Extensive lessons for the GMC to learn from Dr Arora’s case
Dr Arora is a General Practitioner who was alleged to have engaged in dishonest conduct which formed part of the GMC’s allegations at a hearing before the Medical Practitioners Tribunal (MPT) in May 2022. She was alleged to have dishonestly claimed to the IT department at the service she was working for in 2020, that the medical director had emailed her and promised to provide her with a laptop. The MPT found this allegation alone proved, that her fitness to practise was impaired, and that she should be suspended for one month.
The determination and sanction imposed led to widespread anger and criticism across the profession about the GMC’s handling of the matter. Concerns were raised regarding why the case had been referred for a hearing, the possibility of bias regarding Dr Arora’s ethnicity, and imposition of an overly harsh sanction. The case and its outcome were seen as once again showing ‘a regulatory process lacking in fairness; of a system in which the stakes seem much higher if you are a black or ethnic minority doctor’.
Dr Arora’s representatives lodged an appeal at the High Court which the GMC did not contest. The High Court Judge quashed the MPT’s determination on the facts and therefore their determinations on impairment and sanction as well.
The GMC then announced a review of the case and Professor Iqbal Singh CBE and Martin Forde KC were appointed as co-chairs.
The co-chairs published their report in November 2022 which highlights that there were missed opportunities at several stages of the investigation process which should have prevented this case from being taken all the way to an MPT hearing. The report makes a series of recommendations for the GMC to act upon at each stage of their investigation process which are summarised below.
The referral stage
The report found that there was, ‘…no evidence to suggest that the GMC advised the referrer to consider raising their concerns with Dr Arora’s RO in the first instance.’ The report recommends that in cases where there is no immediate risk to patient safety, the GMC should promote a “local resolution first” culture via their GMC Employer Liaison Adviser (ELA) or RO.
The decision to promote the investigation
The report noted that the GMC’s investigation plan did not encourage the identification of aims and priorities. It states that, ‘providing clarity about the purpose and scope of an investigation from the outset can help ensure the GMC only take forward allegations which meet the appropriate threshold.’ The report recommends that the GMC review its investigation plan guidance to consider whether it should include more about the aims, priorities, and scope of an investigation.
The point at which allegations are put to a doctor for their response (Rule 7)
At this stage in Dr Arora’s case the GMC had misgivings about the allegations in the Rule 7 letter and whether these amounted to serious misconduct (although these were not shared outside the GMC). The report agreed with these misgivings and recommended that the GMC do more to embed a culture of professional curiosity and consider developing an escalation process to ensure concerns about cases are raised at the right level.
The case examiner decision
The report found that the GMC Case Examiner incorrectly applied the legal test for dishonesty and was wrong to conclude that Dr Arora’s actions could be said to be objectively dishonest and therefore it should not have been referred to a hearing. In summary, the report recommended that decisions are set out in full with a robust analysis of all available evidence, and that the GMC should consider its guidance in relation to low-level violence and dishonesty and whether it provides sufficient flexibility to decision makers.
The legal team’s input, including instructions to counsel, and counsel’s input before the tribunal hearing; and the presentation of the GMC’s case at the tribunal hearing
The GMC had not asked its barrister to consider the overall merits of the case. The report recommended that barristers should be asked to consider this. It also recommended that the GMC should consider its guidance on the process for drafting sanction submissions to ensure that they include the necessary evidence for an informed decision. The report found that there were multiple missed opportunities for the barrister to stand back and look at the case again.
The authors’ views on communication; fairness, equality and bias; and cultural competence and diversity intelligence
The report noted the changes the GMC has made to its referral process in this regard, but recommends that the GMC develop a programme of training, leadership messaging, and frameworks to ensure decision making processes are fair, consistent, and free from bias. The report also recommends that the GMC embeds a culture of understanding in relation to cultural awareness and sensitivity, and that cultural intelligence (the report defines this as, ‘the ability to understand and deliver fairness and equality while considering cultural diversity’) and cultural competence are built into its processes. The report also states that the GMC should focus on seeking out bias rather than looking for assurance that it does not exist.
The authors’ views on compassion and support
The report recognised the severe detrimental impact the lengthy investigation process can have on practitioners. The report recommends that the GMC consider whether the level of support it offers to doctors in the fitness to practise process is sufficient, and that the GMC should encourage medical defence organisations to improve the support they offer during and after an MPT hearing and encourage ROs to ensure local pastoral support is provided. The report also recommends that the government accelerate legislative reform for healthcare regulation which would allow the GMC to agree consensual disposal of appropriate cases.
What does this all mean for doctors?
The report recommends that compassion should be a key component of the regulatory process. If the recommendations of the report are fully implemented by the GMC and by extension other healthcare regulators, it should bring an end to cases such as Dr Arora’s being subject to full GMC investigation and erroneously referred to a full hearing before the MPT.