Rapid response by Dr Peter Wlimshurst BMJ 18 July 2016
Quis custodiet ipsos custodes
I have considerable doubts whether the GMC’s proposed changes to fitness to practise procedures as outlined by Anna Rowland will benefit either patients or doctors.
I am surprised by the GMC’s claim that the proposals have received positive feedback from patients. The GMC Patient Leaders Roundtable scheduled for 21 June 2016, at which some
of these issues were tabled for discussion, was cancelled by the GMC at one day’s notice “due to unforeseen circumstances” and has not been rescheduled.
I have considerable concerns about the GMC’s plans to pass responsibility for some procedures to employers for two reasons.
1. There are many examples of employers concealing or failing to take prompt action in response to poor clinical care and dishonesty by doctors either to protect the reputation of their institutions or to prevent patients becoming aware of events that might cause the trust to pay compensation. In some cases it took years before miscreant doctors (e.g. A K Banerjee and C Handler) were removed from the medical register.[2,3] In the latter case, the Medical Director of the trust involved in the cover up was a GMC member. It is clear that in many cases the interests of institutions are placed before patient welfare.
2. Institutions have misused disciplinary procedures, including GMC procedures, to silence those who raise concerns. Some trusts employed private detectives to spy on whistleblowers. Others secretly searched through the computers, the desks and even the waste bins of whistleblowers to find something incriminating to use against them. A secret audit of a consultant’s practise by an external clinician has been used. When all those turn up blank, trusts have suspended whistleblowers on fictitious charges. From working with Patients First I know that such spurious suspensions allow trusts to claim that doctors have become deskilled, so that they can no longer be employed or revalidated.
In some cases trusts have made complaints to the GMC about whistleblowing doctors and after a year or more the GMC has dropped the case when the trust failed to provide any evidence. In other cases, trusts have offered to withdraw allegations made to the GMC provided that the whistleblower agreed to withdraw concerns that they had made about patient safety.
There are valid concerned about doctors who died during GMC investigations. Some of those deaths were the result of allegations made by trusts as a result of the types of institutional misconduct described above.
1. Rowland A. GMC review of procedures is complete. BMJ 2016;354:i3654. [See also rapid responsehttp://www.bmj.com/content/353/bmj.i1925/rr ]
2. Wilmshurst P. Poor governance in the award of honours anddegrees in British medicine: an extreme example of a systemic problem. BMJ 2016;352:h6952.
3. Wilmshurst P. No doctor should be untouchable. BMJ 2013;346:f2338.
4. Dyer C. Whistleblower who was excluded from work for five years wins apology from employer. BMJ 2008;336:63.
Competing interests: I was reported to the GMC and investigated for disparagement after I reported the concerns of a national committee that I chaired about misconduct in research.
Some of our concerns were later found proved (i.e. that the research did not have ethics approval and patients did not give informed consent), but the GMC said that they were unable to investigate our allegations that some data had been falsified because the institution refused to allow the GMC sight of the data. The GMC did not use its legal powers to compel disclosure (though the GMC has threatened whistleblowers with High Court injunctions forcing them to disclose documents). I am a member of the steering committee of Patients First, which has collected details of the experiences of whistleblowers. I have supported a number of doctors whose employers made spurious complaints to the GMC.