Co-chairs of Dr Arora case review publish findings
The General Medical Council has apologised after an independent review found it incorrectly applied a legal test when considering allegations that Dr Manjula Arora lied to obtain a laptop.
The learning review, co-chaired by Professor Iqbal Singh CBE and Martin Forde KC, was commissioned by the GMC, to help identify whether there were lessons to be learnt by the regulator from Dr Arora’s case that could be applied to future cases.
Dr Arora’s tribunal hearing earlier this year generated concerns among the medical profession about the GMC’s processes and decision making, including whether bias played any part.
concludes that the dishonesty allegation against Dr Arora should not have been taken forward. It goes on to add that the GMC missed multiple opportunities to stand back and assess whether the allegations were serious enough to be referred to a tribunal, and that they need to do more to embed a culture of professional and cultural curiosity and speaking up.
The report found no clear or conclusive evidence to suggest that biased thinking affected Dr Arora’s case, but emphasised it is vital the GMC continues to proactively seek out bias, rather than simply looking for reassurance that it does not exist.
Professor Singh and Martin Forde KC also recommend that the GMC should continue to encourage a culture which seek to resolve issues locally first, if possible.
The report also acknowledges that the hearing process may need to be adversarial at times, but challenges to doctors should be made politely and respectfully. The authors highlighted that the GMC’s policies and processes at every stage of a fitness to practise case, should emphasise that every doctor is treated with compassion and respect.
"We share the aspiration of the review's co-chairs that modern regulation should contribute to a better health system which is compassionate, fair and supportive. The recommendations in this report will help us to achieve those aims."
GMC Chief Executive
Charlie Massey, Chief Executive and Registrar of the General Medical Council, said:
'I welcome the report by Professor Singh and Martin Forde. Their examination of this case has been detailed, searching and constructive and I am grateful for their expertise and insight.
'The GMC accepts all of their recommendations without reservation. It is clear that there were decisions we did not get right and for those I have apologised to Dr Arora.
'The report’s co-authors found no evidence of bias at any stage of our decision making, or data to dispel those concerns. Like them, I believe that we must go further than simply comforting ourselves that bias is not apparent. The GMC is a collection of humans, each with their own biases. The challenge for us is to continue to seek out potential bias and address it head-on.
‘We share the aspiration of the review’s co-chairs that modern regulation should contribute to a better health system which is compassionate, fair and supportive. The recommendations in this report will help us to achieve those aims.’
Professor Singh, co-author, said:
'We hope that our review of the Dr Arora case will encourage modern regulation which is compassionate, caring and fair. It is our belief that we can make cases such as this into “never events”.
‘Our review makes a series of recommendations, from greater consistency in managing concerns so that “local first” becomes the default, to more rigorous investigation plans and case assurance.
‘But crucially we also need greater levels of cultural competency so that the GMC can better understand the professionals working in our health services.’
Martin Forde KC, co-author, said:
‘At the heart of this case was a misapplied legal test around dishonesty, but there was more besides which could and should have prevented this allegation from progressing and causing the distress which it did to both Dr Arora and the wider profession.
‘We know that investigations are hugely stressful for doctors, and an allegation of dishonesty is among the most serious. The evidence for such allegations must be credible and without nuance, and cases approached with an open mind.’
The GMC is already carrying out work across the organisation to promote fairness in its processes and in the wider healthcare system. This includes carrying out a regulatory fairness review, which is assessing how effectively they look for the risk of bias in their own systems, and how they can embed better controls to prevent biased thinking.
They have also set themselves a new target to eliminate disproportionate complaints from employers about ethnic minority doctors by 2026. This includes:
- working with responsible officers to make workplaces more inclusive and supportive
- implemented an amended referral form to make sure organisations check a referral is appropriate before it is submitted to them
- supporting organisations to understand their thresholds for fitness to practise referrals to help ensure fairer outcomes.