A coalition of medical organisations is calling for the GMC to swiftly be stripped of its powers to appeal fitness-to-practise tribunal decisions, as an FOI revealed this has happened in a further 14 cases since the Bawa-Garba fallout.

It comes as GPs were last month given 12 weeks to respond to plans for sweeping GMC reforms, including quashing the GMC’s powers of appeal. Under those plans, the law may be changed by spring 2022.

But a letter to health secretary Matt Hancock, signed by ‘coalition’ of 13 medical organisations including the Medical Protection Society (MPS), BMA, RCGP and Doctors’ Association UK (DAUK), called for this legal change to instead be included in the forthcoming Health and Social Care Bill.

The Bill is also due to start being implemented from 2022, but an MPS spokesperson told Pulse that this route would give greater certainty that the changes will actually take place, as well as likely being much quicker.

Reforms to professional regulation are often delayed and there are limits on how much reform can be introduced via secondary legislation – the proposed mechanism for the GMC reforms – while the Bill could complete its passage through Parliament by the middle of 2022, they said.

Any legislative change would deliver on a Government commitment made in 2018, when the Williams review into gross negligence manslaughter in healthcare following the case of Dr Hadiza Bawa-Garba recommended that the GMC should lose the right. 

Although the Government accepted the review’s recommendations ‘in full’, relevant legislative changes have yet to be made.

The MPS revealed that the GMC has challenged ‘at least’ 14 MPTS decision since the start of 2018, according to data obtained through an FOI request. This comes after Pulse exclusively revealed in March 2018 that the GMC had launched appeals against its own tribunal 23 times in the 10 months since gaining the right to do so in 2017 – with seven doctors struck off as a result.

MPS president Professor Dame Jane Dacre, who coordinated the letter, welcomed renewed Government commitment that the GMC should be stripped of the power but argued the move ‘should not be held up while a wide range of other complex proposals go through a round of further consultation’, almost three years after the original commitment. 

Professor Dacre said: ‘The strength of feeling on this issue from right across the healthcare community is clear to see.

‘The GMC’s power to appeal decisions made by the MPTS has led to fear across the medical profession and a lack of confidence in the GMC. Implementing this change as part of the forthcoming Health and Social Care Bill would give the profession confidence that their concerns and the recommendations of the Williams review are now being acted on.’

The powers are ‘unnecessary’ as the Professional Standards Authority (PSA) also has the authority to appeal MPTS decisions’, while the GMC is ‘the only UK health regulator’ to have such a right, she added.

She concluded: ‘There has never been a more important time to address this shortcoming.  Covid-19 has sparked discussion about the extent to which individuals should be held to account when working in pressurised and extreme circumstances, and now more than ever, the regulator needs to be able to operate in a way that instils confidence amongst patients and doctors.’

Meanwhile, Commons health select committee chair Jeremy Hunt this morning Tweeted his endorsement of the call for the ‘vital change’, saying it should be ‘actioned ASAP’.

‘[The] Bawa-Garba ruling had a chilling effect  & undermined efforts to create a learning rather than blame culture’, he said.

Last month, the Government published its plans to update legislation to enable swifter resolution of fitness-to-practise investigations, as well as quashing the GMC’s powers to appeal FTP decisions – which it has had since 2017.

A number of the proposed changes come in the wake of the high-profile case involving Dr Hadiza Bawa-Garba, which led to a review into FTP proceedings.

In 2018, the GMC said it would not halt appeals against FTP decisions until the law is changed, claiming it has a ‘statutory duty’ to do so in the meantime.

And a 2019 review found that the regulator should acknowledge its relationship with doctors has been ‘severely damaged’ from the Bawa-Garba case and that it ‘must learn’ from it.

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(View the letter in full here)

Healthcare leaders have urged the government to speed up plans to halt GMC appeals against fitness to practice decisions – warning the regulator has used its powers more than a dozen times since its controversial appeal in the case of Dr Hadiza Bawa-Garba.

The government accepted a recommendation in 2018 from the Williams review to strip the GMC of its power to appeal against decisions by the Medical Practitioners Tribunal Service (MPTS).

The move was seen as a key step towards promoting a culture of transparency and openness in the NHS in the wake of the case of Dr Bawa-Garba. However, the regulator has yet to be stripped of its power of appeal and has continued to use it – with figures obtained by the Medical Protection Society revealing 14 appeals in total since the start of 2018.

A group of 13 healthcare organisations have now called on the government to speed up removal of the GMC’s appeal powers.

GMC appeals

The government set out plans earlier this month to press ahead with removing the GMC’s power of appeal as part of a wider programme of changes to healthcare regulation.

But the group behind the call for faster action – co-ordinated by Medical Protection Society president Professor Dame Jane Dacre – say it should be pushed through as part of the health bill currently going through parliament, and not slowed down while complex decisions are made about wider changes to regulation.

The Williams review recommendations followed the GMC’s controversial handling of the case of Dr Hadiza Bawa-Garba, a junior paediatrician convicted of manslaughter following the death of a six-year old child at Leicester Royal Infirmary in 2011.

A medical tribunal ruled that Dr Bawa-Garba should face a 12-month suspension, but the GMC appealed the ruling in the High Court and struck her off the medical register at the start of 2018 – although this was later reversed on appeal.

NHS culture

Then health and social care secretary Jeremy Hunt said at the time he was ‘totally perplexed’ at the GMC’s handling of the case – warning along with a number of healthcare organisations at the time that he was ‘deeply concerned’ about the impact it would have on efforts to create a culture of openness and transparency in the NHS around mistakes.

In a letter to current health and social care secretary Matt Hancock, 13 leading healthcare organisations have called for section 40A of the Medical Act 1983 – which sets out the GMC’s power of appeal – to be scrapped as part of the health bill currently going through parliament.

The letter was signed by Medical Protection Society, The Doctors’ Association UK, Hospital Consultants and Specialists Association, BMA, RCGP, Royal College of Surgeons of England, Royal College of Physicians, Royal College of Paediatrics and Child Health, Royal College of Surgeons of Edinburgh, Medical Women’s Federation, Association of Anaesthetists, British Association of Physicians of Indian Origin, and Medical Defence Shield.

The letter highlights the conclusion set out in the Williams review that removing the GMC’s right of appeal would help to tackle mistrust of the regulator among doctors and help to build a culture of openness – and with it improved patient safety.

Fitness to practise cases

MPS president Professor Dame Jane Dacre said: ‘The strength of feeling on this issue from right across the healthcare community is clear to see. The GMC’s power to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS) has led to fear across the medical profession and a lack of confidence in the GMC.

‘It is also unnecessary as the Professional Standards Authority has the authority to appeal decisions. The GMC is the only UK health regulator that has such a right of appeal.

‘The government agreed that the GMC should be stripped of the power in June 2018, following the Professor Sir Norman Williams review into gross negligence manslaughter in healthcare. However, until the relevant legislative changes are made to the Medical Act, the GMC can and does continue to challenge decisions.

‘The government’s recommitment to removing the GMC’s right to appeal within the recent consultation on broader professional regulation reforms is welcome. It is however almost three years since it committed to making this change, and it should not be held up while a wide range of other complex proposals go through a round of further consultation.

‘Implementing this change as part of the forthcoming Health and Social Care Bill would give the profession confidence that their concerns and the recommendations of the Williams review are now being acted on.

‘There has never been a more important time to address this shortcoming. COVID-19 has sparked discussion about the extent to which individuals should be held to account when working in pressurised and extreme circumstances, and now more than ever, the regulator needs to be able to operate in a way that instils confidence amongst patients and doctors.’

A GMC spokesperson said: ‘We have made it clear that we are not opposed to this decision [to remove the power of appeal]. The government will decide how and when to bring in these changes. As the Williams review acknowledged, we have used these powers proportionally. To protect the public we will continue to use them while our legal obligation to do so remains in place.’

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