Bow Group Health Research Fellow, Jon Stanley, responds to GMC decision on Dr Bawa Garba

The Bow Group considers the proper regulation of doctors to be essential to the confidence required of the medical profession. The General Medical Council through the Medical Act and other legislation is accountable to Parliament. Its authority is derived from Parliament.

The Bow Group has followed the case of GMC v Dr. Bawa-Garba with interest and dismay. The decision to remove her from the medical register today is extremely concerning and comes at the end of a curious chain of events.

Having been suspended over concerns of her practice a subdivision of the GMC, the Medical Practice Tribunal Service, noted:

“The events leading to Dr Barwa-Garba’s conviction did not take place in isolation, but rather in combination with failings of other staff, including the nurses and consultants working in the CAU that day, and in the context of multiple systemic failures which were identified in a Trust investigation.”

Furthermore it appears, quite extraordinarily, that on one of the wards where the boy she treated was cared for that parents gave their children medication, in this case a prescription only heart medicine. This medicine was not prescribed by Dr Barwa-Garba yet the court has decided she should have instructed the medicine not to be given.

I offer no legal opinion as that is not my qualification but from personal experience as a doctor a medicine cannot possibly be considered prescribed in hospital unless it actually is written so. Patient drug records are capable of noting if a patient has taken their own medicine or else any practitioner can record this both in patient notes and on the drug record.

I cannot fathom how one can be responsible for an action that is beyond one's control as it is beyond one's knowledge or ability to discover through patient documentation. I also cannot understand why the GMC, or a party within the GMC would seek the court's opinion having heard its own specialist panel's opinion.

Did this party believe MPTS judgement was invalid or unqualified? What was the driver that led an individual or a group within the GMC to pursue this case under Section 40A of the Medical Act? We cannot have individuals in regulatory bodies shopping for opinions to satisfy a desired outcome for this questions the objectivity and capacity of the GMC to self regulate. If it cannot, how can one expect any individual doctor to?

The use of formative reflective practice as summary evidence of competence and care is deeply troubling and undoes much of the MidStaffordshire inquiry's call for a duty of candour in the NHS. Competence during training is gradually acquired and mistakes are made both by individuals and of course by teams within systems. Reflective practice cannot function in any credible sense if it effectively leads to self prosecution for any error made.

The outcome is to inflict a penalty on a single individual, to destroy an otherwise flawless career on this chain events should chill every professional and indeed any member of the public. We all have a right to know our accuser and in this case it was clearly not the GMC as a whole. It has put back accountability of healthcare at least a decade by returning to the culture of shame the system but blame the doctor. It was this refusal to see systemic failures that led to so many deaths in Mid Staffs and Morecambe Bay amoung others and has led in a much less publicised manner to a cruel and needless assault on the mental health and financial viability of many doctors, for whom some it was too much to survive. 

The Bow Group notes that overseas and ethnic minority doctors are more likely to be struck off and that this shapes the public's view in such matters. It is imperative we stress this situation arises for a multitude of reasons beyond this article but that it must never used to weigh the merits of any particular case. 

Given the use of Section 40a to refer back to court following the opinion of MPTS and the injury this will inflict on the training and well being of doctors across the UK, in addition to the effective end of reflective practice as a training tool this matter must now be urgently examined by Parliament to consider amendments to the Medical Act and in particular to the decision to remove Dr Bawa-Garda from the register. The precedents unfolding by the hour require this matter redressed.

Thursday, January 25, 2018