When Charlie Massey was appointed as CEO of the GMC in 2016, straight from his position at the Department of Health, 1,300 doctors signed a letter of no confidence, saying

‘His position as the Director General of the Department of Health and advisor to the Health Secretary demonstrates, in our view, a clear conflict of interest…. We are concerned as to how the GMC can maintain its independence with this appointment.’

Nine years later, as the BMA announces that only 16% of their respondents now have confidence in the GMC’s ability to fulfil its primary function – protecting the public – a key insight which we gained into GMC decision-making once again raises the question of GMC independence.

The key insight – “We just decided not to do that”

Through our legal case we have gained a new insight into how the decision not to set a Scope of Practice for PAs and AAs was reached.

A judicial review hinges around a decision, so knowing how and when that decision was made is crucial. After all, it was probably the most important choice that the GMC, as newly-appointed regulators, would have to make, since it defined the function of associates. 

The decision was made not to set scope of practice; but how did they reach it? The short answer is that they just decided. 

As our legal case came closer to the actual hearing they attempted several rationalisations, but never did they dispute that this decision was both un-minuted and taken without any form of risk-assessment. 

Nor did they reflect or reconsider the wisdom of that decision when they received

• the results of their own internal and confidential survey (which showed significant levels of concern about scope)
• several surveys by Colleges and other groups (which they dismissed as being intrinsically biased)
• numerous Prevention of Future Death reports.

Professor Melville, in his second witness statement, admitted openly that 

It is important to emphasise that this was not a process which involved a single decision maker, making a decision on a specific date, as to whether the GMC would, or would not, define scope of practice for PAs and AAs. At §58 of my first witness statement, I made clear that ‘the development of standards and guidance for PAs and AAs was an iterative process, and that it is not possible to pinpoint a single date on which the GMC decided not to set scope.

The starting point for everyone at the GMC was our existing model for regulating doctors and our understanding that the Department of Health expected us to adopt a broadly similar approach for associates. Decision-makers at every level (from members of the GMC Council to members of the programme team) were aware that concerns had been raised about scope of practice and they were unanimous in their view that it would not be appropriate for the GMC to address these concerns by setting limits on the type of work that associates could undertake.

It is hard to fathom how a safety-conscious and independent regulator could have reached such a conclusion, could fail to keep records of how they reached it and could have had so little regard for public safety. Unless…

Unless the decision came right from the top

We came across another recent example of micromanagement by the CEO.

During the preparation for our legal case we came across a correspondence between Mr Massey and a College regarding whether or not supervision of associates should always be done by a consultant-equivalent or only usually – the GMC preferring the latter wording.

What strikes us as odd is that this critical piece of wording is being addressed to the CEO – why is this level of detail within the remit of a CEO?

What should the leaders of our profession do now?

Regardless of the final outcome of our legal case, the way in which the decision not to set scope was made is deeply concerning behaviour. It reveals a great deal about their internal working as an organisation. The Medical Royal Colleges, Specialist Societies, Trades Unions and other professional groups and Associations need to be fully aware of the GMC’s decision-making process;  and should reflect on the appropriateness of how the GMC reached the position that they did.

The GMC has of course claimed that … because we’re funded [by doctors], we’re free of political influence and able to carry out our statutory duties independently. 

We all need to think about the ramifications of this claim. And we should all take a moment to reflect and consider whether the GMC is a truly independent regulator, free of political will and interference.

We are still short of cash

The extra work in getting full disclosure and the additional day in court has ramped up our costs. We are reliant on your help – please make a donation so that we are not left with a shortfall.