To many ethnic minority doctors, an employment tribunal’s damning verdict, that “there might be discrimination infecting the referral process” at the General Medical Council (GMC) is not surprising. The regulator has become a leviathan: unaccountable, hegemonic, and institutionally racist. Piecemeal attempts to self-regulate have failed, so the time has come for the medical profession to speak up.
The unjust persecution of an ethnic minority doctor, Omer Karim, by the GMC is typical of how it deals with ethnic minority doctors. The employment tribunal highlighted the disproportionate number of complaints made about doctors from ethnic minority backgrounds compared with their white colleagues, and the “evidence about race which show a higher degree of adverse outcomes for ethnic minority doctors.” Karim was accused of bullying in 2013 by his hospital management after he raised concerns about the hospital’s bad management and underfunding in a local radio station. He was referred to the GMC and suspended from work. Following about four years of investigations, tribunals, and restrictions on his practice, he was cleared of any wrongdoing in 2018. The GMC’s investigations hung over his head for about half a decade and destroyed his career. In Karim’s words: “Right from the outset, the GMC saw me as a guilty black doctor.”
The GMC has a long history of discriminatory and wrong-headed approaches to disciplinary matters in particular regarding ethnic minorities. Under immense pressure including last year’s Black Lives Matter movement, it has promised action. However, it has focused on referrals from employers to deal with its problems. While it is true that 42% of complaints by employers are against ethnic minority doctors, who comprise 29% of UK doctors (some report ethnic minority doctors are two times as likely as a white doctor to be referred), that is only part of the problem. As well as investigating the employers’ referral process, the GMC should put its own house in order as doctors from ethnic minorities who graduated in the UK are 50% more likely to get a sanction or warning than white doctors. It is not merely a case of disproportionate referrals to the GMC, it is the GMC and its practices, processes, and culture that are the problem. But rather than a root and branch reform of its institutional culture, it seems that the GMC is placing the blame elsewhere.
In 2017, the GMC went to great lengths to ensure the erasure of Hadiza Bawa-Garba, a black ethnic minority doctor. It rejected the results of its own Medical Practitioners Tribunal Service (MPTS), which recommended a 12 months suspension rather than erasure, and appealed to the High Court to overturn the MPTS decision. Its actions plunged the profession into deep turmoil with wide-ranging and far-reaching consequences. The GMC spared no effort in its resolve to strike off Bawa-Garba who was working in unsafe, understaffed conditions and only relented after it lost its legal challenge. Bawa-Garba has recently been allowed to practise again without restrictions.
Not learning from these serious errors of judgement in the case of Bawa-Garba, the GMC has continued to appeal tribunal decisions, with data showing that the GMC have appealed against the decisions of its own tribunals 14 times since 2018. Jane Dacre, president of the Medical Protection Society, who recently coordinated a letter signed by 13 healthcare organisations to remove the GMC’s power to appeal against tribunal decisions, said that the GMC’s actions have “led to fear across the medical profession and a lack of confidence in the GMC. The GMC is the only UK health regulator that has such a right of appeal.” The GMC’s challenges against MPTS decisions are at odds with the UK government’s decision that the GMC should be stripped of the power, following the Norman Williams review in June 2018.
While regulation of medical professionals is necessary, whether this is best achieved through an organisation like the GMC is debatable. The GMC was established in 1858 as a way of accrediting formally trained doctors against quacks and protecting patients from harm. However, it has become too powerful in its reach, intrusive in its conduct, and unaccountable in its actions. It focuses entirely on the actions of individual doctors to “‘protect patients” and neglects systemic issues, including government policies that have far more harmful consequences on patients’ lives and the viability of the health system . Underfunding, unsafe working conditions, unmanageable workloads, cuts to vital healthcare services—these are all areas that directly impact patient safety and doctors’ ability to practice safely, but the GMC is seemingly and inexplicably not interested in these matters. Its disciplinary processes take too long and are punitive in nature, and although it acknowledges the problems, it has taken little meaningful action to initiate reform. Its actions are likely to be a significant contributor to healthcare professionals’ stress, burnout, and defensive practice. The GMC has created a culture of fear especially among ethnic minority doctors who feel that they are easy targets for disciplinary actions in a healthcare system that is increasingly unsafe to work in. When faced with a GMC investigation, many doctors have taken their own lives.
The crux of the issue is who regulates the regulator and whether the GMC is able to reform. Complaints against doctors and disciplinary processes are best handled by local tribunals and revalidation should be a matter for local trusts. The medical profession in the UK is in a deep crisis, exacerbated by the covid-19 pandemic and years of mismanagement, and the GMC is part of the problem. It should not take the court of law to state the obvious. If the organisation is not amenable to reform, it should be stripped of its powers by government legislation. The profession has a moral duty to stand up for what is right, and ensure fairness and justice.
Mohammad S Razai, Academic Clinical Fellow in Primary Care, St George’s University of London. Twitter: @mohammadrazai
Competing interests: None declared.