Wednesday, 20 April 2011

Prof. Charlotte Humphrey, GMC, and Ethnicity of Doctors' Fitness to Practice

Professor Charlotte Humphrey et al. published in BMJ an article with the title:

Place of qualification and outcomes of UK General Medical Council "fitness to practice" process: cohort study. CLICK HERE TO READ

The title we wish we could see would be "Ethnicity of Doctors facing GMC Fitness to Practice Procedures" with reality based conclusion that there is ethnic discrimination before, during and after GMC Fitness to Practice procedures irrespective of place of doctors' qualification. If the authors had real commitment to study the relationship between ethnicity and disciplinary procedures they would have found ethnicity (not the same concept as race) of doctors for themselves. But not bovvered . But very educated.

I note with interest the failure to declare conflicts of interests in the article published by BMJ.
However, I investigated it. I could not identify any obvious conflicts of interests for Professor Martin C Gulliford and Ms Shaista Hickman the other two authors from my research on the internet.

However, in the case of Professor Charlotte Humphrey it is different even though she did sneak in the fact that she did audit on GMC in the main body of the article, i.e. in different context. So telling but not telling and just a little bit pregnant. You can find the fact that she worked for GMC in the part of the article titled: Meaning of study. Here it is:

" Another possibility is that inquiries ( this means complaints against the doctor sent to their regulator, General Medical Council) involving UK qualified doctors are assessed as being in some way “less serious” than those involving a non-UK qualified doctor with the same inquiry details. Against this suggestion, we note that an independent audit of recorded documentation about decisions on fitness to practise taken at the request of the GMC in 2007 by a team involving one of the authors (CH) found no evidence of assessment criteria being inconsistently applied. "

We could understand from this that GMC consistently applied discriminatory criteria. Wonderful.

Contrary to Professor Humphrey's claim in her so called independent audit there are procedures within GMC which support discrimination against, for example, locum doctors the majority of whom are of ethnic minority origin as well as doctors in private practise. The GMC policy to treat locums and those in private practise differently became officially part of the GMC policy since May 2004. Do they have insight, are they bovvered?

GMC also treats complaints from NHS management more seriously compared to those from members of public. It is simply more difficult to fight an organization than a vulnerable individual patient/relative/friend.

NHS management are also more likely to retaliate against locums, foreign doctors they do not have to face up to on a daily basis unlike consultants in substantive posts and against those who have no contractual protection like e.g. NHS (National Health Service) consultants. Eventually, it may have been hoped everyone would wish to be "safe" in a safe NHS permanent jobs and not give financial headaches to the management of NHS trusts.

Locum doctors are less likely to be well connected. In old boy network which now includes women sometimes, connections and sense of obligation do matter.

However, Professor Humphrey et al in their audit of GMC claimed that Stream 2 (less serious complaints) coming to GMC are referred back to employer in the case of those in private practise and locums. Most locums and those in private practise are self employed and GMC did not refer back to locums and doctors in private practise to sort out the complaints against them. Oh, no. Instead, they were taken up as Stream 1, serious complaints and investigated by GMC with no mercy whatsoever i.e in passive aggressive stance. Investigators were forced to investigate things that could have be done by someone else.

At that time Chief Medical Officer, Ian Donaldson had the idea idea that locums were more dangerous. No, he was not hospitalized for paranoid delusions or ideation and there is no evidence have that he ever had this problem. Locums just cost more as agencies have to be paid as well. It is more work asking for more money from treasury. The feeling of lack of control led to abuse of power and influence with disastrous consequences. Doctors careers were destroyed by GMC, some were bankrupted and some died. Seventy six doctors died in recent years during GMC investigations. However, this was not the measured outcome by Humphrey et al.

Professor Humphrey acted as the auditor of GMC, and was commissioned by them. The report some forty four pages long was titled; "External audit of decisions in the investigation stage of the GMC's fitness to practice cases" July 2007. CLICK HERE TO READ THIS REPORT On page four it tells you it was commissioned by GMC as an independent report.

GMC loved the audit report produced by Professor Humphrey et al in July 2007 and said to Council on 19-9-2007 6a paragraph 4 page 2:

"4. As members are aware, we have entered into a partnership with the Economic and Social Research Council (ESRC) to commission detailed research on medical regulation. As previously described to Council, the agreed research programme will address a number of issues relating to the GMC and fitness to practice and to the wider regulatory framework.

5. In the meantime, in December 2006 and with the agrement of the Fitness to Practise Committee (FPC), we commissioned an audit of our investigation stage decision making from King's College London (KLC)
(This is where Professor Humphrey works). The aim being to give assurance to FPC and to Council that fitness to practise decisions were being made in accordance with Council's agreed policy. Some preliminary findings of that audit were reported to Council in July 2007, as part of the covering paper to the Annual Statistics. KCL's full and final report is attached at Annex A."

The paper by Professor Charlotte Humphrey et al. published in BMJ an article with the title:

Place of qualification and outcomes of UK General Medical Council "fitness to practice" process: cohort study. CLICK HERE TO READ was funded by ESRC.

Professor Humphrey worked as adviser for NCAS (National Clinical Assessment Agency), organization known to refer cases of foreign doctors to GMC without any investigations whatsoever. We would like to know what advise she could give them. This question arises especially on reading the "External audit of decisions in the investigation stage of the GMC's fitness to practice cases" July 2007 where it is claimed that doctors in private practice and locums are referred to their employer by GMC in the case of Stream 2 complaints (less serious). Impossible. Locum doctors and those in private practice are self employed. GMC, in fact, took those doctors straight up to Stream 1 serious complaints investigations prejudicing a lot of things.

The majority of locum doctors are ethnic minority doctors and they appear before GMC with increased frequency. Locums can be white race and a member of an ethnic minority and trained in UK. They could be instantly recognizable because of either their accent or surnames. This alone could be the starting point of victimization that progressed to sham peer reviews by GMC.

Researchers did not have proper ethnicity data.

Race and ethnicity are not the same thing. There are many ethnic groups within the same race. Ethnic discrimination is a reality that has to be faced up to.

It is usual practice when there is more than one author for them to declare their conflicts of interest individually at the end of the paper. That has not happened. Instead one is provided with a link to a blank form and information that reader can obtain the copy of their report of conflicts of interests if they apply for it. Yes, busy doctors would rush to do just that. Here is what it looks like:
  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that they have no non-financial interests that may be relevant to the submitted work.

What about financial interests?
What about these: "In addition to her university based research she has acted as expert advisor for a number of national bodies including the National Clinical Assessment Service, the Commission for Health Improvement, General Medical Council and the Bristol Royal Infirmary Public Inquiry" as on King's College website.

In other countries foreign doctors have been found to have performance equal or better than local breed in USA and Canada, for example. But not in UK according to GMC.

British Medical Journal is published by British Medical Association which failed to support ethnic minority doctors when they looked up to them for support.

Busy doctors reading "Place of qualification and outcomes of UK General Medical Council "fitness to practice process: cohort study." CLICK HERE TO READ could just read the title of the article and the conclusion and conclude there is no racism, there is just the place of qualification that matters. Please. Here is their conclusion:

"Inquiries to the GMC concerning doctors qualified outside the UK are more likely to be associated with higher impact decisions at each stage of the fitness to practice process. These associations were not explained by measured inquiry related and doctor related characteristics, but residual confounding cannot be excluded."

GMC receives complaints. It is supposed to conduct an investigation. Language does matter.

Paragraph 18 of this GMC document shows GMC treated locum doctors and those in private practice differently. Please click Here to read it.


Anonymous said...

There is historic bias against Locums who are undermined, treated more aggressively by the GMC and perceived only 'money minded'.I am aware some doctors have opted locum roles only because of unnecessary interference from the NHS Managers. Its not correct that they are poor performers. They, rather to compete harder in this current job situation which is possible if they show real competencies.

Anonymous said...

The only way to bring transparency in the UK Regulatory system is a radical reform of the GMC. Many people say GMC should be abolished, which i feel is an uphill task .If it happens it will be wishfull dream comes true.

I think a strong group of patients, carers, genuine voluntary organizations (n.b: some voluntary organizations work for the establishment and infiltrate only to get intelligence, so need to be cautious)and anonymised group of doctors may play a role.
Furthermore,any GMC discriminatory scandals should be highlighted in the media including Wikileaks.

I understand its a long process but cultural changes take a great deal of effort and determination.

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