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Bawa-Garba case: was the GMC biased?

Medicine Balls

Phil Hammond

Thursday, 22 February 2018

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Doctor_AdobeStock_68403276_v2.jpg“Is the General Medical Council racist, or just wrong?” It’s a question on many doctors’ lips following the pursuit, blame and permanent professional erasure of Dr Hadiza Bawa-Garba who did what many thousands of doctors have done before her, and misdiagnose sepsis whilst under enormous pressure, leading to a tragic and potentially avoidable death. One such doctor who has openly admitted to the same error is Sir Graeme Catto, who rose to become President and Chair of the GMC until 2009, without the inconvenience of being struck off on the way.

In his latest blog, Chris Preece described Dr Bawa-Garba’s circumstances which created the perfect storm for serious errors. With a safely staffed team around her, these errors would likely have been checked and corrected.

Jeremy Hunt sees himself as a champion of patient safety. Indeed, the 2015 Tory manifesto promised that the NHS “will offer you the safest and most compassionate care in the world”. Hunt must now act urgently to legislate for mandatory safe staffing and skill mix, time-limited shifts and compulsory breaks for acute and emergency NHS care - even if routine care has to be postponed as a result. A plane would be grounded without the right staff to fly it and a safe number of passengers on board. But every day in the NHS patients die because of staffing gaps and a lack of beds to cope with the demand.

Hunt talks a lot about ‘zero avoidable harm’ in the NHS and ‘zero in-patient suicides’ but his track record on the essential safe staffing to support this is poor. The NHS provides widespread exceptional care but its recurrent weakness is that it has had, for decades, far fewer staff and beds per head of the population than other comparable countries. If the government was serious about safety, it would have invested in increasing staff numbers far sooner, and expanded bed numbers so that hospitals are not dangerously full every winter with patients dying because they can’t access prompt emergency care. A brave Hunt would have supported legally enforceable safe staffing and skill mix rotas long ago. Instead, the safe staffing work of NICE was side-lined and Hunt blundered into a highly damaging war with junior doctors to try to stretch them across more weekend shifts when they argued there were already far too many dangerous gaps in the rotas on weekdays and more staff (and beds) were urgently needed. The winter crisis shows how right they were to speak up, but the striking off of Dr Bawa-Garba by the GMC may drive them back to secrecy and cover up, fearful that telling the truth will leave them hung out to dry.

In this particular case, the GMC argued that despite the context of the challenging working conditions, Dr Bawa-Garba was found guilty of gross negligence manslaughter and this should automatically mean that she should be struck off to ‘restore public confidence’. In fact, there is no law that says a doctor guilty of manslaughter has to be struck off, and with a different defence team Dr Bawa-Garba may succeed in her appeal. On the matter of ‘public confidence’, it’s hard to understand how the GMC allows convicted gropers and fraudsters to return to or remain on the register, but strikes off somebody who was admitted to serious but very human errors, as we are all professionally bound to do.

Doctors work in teams, but are struck off as individuals. The death of Jack Adcock is a team error, for which Dr Bawa-Garba’s consultant and employer should be equally accountable. By pinning the blame on an individual in such a public way, the GMC has shown a shocking lack of understanding of safety science, the current culture and working conditions of junior doctors, and what effect this is likely to have on the morale, recruitment, retention and candour. My guess is that those hard-to-recruit-to emergency specialties just got a whole lot harder. And some doctors may just walk away from a shift rather than cover absent colleagues and rota gaps because of unacceptable risk both to their own well-being and their patients’ well-being. Only when units have to close-down due to lack of staffing will the message get through to the government.

As for the charge of racism, the British Association of Physicians of Indian Origin (BAPIO) certainly believes the GMC has a case to answer. It writes: “Given the published data that BME doctors are three to five times more likely to get GMC public warnings and restrictions compared to white doctors, we find it hard not to come to the conclusion that Dr Bawa-Garba’s pursuit by the GMC reflects the inherent bias that exists within the GMC which treats BME doctors differently and harshly.” If Dr Bawa-Garba had been a white man, would this case ever had happened?

Author's Image

Phil Hammond

Phil is a GP, writer, comic and broadcaster and been a lecturer in medical communication at two universities. He has been Private Eye’s medical correspondent since 1992 and a regular guest on several shows including Have I Got News for You and Countdown. He presented five series of Trust Me, I’m a Doctor on BBC2 and his Radio 4 sitcom about GPs struggling with the NHS reforms - Polyoaks - has been re-commissioned for a second series. Author of three books - Medicine Balls, Trust Me, I'm (Still) a Doctor and Sex Sleep or Scrabble? - he also has two DVDs. Phil launched a website to encourage NHS staff, patients and relatives to speak up when they come across poor care. He had a passionate argument with Andrew Lansley on BBC 1's Question Time, describing the Health and Social Care Bill as 'unreadable' and '358 pages of wonk'.
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