How the General Medical Council Harms Patients and Doctors

Dr Dermot J Ward

“The main objective of the General Medical Council in exercising their functions is to protect, promote and maintain the health and safety of the public.” Actually, there is a 12th century Greek manuscript of the Hippocratic Oath and while there are some variations the message delivered is still the same. do no harm. It appears that the GMC wishes to steal some of the emperor’s clothes.

This somewhat belated GMC declared main function is surely admirable but regrettably the currently structured and functioning GMC is significantly failing its alleged central goal, both passively and actively. Surely, I hear you say, that can’t be true. Let me start with the example published in the The Daily Telegraph, 28.03.2016, from that newspaper’s highly respected weekly medical columnist, Dr James Le Fanu. His headline that day was ”Wronged parents lose their champion”. A reread of that whole piece which revolves around the “shaken baby syndrome” and a GMC since 2012 Medical Practitioner Tribunal Service MPTS Hearing decision to erase the name of an internationally respected neonatal neuropathologist from the Register is remarkable. Understandably it evoked “a group of 25 prominent lawyers, pathologists, paediatricians and neurologists, who rallied to her defence asserting in essence, that she was a victim of a concerted campaign to discredit that doctor, (Dr Squier). That group claim, “…this is indicative of a troubling pattern…where the authorities (in this case the GMC) inflict harsh penalties on those who fail to toe the establishment line”.

For those readers who fear I’m about to delve into “Odyssey” again you can relax! But that does not in any way diminish the importance of series. Instead I want literally to spell out the supporting letter from a distinguished MP, Mr Austin Mitchell. I have referred to it as a hugely important important document which drove me to attempt to defend a colleague but was refused permission to do so, even as the only supporting defence witness. Dammit, I have never spelt out that report until now for its general importance to the profession as a whole.

This is the letter:-
23rd July 2002
The letter is addressed to one Mr Paul Philips, Director of Fitness-to-Practice, General Medical Council, 178 Great Portland Street, London W1W 5JE. It begins;-

“Thank you for your letter dated 24 June with regard to Dr John Harding Price. I am disappointed to find that it does not deal with the facts in this case, particularly with my concern that the impact of the Shipman case on GMC decision-making produced a reaction that led to a rush to judgement in the case of Dr Harding Price and a decision that was not only unreasonable but would not have been taken under previous practice.

1. 12 November 1999 Dr Price was informed of the allegations against him.
2. On 28 January Dr Price was informed the Preliminary Proceedings Committee had met on the 18 January and that they considered a charge should be formulated and considered by the Professional Conduct Committee.
3. On 31 January 2000 the Shipman debacle became public knowledge to indicate accusations arising from the fact that it had done so little in the Shipman case.
4. In February 2000 the GMC set up an Interim Order Committee. This is predominately lay not professional and the rules written for it are unfair.
5. In March 2000 Dr Price’s case was reheard, this time in secret and without professional advice. He was suspended by this new committee presumably as one of the very first to go before it. Nothing was heard “beyond reasonable doubt” and in the end he was found guilty of something he had not been charged with, namely, communication failure.
6. That was done in August 2000. This is clearly not good enough and falls outside Article 6 of the Convention of Human Rights.

The GMC rushed to Judgement. Its decision has not been confirmed by any other professional body nor by the witnesses who have refused to confirm their allegations or the GMC’s testimony in court, by video link, or even by sworn deposition. It seems to me as an outsider, that one particular case, an aberration which could happen to any practitioner, has been treated as the tip of an iceberg of infamy comparable to Shipman’s, resulting in a rush to judgement to show that the profession could be tough even in minor cases. I should add that Dr Price provided care, support and treatment for a particularly defenceless and needy section of Grimsby society because of his work in and concern for drug treatment, mental illness (badly provided for in our area) and care of the mentally ill in society. His work should be judged in that context and in the light of the fact that no one now provides that support. This is not a prissy middle-class society. (My italics and emphasis).

There is in my view, a case for the full General Medical Council to look at this as a matter of natural justice. There is also the important issue of Human Rights, namely that doctors should not be set apart from the right’s of other people. They must be allowed a full and fair defence at all stages of GMC deliberations. It may be that previous practice was too deferential to the doctors but that is no reason to rush to swing the balance the other way.

A full Professional Conduct Committee in Dublin found that not only was there no professional misconduct but hat the charges against did not stand up to the criminal standard of proof required (and some could not even be regarded as charges). So this is a most serious matter that requires that the full General Medical Council to review the matter urgently. I hope that you will again look at this issue.

Yours sincerely

Austin Mitchell.”

There is little wonder with all that legal impropriety (my euphemism) that In the course of bearing witness I was forbidden to read that report. It is so damning of the GMC Medical Practitioner Tribunal Service in Manchester.

In the particular instance of the Dr James Le Fanu’s comment there appears to have been a complete failure to consider the deprivation consequences of highly skilled medical care to grieving parents and children deprived by the GMC of the high specialised internationally recognised clinical skills of a consultant neonatal neuropathologist.

There is too the distinct loss of the concept of “medico-legal” to that of solely “legal” up to this time. There is also (or there was up to very recently) a judge who was/is chairman of the MPTS in Manchester. The Wikipedia GMC website tells us that the medical profession has been self-regulated since 1858 but I am unable to be clear, (from the Wikipedia website on the GMC) that it is or is not still self-regulated. If there is doubt we (that is the medical profession via its profession’s representatives) should study and learn from the free press how to openly reclaim and proclaim its self-regulated status. Time was that significant changes and appointment of doctors and others to the General Medical Council followed balloting of all doctors on the GMC Register thus ensuring that while this could not 100% guarantee that the Council’s decisions in its activities were infallible. it was legally and medico legally agreed the system, for instance, in fitness to practise Hearings, delivered judgements which, while allowing for human frailty, were less likely to be flawed compared with any other decision process in that medical situation. Thus, we need not be surprised, or especially condemnatory, to read in The Daily Telegraph (11May, 2017), a headlined article ‘Judge removed from office’ as four censured’. Like doctors, because of their heavy responsibility, so too are judges held to account. Indeed as I stated for the record in Irish Medical Times, 6th Dec 2013, lest it be suggested that I lack proper respect for the rule of law I stated:

“…..Our civilisation in these Islands depends on respect for our democratic system and the judiciary, our system of justice that has evolved over time, Roman, Christian, Magna Carta, on natural justice, rules of evidence and due process.Without this we have nothing. Even at its best it is beset by human frailty. No court guarantees justice because of this; only the possibility of justice. Otherwise, there would be no need for courts of appeal.”. .….

A somewhat different area of GMC harm to patient care and medical standards is the widely publicised Dr Hadiza Bawa-Garba which relates to the relatively recent medical practice open open reflexion by individual doctors of mistakes made by them. Learning from such openness has been considered to have improved standards of medical treatment generally thus benefitting the patient population at large. On May1, 2018 The Daily Telegraph’s Health Editor, Laura Donnelly headlined a piece “Doctors no longer admit errors after prosecution of paediatrician.” The item was inspired by a survey of 682 GPs in “PULSE”, a UK medical newspaper. 52% said they had “stopped or adapted their reflections since the 2015 case. A doctor who gave evidence in defence of Dr Bawa-Garba said his advice was “only to write down what you would be happy to have read back in court”. Two other individual named GPs have echoed similar not unexpected sentiments. It is reasonable to consider that this case alone and the manner of its legal treatment will promote the loss of the acknowledged benefit of open reflection, thus diminishing the overall standard of medical care and treatment caused by the practice of more defensive medicine.

Moving on in the area of public and patient GMC generated harm, the manner in which the GMC arbitrarily some years ago decided that retired medical practitioners who since the GMC’s inception would occasionally attend, when asked, to patients, more usually friends and family not so seriously ill or thinking themselves to be ill would be adequately medically managed without any financial consideration. They were also allowed to remain – though retired from active practice – on the GMC Register without having to pay the annual subscription rather as receiving the freebee bus pass for retired folk in general. Thus as these retired doctors were banned from writing a prescription, nurses were being allowed limited prescription rights for the first time as the most experienced medical doctors in long years of practise across all specialty were no longer able to carry out, on pain of litigation, if they wrote the simplest prescription or offered advice backed by their lifetime’s work and highly professional medical training. There has never been evidence of the practise causing harm. I can’t help wondering if the absence of this whole cohort of unsung medical care and expertise from a hugely experienced group of doctors has contributed to the current UK widely acknowledge recent swamping of overworked A&E departments.

The unctuous holiness (and harm) of that GMC claim of protecting the public as above encourages at least 2 eulogies for the profession. The first is an article by the writer Andrew O’Hagan (DT 15 May. 07),”We should treat our doctors like gods.” It’s a moving piece precipitated by the excellent life saving treatment received by his 12 weeks old daughter at the Royal Brompton and Harefield NHS Trust. The second is the life and output of Roy Porter, “The greatest medical historian of his generation” who died at the sadly young age of 55 in 2002. His magnum opus, “The greatest benefit to mankind”, subtitled “A medical history of mankind from antiquity to the present”, 1997. The case rests.

Dame Caroline Swift has been appointed as the new Chair of the Medical Practitioners Tribunal Service (MPTS) – the body that makes independent decisions about a doctor’s fitness to practise medicine in the UK.
Dame Caroline was appointed Queen’s Counsel in 1993 and a High Court judge in 2005 until her retirement in 2015. She will take up her post from 1 January 2017, succeeding His Honour David Pearl.

WIKI In 2001 size of council reduced from 104 to35 and increasing the proportion of lay members. (No balloting of members)