Events in 1999/2000 focussed political and public attention on the question of who regulates and monitors the doctors. The statutory regulatory body, the General Medical Council, came under considerable criticism and was accused of protecting doctors at the expense of patients. Several high profile cases of badly performing doctors raised serious concerns:
In Bristol, two paediatric cardiac surgeons were struck off the medical register after it emerged that mortality from their operations was approximately double what would be expected. Approximately 30-35 babies are believed to have sufffered avoidable death; many more suffered substandard care and had substandard outcomes. Even though this had been known to the surgeons concerned for some time they continued to operate and were allowed to continue. The whistle was eventually blown in public by an anaesthetist at the hospital. An additional worrying aspect of the case was that his initial efforts to raise the matter internally and locally with regional heads of surgery and anaesthesia had met with considerable pressure to keep quiet. A public report into the case was published in July 2001. Amongst many observations was the fact that the doctors concerned, and the senior nursing staff, colluded in creating a club culture of fear that prevented the concerns of more junior staff either coming to light or being acted upon.
Harold Shipman was a single handed GP in Manchester who personally killed by lethal injection approximately 230 women of various ages for no obvious personal material gain. 3 patients died while in his surgery. His standardised mortality rates were statistically well above average and the anomaly could have been detected much earlier, if anybody had been bothered to look.
Rodney Ledward styled himself as the fastest gynaecologist in the South. His operative technique damaged hundreds of women - approximately 400 came forward - but he was not struck off by the GMC until September 1998, long after the details of his case were publically known. A report (The Ritchie Report) was commissioned to examine why the problem had gone undetected or unaddressed for so long, and this reported in June 2000. One of its key findings was that staff who might have voiced or who did voice concern had been intimidated by his consultant status. The Secretary of State for Health (Alan Milburn) promised to end the 'Consultant is King' culture. The BMA retorted that the days where Consultants chose to behave like gods were long gone. Sir Lancelot Sprat was unavailable for comment, but was believed to be still working in any number of teaching hospitals around the country (see Bristol, above).
Richard Neale was another UK-originate Gynaecologist who was struck off the Canadian medical register in 1985 following the deaths of two patients. He subsequently returned to the UK, where he was then allowed to practise normally as a Gynaecologist despite his Canadian judgement. In 1995 he was given a large sum of money and a clean employment reference to leave the hospital where he had been working for the previous 10 years, after concerns were raised internally about his performance. The hospital did not raise their concerns with the GMC at that time. Only in 2000 did he eventually appear before the GMC, charged with 35 counts of clincal incompetence, following which he was struck off the UK medical register.
Following the Bristol case the GMC began to accelerate its proposals for reaccreditation of doctors, however by June 2000 it was clear that their proposals were not percieved as sufficient and in any case were not being implemented fast enough. There are proposals for an annual reaccreditation system to be set up within the NHS as an employer, and outside the direct control of the GMC. Meanwhile the medical press has been openly voicing concerns that the GMC is clearly failing to protect either patients or the reputation of doctors as a profession. The GMC has responded by decreasing the size of its governing committee from an unwieldy 130 members to a slimline 35, opening a new disciplinary hearings tribunal office in Manchester, and tripling the annual cost to doctors of being on the register.
February 11th 2003
Dr Jeremy Rogers MBChB (Manc), MRCGP, DRCOG, DFFP, GP(T)
jeremy@cs.man.ac.uk
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