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Medical
bias
The General Medical Council (GMC) deals more harshly with doctors qualifying
overseas than UK-trained doctors, according to a recent report by the Policy
Studies Institute. Dr Sherry Williams, a barrister and head of medical services
at the Medical Protection Society in London, talks to Veronica Cowan about that
and other areas of concern that the PSI report raises...
The General Medical
Council (GMC) is dealing more harshly with doctors qualifying overseas than
UK-trained doctors, according to a report by the Policy Studies Institute (PSI).
It found that, while the proportion of complaints received by GMC has remained
the same in the past five years, the proportion of overseas qualifiers appearing
at the Professional Conduct Committee (PCC) has steadily increased. It noted
that anomalies, such as disproportionate referrals of overseas qualifiers with
convictions and those in the dishonesty/criminality and dysfunctional personal
behaviour categories, mentioned in a previous report, remained.
The report also found continuing differences between the outcomes
of cases, with NHS doctors trained overseas being three times as likely to be
found guilty of a disciplinary offence than a UK-trained doctor, but states that
the factors determining this outcome could not be assessed without a detailed
analysis of the reasons for the decisions made. It said: "The main problem
in analysing the differences in outcomes between UK and overseas qualifiers at
all stages of the GMC fitness to practice procedures remains the fact that there
is no discernible common agreement on the criteria and threshold to be applied
in reaching a judgment on the seriousness or gravity of cases. This has led to
problems in ensuring consistency both within and between the different stages of
the GMC procedures".
So what is the typical procedure? Dr Sherry Williams, a barrister and head of
medical services at the Medical Protection Society in London, which acts for
doctors, explained: "The initial part is purely administrative, and
involves a decision on jurisdiction. About half of the 4,000 complaints cannot
involve the GMC because it can look only at complaints against registered
medical practitioners. The complaint is copied to the doctor for comment, and
replies are copied to the complainant".
The next stage, she explained, is that a medically qualified screener looks at
the complaint, and decides whether there is something that requires
investigation. The screener's memorandum saying why it is being sent forward is
with the file. "A lot will be thrown out at that stage. If there is a prima
facie case of serious professional misconduct, the papers go before the
Preliminary Proceedings Committee (PPC)".
The PSI report identified this part of the procedure as an area of
concern, having found notable differences between the proportions of UK and
overseas qualifiers referred at this stage. It said screeners might not be
applying common standards in their assessment of cases. Moreover, although the
average ratio of UK to overseas doctor referred to the PPC was roughly 2:3, some
screeners had a ratio of almost 1:1 while others had a ratio of 1:3.
Dr Williams continued: "The doctor is informed - and given an opportunity
to add comment within 28 days. Then all the papers go to the Preliminary
Proceedings Committee of the Council, made up of doctors and lay people. They
decide whether the allegations, if proven, could amount to serious professional
misconduct. Alternatively, they may move the case to a �health� or
�performance� panel".
This was another area of concern. The PSI report noted that UK qualifiers were
more likely to be referred to the 'health� procedures panel and overseas
qualifiers to the 'performance' procedures panel by the screeners, particularly
in cases referred by public bodies.
If it is thought that the complaint may raise an issue of serious
professional misconduct, it goes to the Professional Conduct Committee where
there is a full hearing to test the evidence. "There is a quorum of five -
medical and lay and a legal assessor. The GMC is the prosecution and the doctor
is usually defended by a lawyer", explained Dr Williams. She observed:
"It is an open tribunal hearing, which rarely sits in camera, and the
standard of proof is beyond a reasonable doubt that serious professional
misconduct has occurred. The doctor puts forward mitigation, and references to
influence the sanction".
Dr Williams said any appeal is to the Privy Council, but that will soon change.
It used not to challenge many decisions but now that the sanction can be erasure
from the register for a minimum of five years, it does. "A challenge to the
GMC on grounds of racial discrimination could be by means of appeal (if
available), complaint to the Employment Tribunal or possibly judicial
review", she concluded. (26/02/03)
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