We need the GMC to set a powerful precedent by speaking up about the dangers of rota gaps, says Rachel Clarke
Watershed moments, if genuine, are palpable. We can feel it when something tectonic is afoot. Who will forget how, last year, the blackened shell of Grenfell Tower fractured a country’s belief in itself as fundamentally humane? Or the fury unleashed by Harvey Weinstein’s victims, and the potency of #MeToo as it rips round the globe?
Medics have a habit of thinking nothing matters quite so much as medicine. But last week’s successful appeal by the General Medical Council to have paediatric trainee, Hadiza Bawa-Garba, permanently struck off the medical register is nothing if not an NHS watershed.
What is at stake here—as unsafe staffing continues to wreak havoc on our ability to provide patient care—is whether the profession’s regulator finally has the gumption to confront this reality. Or, will it continue to ignore the state of the health service, thus permitting individual practitioners whose abilities—it knows full well—are so crippled, so often, by skeleton staffing, to shoulder the blame for NHS-wide failings? If ever there was a moment to put patients first, this is it—as people continue to die on trolleys in hospital corridors, or at home while waiting for the ambulance that never arrives.
In 2015, Bawa-Garba was convicted of gross negligence manslaughter for the avoidable death, from sepsis, of a six year old boy, Jack Adcock, after a jury concluded her mismanagement of the child was “truly exceptionally bad.” The GMC then insisted that public confidence in the profession could not be maintained unless Bawa-Garba was permanently erased from the register.
Superficially, this may seem reasonable enough. A young child had died in unforgivable circumstances, a doctor criminally convicted. So why has her treatment so convulsed the profession? We are angered, in part, by the absence from the GMC’s narrative of the possibility that Bawa-Garba’s negligence arose because it was the working conditions into which she was thrust that day that were “truly exceptionally bad.” Rota gaps forced her to cover two other doctors’ jobs as well as her own work. Her consultant was off on a teaching day. The hospital IT had broken down, causing chaos.
So what, precisely, was Bawa-Garba meant to do? Down tools and say it was unsafe for her to work? Is that what we should all do now—simply walk out on our patients when rota gaps are dangerous? Or struggle on, sick with dread, knowing a patient may slip through the understaffed net, and that we too may face criminal conviction as a consequence?
When this question was put to him last week on BBC Radio 4, the GMC’s chief executive, Charlie Massey was evasive, refusing to answer. Small wonder doctors are afraid. Many of us battle daily with understaffed bedlam. Fancy a spot of corridor medicine, anyone? Picking the patient you think will die next in the corridor, to award them the one empty space in Resus? Yet the GMC’s only advice to those trainees now terrified of both treating and not treating their patients is platitudinous—essentially, to tell someone senior you think conditions are suboptimal.
That, frankly, is not helpful. What is the point of frontline doctors speaking out about understaffing when all those with actual clout—the GMC, the CQC, Jeremy Hunt, and the prime minister—know that in today’s overstretched NHS, patients are jeopardised by rota gaps daily. It is ironic that the profession’s regulator, so committed—ostensibly—to NHS candour, is itself refusing to be candid in public about the dangers to patients of endemic understaffing.
Last week, doctors took matters into their own hands, crowdfunding £160,000 in donations in less than 24 hours to provide expert legal opinion for Bawa-Garba. Those are sobering statistics for a regulatory body that purports to uphold public confidence in doctors—yet appears to have lost the trust of its rank and file.
Vague and hollow reassurance from the regulator no longer cuts it for doctors. We need action, not empty words. In the spirit of preserving patient safety, the GMC could set a powerful precedent by speaking bluntly about the dangers of rota gaps. It could insist we report every single one of them, and make it quick, easy, and—crucially—safe for us to do so. A simple, anonymised GMC form on which we can document every staff shortage without fear of employer retribution. It could collate these data nationally and publish them openly. Imagine the force of a GMC divulgence of the scale and repercussions of doctor understaffing.
Recently, I had a conversation with a senior figure in the NHS who, irked by doctors speaking out, asked me: “Don’t you think you have a corporate responsibility to maintain public confidence in the NHS?” I took a deep breath. The rot that passes for “candour” could not have been phrased more succinctly. “No,” I replied. “I think quite the opposite. Covering up risks, if they exist, is the exact opposite of candour. If I thought it was okay to spin away reality, I’d be a politician, not a doctor.”
It is time for the GMC to choose. Does it wants to be part of the problem or the solution? Because, right now, every one of us could state the same refrain: #IAmHadiza.
Rachel Clarke is a specialty doctor in palliative medicine. Follow her on Twitter @doctor_oxford
Competing interests: None.