Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors' professional behaviours and attitudes towards the regulator

Abstract

Objective: This paper examines the impact on doctors' attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case.

Design: A cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case.

Setting: Primary and secondary care settings across a broad geographical spread in England.

Participants: 474 doctors.

Outcome measures: Attitudes towards the GMC and two professional behaviours in TPB dimensions.

Results: Attitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC's disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors' attitudes or intention to reflect or raise concerns.

Conclusions: The lack of change in doctors' attitudes towards the GMC's guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors' trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors' overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism.

Keywords: medical education & training; medical ethics; protocols & guidelines; risk management.

Figure 1

Google Trends for Dr Bawa-Garba with key dates shown: 18 February 2011, when Jack Adcock died; 4 November 2015, when Dr Bawa-Garba was found guilty of manslaughter; 25 January 2018, when the GMC won its appeal against the Medical Practitioners Tribunal Service and Dr Bawa-Garba was struck off; and 1 August 2020, the present. The second peak after 25 January 2018 is Dr Bawa-Garba’s successful appeal in August 2018. GMC, General Medical Council.

Figure 2

(A) The changes of participants’ responses to ‘I am confident that doctors are well regulated by the GMC’ over time. Line fitted is a lowess curve. (B) The changes of participants’ responses to ‘I am confident that the GMC’s disciplinary procedures produce fair outcomes’ over time. Line fitted is a lowess curve. GMC, General Medical Council.