Comment: Mastery is a blind alley



“Since, moreover, he cannot renounce mastery and become a slave again, the eternal destiny of masters is to live unsatisfied… ” The Rebel: An Essay on Man in Revolt by Albert Camus


 

You could almost sense the relief at the GMC after Professor Norman Williams’s rapid review on Medical Gross Negligence Manslaughter reported back in June.

But if his findings temporarily lowered the heat around junior Dr Hadiza Bawa-Garba’s striking off by the High Court, her successful appeal in July placed the regulator in whose name the prosecution had been fought, and its Chief Executive Charlie Massey, firmly back on the hotplate.

Scrutiny now falls on the decisions which led the GMC to drag the young paediatrician through the courts in February, a course of action which placed it on a collision course with its own tribunal, the MPTS, which had earlier found her fit to practise.

At the time, then secretary of state Jeremy Hunt tweeted that he was “totally perplexed” by the GMC’s decision to appeal its own independent tribunal’s proposed sanction of Dr Bawa-Garba’s Medical Licence.

He commissioned the Williams review, to which HCSA was a contributor. Its report was published on 11th June.

In an earlier interview with Pulse magazine, Massey claimed he himself was “perplexed” that Hunt was perplexed and commissioned his own separate review, originally chaired by Dame Clare Marx.

Thus, the GMC potentially finds itself in a spiral of misunderstanding and conflict with Williams, its own MPTS, and the profession it purports to regulate. 

Although Massey has begrudgingly issued an apology to the profession over the case, conspicuously absent has been any acknowledgment that the GMC was simply mistaken in the decision to appeal its own tribunal service.

Instead, he has maintained that the GMC had taken “legal advice” which apparently mandated the appeal to the High Court. To date Massey has not elaborated as to why the GMC was so legally compelled.

Freedom of Information requests show that the “advice” was prepared at a cost of £2,000 by Ivan Hare QC, who then went on to represent the GMC in the High Court hearing.

The same FoI request shows that the decision to proceed was taken at executive level by Massey alone, without reference to the GMC Council, of which Professor Terence Stephenson is chair.

It was also taken, despite the potential significance for the entire profession, without seeking a second independent legal opinion.

If this unilateralist approach to such an important matter is shocking, the tone of the assault levelled at Dr Bawa-Garba in pressing home the GMC case was more so.

Even at the appeal hearing in July the regulator’s defence of its position, put forward by Hare, amounted to a personal attack on the doctor and her integrity, in stark contrast to the more logical arguments put forward by her QC which ultimately won the day.

Perhaps Massey’s political ineptitude, and a seemingly “star struck” attitude to a single barrister’s opinion, reflects the fact that he lacks an understanding of his role as the head of an independent regulator.

Instead of seeking to resolve matters by offering to resign from his lucrative post, allowing a fresh start, Massey has responded by stating that the GMC is a “creature of statute” which finds itself trapped in a framework of outdated legislation with no flexibility to act.

This position is contradicted by the commissioning of the Marx review, now led by Professor Leslie Hamilton  after its previous lead was appointed the next GMC chair. One must assume that this review has been briefed to find the legislative and operational flexibility which Massey and the GMC have as yet failed to identify.

With Dr Bawa-Garba’s appeal successful, it is time to reflect on the position in which Massey has landed himself and the GMC, and our response as a professional association representing all grades of hospital doctors.

Massey has been GMC chief executive and registrar since November 2016. He was a career civil servant, having previously worked in the Treasury, Cabinet Office, Department for Work and Pensions, Pensions Regulator and the Department of Social Security. He was then director general for strategy and external relations at the Department of Health.

He came to prominence to the medical profession in February 2016 after a particularly unconvincing performance as Hunt’s stand-in at a parliamentary select committee hearing, widely shared on social media, examining workforce proposals for a 24/7 NHS.

Massey’s GMC salary is between £230,000 and £235,000 per annum. He also receives a defined contributory pension worth 12 per cent of salary. This generosity of salary and benefits may perhaps explain the gilded cage in which Massey finds himself trapped.

It appears from the Bawa-Garba controversy, and other recent cases, that Massey’s GMC has become over-dependent on the opinion of “experts” from both the legal and medical professions. This legalistic approach has created a culture clash in that the legal process often demands a “winner” and “loser,” when in fact the complex, team-based nature of contemporary medical practice is far less black and white.

In his interview with Pulse magazine, Massey may have belatedly recognised this, but his response is to consider recruiting even more self-appointed “experts, this time in Human Factors”.

Whether Massey and the GMC can extricate themselves from this self-inflicted damage remains to be seen. HCSA believes the issue highlights the need for wider reform and consolidation of the regulatory sector.

It appears that few doctors would mourn the loss of the GMC, which has a lot of work to do to rebuild trust.

It remains to be seen if the current leadership can achieve this. What is for sure is that repeated “mea culpas” are not enough.

Dr John West chairs the HCSA Communications Committee.