After the Hooper Review and UHB: GMC’s wider system for identifying rogue employers

Dr Minh Alexander retired consultant psychiatrist 1 May 2023

The ongoing scandal at UHB has helped to highlight an engineered injustice against the NHS workforce: a lack of protection against arbitrary discipline.

It is a political instrument of control and helps to serve whatever master is in power. Workforce intimidation can help to hide failures of policy and lack of resources.

In the last thirteen years, we have seen particularly extreme manifestations of this suppression, especially during the pandemic, and we now see unprecedented NHS strikes as a point of no return is reached in government’s ransacking of the public purse and public services.

I hope the letter below to the CEO of the General Medical Council pressing for active measures to identify rogue employers who abuse referrals to the GMC as an improper way to punish doctors, sometimes whistleblowers, is self-explanatory.

LETTER 1 MAY 2023 TO CHARLIE MASSEY CEO GENERAL MEDICAL COUNCIL

BY EMAIL

Charlie Massey

Chief Executive

General Medical Council

1 May 2023

Dear Charlie,

After the Hooper Review and UHB: GMC’s wider system for identifying rogue employers

I write to ask about the General Medical Council’s systems for early identification of rogue employers and thus for protecting doctors from abuse by such employers.

At University Hospitals Birmingham NHS Foundation Trust it has emerged that the consultant body raised a concern with the trust board about cronyism at every level of medical management.

Obviously this would be a grave issue both in terms of safe working environment for doctors and patient safety, as it would create an atmosphere that is unconducive to raising public interest disclosures and it would more likely result in arbitrary treatment of any doctor who raised concerns.

Unsurprisingly, alongside the concerns about cronyism affecting UHB medical management, there have also been reports of arbitrary application of discipline and rapid escalation of disciplinary procedure and GMC referrals.

UHB last year issued inaccurate FOI data about its pattern of GMC referrals and outcomes which caused alarm.

From December 2022 onwards I made several requests for corrected data, after I noticed that UHB’s FOI response could not be true.

The trust has now corrected the record and claimed that these are the true facts:

RESPONSE BY DAVID BURBRIDGE, UHB CHIEF LEGAL OFFICER, 13 APRIL 2023

Dear Dr Alexander

Please find below a response to your email to Dame Yve Buckland, dated 29 March.

For the period 1 April 2012 to 31 March 2022:

– How many doctors the trust referred to the GMC ?

At UHB (prior to and post the merger with Heart of England NHS Foundation Trust (“HEFT”)) there were 22 referrals

At HEFT (prior to the merger with UHB) there were 16 (3 of these are dated just after the date of merger 1.4.2018, but are attributed to HEFT – we believe this may be because there was contact before the change of RO)

– How many of these referrals were signed off by the medical director?

At UHB 14/22, the remainder were signed off by Deputy Medical Director or acting Medical Director
At HEFT 6/16 were signed off by the Medical Director and the remainder were by Deputy or Associate Medical Directors.

– How many of these referrals resulted in no further action by the GMC?

UHB – 4 were concluded at triage, 7 were investigated and concluded with no action, 11 were subject to advice, warning, undertakings, suspension or erasure HEFT – 3 were concluded at triage, 4 were investigated and concluded with no action, 9 were subject to advice, warning, undertakings, suspension or erasure

– How many doctors died whilst under GMC investigation or monitoring?
None

– How many doctors died by suicide whilst under GMC investigation or monitoring?
None
Regards

David Burbridge
Chief Legal Officer

As you can see, this still leaves 18 out of 38 GMC referrals by UHB which ended in cases being dropped at triage or no further action being taken by the GMC, in a ten year period.

Information request

With respect to UHB:

I would be grateful if the GMC could verify if the most recent data supplied by UHB is indeed the correct picture.

Could the GMC additionally clarify in the 20 cases where it reportedly took action, in how many of these UHB cases did the action consist only of advice given to the referred doctor?

Where the GMC action comprised solely of advice given to the referred doctor, was a GMC referral really necessary or would a less formal and drastic route of addressing concern have been possible and/or preferable?

More generally:

What mechanism(s) does the GMC have in place, if any, to detect whether individual employers are making inappropriate or abusive GMC referrals?

What early warning signs does the GMC track, if any, to alert itself of poor employer practices with respect to GMC referrals?

Has the GMC estimated at national level what proportion of GMC referrals annually by employers are inappropriate and/or could have been dealt with another means?

If so, please give the total percentage of GMC referrals annually which the GMC believes could have been avoided.

What policies and strategies does the GMC have in place to address inappropriate referrals, and how does it measure the effectiveness of these policies and strategies?

What quality indicators does GMC monitor, if any, on each employer’s GMC referrals?

What comparative data does GMC collate centrally, if any, to track differences between employers’ behaviour, in terms of quality and outcomes of GMC referrals?

Can the GMC, based on its current systems and data collection, tell whether some employers are outliers in terms of higher rates of GMC referrals which end in no case to answer, no further action, or only advice given?

Does the GMC collate central data on whether it raises concerns with individual employers about poor referral practice or gives formal warnings to individual employers and medical managers about poor practices such as vexatious GMC referrals or GMC referrals which are suspected to be vexatious?

Has the GMC in the last five years disciplined any senior doctor for abusing power and vexatiously referring a doctor under their line management to the GMC, for example, by carelessly or knowingly making a false allegation?

If so, on how many occasions has this happened and what was the GMC sanction(s) applied, for example, undertakings, warning, suspension or erasure etc?

If the GMC currently has no system for tracking poor GMC referral practice by individual employers, and for publishing such comparative data, will it give consideration to doing so in future?

If the GMC does currently track this data but does not publish it, will it give consideration to doing so in future?

Will it also consider a change to Good Medical Practice guidance to specifically make it a proscribed practice for doctors in leadership positions to carelessly or knowingly make unsubstantiated or false GMC referrals or PPA referrals on doctors whom they manage?

Lastly, GMC previously kindly shared a status update on its Hooper implementation project. Could it do so again?

I copy this to Mr Reuser and to Mr Watkinson who as the GMC will be aware, were proven to have been mistreated by UHB. They were referred to the GMC based on very flawed governance processes. This included UHB supplying NCAS (now PPA) with false information.

PPA has since kindly changed its processes, and is now considering strengthening more processes. I hope GMC will do the same.

I am aware of other doctors who have been referred by UHB to the GMC under contentious circumstances, and I hope they will in due course have some resolution of their issues.

As you will know only too well, a GMC referral is a massive upheaval in most doctors’ lives and will cause the majority huge distress and major health consequences. This will be compounded when the referring employer acts in bad faith and is not only unsupportive but actively persecutory.

I also copy this letter to Chaand Nagpaul who is on the external reference group for the ongoing reviews into UHB’s governance.

With best wishes,

Mr Tristan Reuser

Mr John Watkinson

BBC Newsnight

Nancy Cole ITV