GMC Chair Prof Sir Terence Stephenson: 5 Questions

Peter Russell

Disclosures

June 20, 2018

Relations between the General Medical Council (GMC) and the medical profession have plumbed new depths in recent months.

General practice leaders have been angered by the regulator's High Court appeal to overturn a ruling of the Medical Practitioners Tribunal Service (MPTS) which led to Dr Hadiza Bawa-Garba being struck off.

More recently, the government endorsed a recommendation by the Williams review into gross negligence manslaughter cases that the GMC be stripped of its power to appeal against MPTS decisions.

Last month the GMC announced reforms to its fitness to practise process. It has also launched a UK-wide review of doctors' wellbeing to help tackle exhaustion and burnout.

Prof Sir Terence Stephenson

We asked Prof Sir Terence Stephenson, GMC chair, five questions about the current situation.

Q&A

Medscape UK: You were critical of the recent government announcement that the GMC would lose the right to appeal MPTS rulings. Why do you believe this was a wrong move?

Sir Terence Stephenson: The Health Select Committee pressed the government for legislation change before we were granted the right to appeal decisions in December 2015. We also called for the change because patient safety is at the forefront of the GMC's work. Doctors have a right to appeal decisions. However, previously the GMC was powerless to challenge decisions when we thought they were too lenient, too severe, and could undermine the profession or put patients at risk.

We introduced an independent tribunal system for doctors, and I think this has been a huge step forward. Other health professional regulators have not done this and still run their own tribunals. Hence only the GMC was given by parliament a right of appeal against the independent tribunal.

We do not take the decision to challenge MPTS decisions lightly but have appealed 18 cases, all but one of which involved sexual misconduct or dishonesty, and our appeals have been upheld in 16 of those.

If the recommendation to remove this is pursued, it will significantly reduce our ability to protect patients. It is a decision that will have far-reaching consequences and needs to be considered thoroughly.

Medscape UK: Relations between the GMC and the medical profession have plummeted. Do you think this could have been avoided if the GMC had handled the case of Dr Hadiza Bawa-Garba differently?

Sir Terence: The case has set back some of the gains we have made in recent years to develop a better relationship with the profession. It would be naïve to think otherwise.

However, as a regulator we cannot be above the law. Dr Bawa-Garba was convicted by a jury in a criminal trial and sentenced to a suspended custodial sentence for gross negligence manslaughter. We took thorough legal advice from a QC and acted on that advice, that not appealing the MPTS' decision to suspend Dr Bawa-Garba would set a precedent and go above the law.

It's a tragic case. Jack Adcock's family have lost a future with their young son and Dr Bawa-Garba, who was a doctor in training, has lost her career.

Medscape: What are you doing to restore the medical profession's confidence in the GMC?

Sir Terence: We know that recent events have had an impact on doctors' confidence in the GMC but we remain committed to work that will benefit doctors as well as ensuring patient safety.

We are commissioning an independent review by Dame Clare Marx into how gross negligence manslaughter, and culpable homicide in Scotland, are applied to medical practice. We believe the review will help to pinpoint key areas that could be improved.

We have also started a UK-wide review of medical students' and doctors' wellbeing. This is being led by Professor Michael West and Dame Denise Coia. The review will identify the factors that impact on the wellbeing of medical students and doctors.

Their work will involve research and engagement with a range of organisations. Their independent findings will be presented in a report which we expect to be published early in 2019. We will use the findings to work with organisations to improve working conditions and support for medical students and doctors.

Additionally, we are working with a number of organisations, NHS Improvement, the Academy of Medical Royal Colleges, the British Medical Association, the Care Quality Commission, Health Education England, and NHS Employers, to improve issues around the reporting of incidents when doctors in training raise safety concerns.  The process, known as exception reporting, was introduced in 2016 but its effectiveness varies due to organisational cultures, staff engagement and differences in local processes.

This joint working applies only to England but we are working with partner organisations in Scotland, Wales and Northern Ireland to find ways of improving the consistency of rota monitoring, and supporting doctors in training, in those countries.

Medscape: During a panel discussion at the Oxford Union earlier this year you said you wanted to support doctors by being 'the fence at the top of the cliff stopping them falling off' instead of 'the ambulance at the bottom picking them up'. You said you wanted to address mental health and wellbeing of doctors. Could you elaborate on that?

Sir Terence: As previously mentioned, we have launched a review into medical students' and doctors' wellbeing. This review is part of a 3 year initiative we launched in February. We are bringing experts from across the profession to look at ways of tackling the impact of work stress and poor mental health on doctors. 

At the initial event we held to launch this work we invited representatives from a range of organisations including the BMA, Academy of Medical Royal Colleges and the Royal College of Psychiatrists. The symposium helped to identify actions that can be taken to address workplace factors that affect mental health and wellbeing.

We know doctors and doctors in training are under huge pressure – we have seen that from our National Training Survey results – and I am a practising paediatrician and I know only too well how stretched staff are. We want to do what we can to try and ease the pressure.

Additionally, we've also reformed our fitness to practise processes to make them more compassionate for doctors who are vulnerable and being investigated. This has included introducing provisional enquiries. These enquiries mean that investigation staff can request information at an early stage, such as medical reports of incident reports, to enable us to decide whether a full investigation is required. This process saw us prevent hundreds of doctors being subject to an investigation in 2017.

In addition, we are now able to halt an investigation if a doctor is unwell to allow him or her to seek medical treatment. Furthermore, we've improved the way we communicate with doctors to be more empathetic while still fulfilling our statutory functions. Doctors subject to investigation have an initial point of contact who will assist them with any questions. This means doctors are only speaking to people who are familiar with their investigation.

Medscape: The government recently announced it would relax immigration rules to allow more doctors and nurses from outside the European Union to come and work for the NHS. How critical do you think this move will be for staffing levels in the health service?

Sir Terence: Staffing levels in the NHS aren't a matter for the GMC but like others we have been frustrated by cases of doctors who have been unable to get the visas they need to come and work here.

We are pleased the Government is now acting on the concerns that were raised by us, and others, and is tackling this issue.

The medical profession in the UK relies on the expertise of doctors from overseas. Their contribution and the diversity of experience they bring are invaluable.

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