide, chaired by Leslie Hamilton, in response to the treatment of trainee paediatrician, Hadiza Bawa-Garba.

The GMC angered the profession by pursuing Bawa-Garba, who was convicted by the courts of gross negligence manslaughter and given a suspended sentence.

The regulator appealed to the courts when its own medical tribunal said she should just be suspended.

Bawa-Garba had an exemplary record for her six years in medicine until the death of Jack Adcock, a six-year-old in her care, when she was under pressure and without proper supervision in a poorly resourced hospital.

Leslie Hamilton, a former children’s heart surgeon who chaired the review, said: “Many questioned why an individual trainee working under pressure should carry the blame for what they considered to be wider systemic failings within her working environment. They recognised her situation in their own working lives and felt that ‘there but for the grace of god go I’.”

Hamilton said doctors could identify with her. “She was recognised as a good doctor. They looked at this good doctor and couldn’t work out … what made her make errors that were so bad that a jury actually thought they were criminal. And that just sent a shiver of fear. So there was already huge concern. And when the GMC took their appeal, that was the final straw, if you like.”

Professor Jackie Taylor, the President of the Royal College of Physicians and Surgeons of Glasgow, called for urgent action by government and NHS bodies.

Prof Taylor said: “I’m glad that this report recognises that the actions of the GMC in this case undermined the trust that the medical profession has in our regulator. It will not be an easy task to rebuild this damaged relationship, but it’s vital that action is taken to build on the positive progress that has begun over the past year.

“Doctors must have confidence that the system is not loaded against them when mistakes are made. Developing a truly just ethos within the NHS means that we must all work together to create a learning environment, not a blame culture.”

While the GMC has claimed to promote an open culture in the NHS and self-reflective learning, it pursued a vulnerable junior doctor over a genuine clinical mistake, commented one doctor who wished to remain anonymous. Bawa-Garba was reinstated to the medical register in August 2018 by the Court of Appeal.

The report calls for reflective practice to be given legal protection – to ensure that care can be improved in a ‘no blame’ culture.

The report also says the GMC should be stripped of its power to appeal against the decisions of its disciplinary tribunals.

It also expressed concerns about the evidence given by medical experts, and that the GMC had to be transparent about the qualifications of the experts it used. The report recommended that two experts should be required in any case about clinical misconduct.

The GMC has accepted the findings.

However, the criticisms are so profound that many doctors question whether the current leadership can continue.

Charlie Massey, Chief Executive of the GMC, said: “The report says we must rebuild trust with the profession, and we fully accept this challenge. Having reflected as an organisation, we are committed to acting on that and taking forward all the recommendations in this report directed to us.

“We share this report’s desire for a just culture in healthcare, and acknowledge that we have a crucial role in making that happen. We are already making progress. Work is underway to address some of the key issues raised in this report but there is plenty more for us to do.”

Both the BMA and HCSA have, in past, said that the CEO’s position has become untenable. Up until recently, Massey – who earns between £240,000 and £250,000 – has defended his decision making.

“I don’t believe I had any choice but to take the decision I did,” he told BMA News in June 2018.

The report also identified a high skew of referrals of doctors from ethnic minorities and problems with supporting practitioners’ mental well-being.

Read the reaction to the report.

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