GMC Exposed

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Not Fit to Practice
By A Human Rights Advocate

Ms X describes her experience of the General Medical Council UK

The General Medical Council UK (GMC) is to lose its powers of self-regulation but we must wait to see how genuinely independent the new setup will be.

The public has been 'reassured' by the Department of Health and the GMC itself that the several tweakings in past few years would lead to the GMC being capable of acting in the public interest rather than as an effective protective body for failing doctors.

It clung on to the assertion that it could act as both judge and jury despite many public and many less reported scandals.

The 'screeners' (currently case examiners) appointed by the GMC Fitness to Practice Teams have much to answer for. It has not been just those at the top levels of the hierarchy but those who went along, sheep-like, with a culture of arrogance towards those who in good faith, have raised concerns about practice.

Years ago the GMC would not even consider cases referred by advocates if these screeners deemed they did not amount to 'serious misconduct' and therefore would not lead to practitioners being 'struck off' the register. This stupidity encouraged a drip effect whereby some members of the medical profession took an abusive, arrogant attitude themselves, towards the lack of power of the GMC to regulate effectively.

Over the years the GMC has cottoned on to the fact that they needed to act on 'concerns' rather than simply 'complaints'. This was a huge step forward but in my experience led mainly to admonishments being handed out in the form of letters advising changes in practice. These were weak and enabled some members of the particularly psychiatric-psychotherapy profession and their member organisations to 'cock a snook' at the GMC.

However the GMC colluded in this as they were very aware that cases referred to them for breach of GMC Guidelines, and in particular with reference to using people for research and publication, had led to at least seven successful 'concerns/complaints' being addressed by these letters of advice.

They were obviously aware that they did not prevent further abuse of individuals rights to privacy; informed consent; confidentiality as enshrined in GMC Guidelines; Data Protection; Common Law Rights to Privacy; Human Rights to Privacy - to say nothing of the expectation of being treated with common decency and integrity in any relationship but especially where the power differential can be used to abuse trust.

One of the most blatant abuses of public trust involves the Royal College of Psychiatrists and the GMC's handling of a case against a psychiatrist-psychotherapist Ms A.

After initially claiming that she had gained consent for a study involving the so called lack of mothering skills shown a group of women and the subsequent publication of that sensitive information without informed consent, Ms A admitted there was no evidence to support her claim that she did obtain consent. Despite using a medical defence lawyer she was admonished by the GMC to change her practice. They admitted she was in breach of GMC and other guidelines.

The case was raised as a 'concern' rather than 'complaint' but was dealt with as a 'complaint'. This demonstrates that the GMC did acknowledge her case as being serious.

A few months later though Ms A was appointed to the Fitness to Practice Panel of the GMC. The College of Psychiatrists were aware of the GMC decision against her as obviously were the GMC yet she has been sitting on the Fitness to Practice Panel for several years until she has resigned recently.

This resignation has occurred after the attention of the GMC was drawn to Ms A's appointment to a College Ethics Committee. It was totally inappropriate. The GMC claimed that they had no jurisdiction over her appointment to a College Ethics Committee. The College would not state whether those who appointed her knew of the GMC decision against her.

The GMC team handling the concern about her fitness to sit on an Ethics Committee did not admit that Ms A was in fact sitting on the Fitness to Practice Panel. More recent enquiries reveal that she claims she decided herself to sit down from the Panel whilst her (second) case was being judged. This though, it seems, was not even a statutory requirement of the GMC.

The attitude of the GMC initially was that there could be a case to answer.That they stated this so early on in the proceedings is unusual. However once they realised that Ms A was actually sitting as a member of the Fitness to Practice Panel herself, their attitude became obstructive and lacking any transparency. Whether they realised she had been judged guilty of an offence previously, whether she had declared the offence at her interview for a place on the Fitness to Practice Panel, whether the College had encouraged her appointment to suit their own interests (although this is against GMC appointment guidelines) at what stage the GMC Team realised her offence can only be speculated upon as a GMC spokesperson refused to discuss the issue.

They also refused to state whether or not a record of the case is still held on file at the GMC. (A further copy will be sent as records of cases for obvious reasons, need to be on file). Ms A and all those in influential positions who colluded with her were let off the hook by the GMC.

This case was complicated by the fact that Ms A had for many years been a Trustee of an organisation which was set up in the first place to deal with abuse by psychotherapists. One of her fellow Trustees was an ex member of the BMA Ethics Committee and defended her all the way until she resigned from the Board of Directors - but only when the GMC decision was due finding her in breach of GMC Guidelines. All but one of the Trustees resigned but she hung on to the last partly because she no doubt believed her position and her colleagues in influential positions would protect her. They tried very hard and to some extent succeeded.

Ms A continues to practice, she is allowed to monitor and comment on the lives of vulnerable people who have no knowledge of her own background, she publishes on the subject of Ethics and continues to sit on various Committees which have some influence on other practitioners.

Over a period of twenty years a pattern did emerge - of resistance to proper investigation, of arrogant refusal by Colleges and Specialist Groups to submit to monitoring and independent complaints procedures. Collusion by colleagues especially those at the top end of hierarchies and in influential positions, and again the inability to adapt and change of those who had often been in entrenched positions they had come to believe were unassailable as long as they all stuck together.

The culture has changed, the public are more informed and will form networks to challenge abusive behaviour but there are still some in positions of influence now who have had either concerns directly raised against their practice or who have assisted those who have had concerns successfully addressed by the GMC and other bodies to be appointed to positions of prestige and influence.

The GMC has failed in the past; it has also been made a fool of by some of its members. Changes are being brought about partly because networks, campaign groups and whistleblowers can now get their voices heard through the net. That it took this sort of action to bring about changes to ethical practice is shameful but encouraging in that societies do demand and will fight for ethical practices. The current method of appointing members to the Fitness to Practice Panel is through open appointment, which is handled by the Fitness to Practice Development Team. (See below) Readers can judge for themselves how many loopholes this leaves with regard to truly protecting the interests of both public and doctors.

EMAIL FROM THE GMC

Subject: FW: 2nd request for information
Date: Mon, 26 Mar 2007 15:55:51 +0100

Panellists are appointed to sit on the Fitness to Practise Panel following an open competition. The GMC engages a recruitment agency to carry out the administrative functions. An independent assessor from the Office of the Commissioner for Public Appointments monitors the process to ensure consistency.

Panellists may be either medical or lay. Medical panellists are doctors i.e. they hold a medical qualification. A lay panellist is an individual who does not hold, and has never held, a medical qualification.

Posts for medical panellists are advertised in the BMJ, GP, Hospital Doctor and on the website of Doctors. Net. Lay posts are advertised in the national press (Sunday Times, Guardian, Scotsman, Western Mail and Belfast Telegraph). In addition, all panellists' posts are advertised on the websites of Black Britain, the Ethnic Professional Network (EPN), executivesontheweb.com and the Association of Disabled Professionals. In the most recent recruitment round for lay panellists the posts were also advertised on the website of Women in Banking and Finance and on the Public Appointments Unit website.

The application papers make clear the key competencies required of panellists. I attach a copy of the person specification used in our most recent recruitment round which sets out what those competencies are.

The recruitment agency carry out a structured/competency based evaluation of each application. The results of that evaluation are presented at a Sift meeting the purpose of which is to identify the candidates to be invited for interview. The process ensures that those invited for interview are the applicants who most closely fit the person specification but it also enables the Sift meeting to have regard to the need for balance in terms of diversity, skills and experience.

Applicants invited for interview are asked to arrive one hour before the interview to read and consider a case study that forms part of the interview. The interview explores the applicants' competencies. In order to ensure consistency all those involved in interviewing candidates attend a half-day briefing session at which the questions to be asked are discussed and steps taken to ensure that the scoring criteria are understood. Applicants who are successful at interview are considered suitable for appointment subject to satisfactory completion of training. That training takes place over three days during which the applicants are assessed. Only those who successfully complete the training are appointed.

Appointments are for a period of four years, or until a panellist reaches the age of 70, whichever is the sooner. Panellists may be appointed for a second term of office, provided they are assessed as suitable for reappointment. Further on going training is provided to panellists each year to ensure they are up to date with recent developments, including key judgments made by the Courts which impact on how panels are required to undertake their functions.

The decision as to which panellists sits on a particular case is based largely on the availability of panellists but factors such as ethnicity and gender can also affect empanelment as we aim to ensure diversity in terms of gender and ethnicity.

I hope this provides you with the information you require

Person specification

Anyone appointed must exercise their responsibilities in judging cases as individuals, not as representatives of other organisations.

Successful candidates must be able to make thoughtful and unbiased decisions in the context of the GMC’s jurisdiction, which is both to protect patients and to act in the wider public interest. In particular, this will require:

a. Genuine interest - the ability to demonstrate a real interest in the work of Fitness to Practise panels with the desire to make a significant contribution to enhance the public/professional perception of the GMC and ensure a fair and transparent process that protects the patient.

b. Intellectual and analytical ability - the ability to concentrate for long periods of time, to understand and assimilate complex facts and arguments. They must also be able to recall such evidence and information speedily and accurately.

c. Sound judgement - the ability to exercise discretion effectively, to work within the statutory framework, to apply the Council’s policies and follow the guidance issued, whilst being able to differentiate and weigh up competing arguments and draw sound conclusions capable of justification under close scrutiny.

d. Decision making - an ability to make important and difficult decisions on highly sensitive matters within tight timeframes, whilst ensuring judgment is not swayed by personal bias or interests but instead to ensure that decisions are based on evidence;

e. Work with others - the ability to argue a coherent position; when taking a different view from other members of the panel to challenge constructively and to arrive at shared and balanced judgements on contentious issues.

f. IT literacy – both general familiarity with the hands on use of IT and the ability to access websites and communicate by email, sending and receiving communications with attachments (some being Adobe pdf files).

g. Confidentiality - the understanding of confidentiality in relation both to evidence and to the panel’s deliberations, and to be committed to it.

h. Communication skills - excellent communication skills, both oral and written, and be able to express themselves clearly and succinctly

i. Commitment to Equal Opportunities - an understanding and appreciation of, and a commitment to, the principles of equal opportunities and diversity with a non-discriminatory approach to cultural communication differences, with an appreciation of the issues faced by marginalised groups.

j. Integrity - this quality includes generating the trust, confidence and respect of others and also dealing impartially with all matters raised during panel hearings. Those appointed must be people of demonstrable integrity with a commitment to follow the Principles of Public Life as drawn up by the Committee on Standards in Public Life

k. Sound temperament - the qualities expected of successful applicants include remaining patient, tolerant, even-tempered and courteous.

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