The General Medical Council (GMC) has pledged to act upon recommendations made by its most recent internal review into how it "monitors for and mitigates against bias in its decision making". The doctors regulating body said the 23 recommendations "are now being taken forward, with some already in progress".
The 27-page report follows a long series of controversial decisions by the GMC – many of which were followed by their own dedicated reviews – that resulted in extensive criticism of its handling of fitness to practice cases, which led to multiple accusations of racism and saw the regulator labelled as 'dysfunctional' and 'not fit for purpose'.
The internally commissioned review, to which the GMC said over 40 GMC and Medical Practitioners Tribunal Service (MPTS) staff substantively contributed, with an additional 900 "colleagues" that contributed via surveys, focus groups, team meetings, and one-to-one interviews, made recommendations covering five main areas:
- A more consistent approach to the GMC's auditing of the fairness of its work, including seeking more external feedback
- Increased consistency across the organisation, with the introduction of a single set of decision-making principles
- Equality, diversity, and inclusion (EDI) training for GMC staff to be tailored across different roles
- More detailed data about GMC fitness to practise processes to be published
- Ensuring fairness and EDI are embedded into the way the GMC operates in future, when the Department of Health and Social Care introduces a new regulatory framework for healthcare professionals
Bias 'Inherent in Human Nature'
Report author Laura Harding, regulatory fairness lead at the GMC and chair of the Deptford Allotment and Gardens Association, said on its release: "All humans are biased in some way, even if they are not always aware of it. It is our responsibility to look for the risk of bias in our work and to mitigate it. I am heartened that many of the improvements we identified are already being implemented, and the GMC has made firm commitments to act on the others.
"All of us in an organisation such as the GMC make decisions, and no matter how big or small they are they each have an impact. Managing the risk of bias in those decisions is vital, and will result in fairer decisions for everyone who interacts with the GMC."
GMC Chief Executive Charlie Massey commented: "This was a comprehensive review of processes and decision-making across the GMC. We are already implementing many of its recommendations, and work on others will follow as part of our ongoing commitment to equality, diversity, and inclusion, and to learning from recent cases.
"A degree of bias is inherent in human nature, and so a fundamental principle of our approach is to look for the risk of bias and to assess the controls we have in place to manage it. The recommendations in this report are key to that."
Background of Past Cases
Explaining the background to the latest review, it acknowledged that in June 2021, an Employment Tribunal had upheld a claim that the GMC had racially discriminated against surgeon Omer Karim in a fitness to practise case. The new review, however, noted that the GMC had been "granted permission to proceed with an appeal".
That case, in turn, followed the Court of Appeal ruling against the GMC in August 2018 in the Dr Hadiza Bawa-Garba case, involving a paediatrician whom the GMC sought to strike from the medical register following her conviction for manslaughter of a patient.
When the MPTS rejected the GMC's request, accepting Dr Bawa-Garba's plea that the unit was under severe pressure and she had failed to receive senior support, the GMC lodged an appeal. This led to a campaign against the GMC's right to appeal MPTS decisions, followed by two subsequent reviews supporting that conclusion.
Last month however, it was reported that nearly 5 years on, the GMC continues to appeal MPTS decisions. Figures suggested it had enacted at least 23 such appeals since the Government committed to ending the practice in June 2018 – the most recent in December last year. The GMC blamed the Government's failure to enact the appropriate legislation, although it has recently promised a "more compassionate approach" to investigations.
GMC Will 'Actively Seek Out Bias'
Ms Harding's new review said: "The actions will ensure the GMC actively seeks out and addresses any potential bias in its processes." This was the key recommendation following the case of Dr Manjula Arora, suspended following allegations that she had "lied to obtain a laptop".
That case ultimately hinged on the fact that when Dr Arora , who is not a native English speaker, asked for a laptop for work purposes, she was told her interest was "noted", which she took to mean that one would be forthcoming. When she asked again, she told local IT officials that she had been "promised" one – and this resulted in her being found dishonest and suspended for 1 month, a sanction overturned after protests.
The independent review that followed, published in November last year, noted that the case had caused "significant anger and anxiety among the medical profession" and concluded that the GMC had "missed multiple opportunities" to assess whether the allegations were serious enough to be referred to a tribunal.
It resulted in the GMC issuing an apology for its handling of the case and promising that similar cases would become 'never events'. Mr Massey said that the GMC accepted all of the review recommendations "without reservation".
At the time, in an opinion piece published in the BMJ, Dr Kamran Abbasi, BMJ editor in chief, said that the "standard playbook" of the GMC was "to express regret, vow to change, and, behind the public façade, continue with business as usual". He warned that the GMC had "promised reform time and again", yet successive GMC leaders had "failed to deliver" on the recommendations of multiple reviews and inquiries.
Responding to GMC review and promise, Dr Latifa Patel, BMA equality lead, said: "This review acknowledges that bias in the GMC exists and needs to be systematically challenged, rather than simply looking for reassurance that it doesn’t. This change in approach is to be welcomed.
"We have been campaigning for reform of the GMC for years so it is good to see it moving away from repeatedly comforting itself that there is no evidence of bias in its decision making processes," she added. "Only time will tell if the actions set out today to mitigate against bias and provide greater transparency and reassurance will be effective and improve doctors’ confidence in their regulator. The review rightly highlights the need to involve stakeholders such as the BMA in future audits."
"We will continue to monitor the GMC’s progress and press for improvements until we have a regulator worthy of the full confidence of UK doctors," she said.
