Chapter 6: The General Medical Council
The GMC investigation: initial steps and first Interim Orders Committee
Concerns about events at the hospital were first brought to the attention of the GMC in 2000. There is no suggestion in the documents seen by the Gosport Independent Panel that the GMC was notified, either by the Royal College of Nursing or by the NHS, about the concerns expressed by nurses in 1991. Nor is there any suggestion that the GMC was notified by Hampshire Constabulary or Portsmouth HealthCare NHS Trust, or anyone else, when concerns were expressed about the death of Gladys Richards.
The first time the GMC was notified by any person or organisation about the concerns at the hospital was in a telephone call on 26 July 2000, followed by a letter the next day from Acting Detective Superintendent (Acting Det Supt) Raymond Burt (GMC101057, p1105). That letter told the GMC, for the first time, that there was a police investigation following a complaint from the family of Mrs Richards, that she had been “unlawfully killed as a result of treatment”. The GMC was told “the investigation is on going and no criminal charges have been preferred”. The letter is headed “Re: Dr Jane BARTON GP” and goes on to say:
“The doctor who appears to have been responsible for the care of Mrs RICHARDS at the time is Dr. Jane BARTON ... who is a General Practitioner practising in Gosport, Hampshire. Dr. BARTON is additionally engaged by the Portsmouth Healthcare (NHS) Trust as a visiting Clinical Assistant at the GWMH.” (GMC101057, p1105)
Dr Barton had in fact tendered her resignation from her role as a clinical assistant at the hospital on 28 April 2000 with a two-month notice period (GMC100891, p135).
There is nothing in the documents available to the Panel to show any contact between the police and the GMC between then and April 2001. On 30 March 2001, Hampshire Constabulary issued a press release saying that the investigation was complete and that a file had been passed to the Crown Prosecution Service (CPS). Following local and then national media reports in April (described in Chapter 9), which suggested that the police were looking at the deaths of other patients, the GMC telephoned and then wrote to the police on 11 April 2001 (GMC100917, p538). In that letter, the case worker said that the GMC had been granted additional powers by Parliament the previous summer which, in effect, allowed it to consider restricting a doctor’s registration status, without prejudice, at any stage of its proceedings if it was deemed to be in the public interest or in the interests of the doctor concerned. All meetings of a new Interim Orders Committee (IOC) were to be held in private.
The GMC letter stated: “It appears that, given the nature of the allegations against Dr Barton, this case may fall into the above category” (GMC100917, p538).
The IOC was established in August 2000 as a direct result of the public concern caused by the GMC’s inability to act in the case of Harold Shipman, despite the fact that he had been arrested on a charge of murder. A case had to be considered by a Medical Screener before it could be referred to the IOC.
The IOC (subsequently the Interim Orders Panel) had the task of deciding whether it was necessary to suspend a doctor’s registration or to impose conditions on a doctor’s registration, pending a final decision in the case. Interim orders are imposed if it is necessary to protect the public, or is in the public interest or in the doctor’s interest. Such orders can be imposed for a maximum of 18 months, after which time they must be reviewed in the High Court.
In the same letter of 11 April 2001, the GMC said it needed sufficient information to consider if an interim order was appropriate and asked the police to provide “a brief case summary, copies of witness statements, transcripts of interviews conducted, copies of the medical expert’s report and the relevant medical notes". The GMC acknowledged that in the handling of confidential information the police needed to “balance the rights of privacy of the individual against a necessary need to protect the public” (GMC100917, p538).
The GMC pursued its request in a meeting between its solicitors and the Hampshire Constabulary and in a further letter of 4 May 2001 (GMC100917, p545). On 6 June, the police provided the GMC with the clinical notes of Mrs Richards and statements from two members of her family (p554). The police did not provide the GMC with Professor Brian Livesley’s report (see Chapter 5).
The GMC began to investigate Dr Barton as soon as it received this information. On 13 June, Gerry Leighton, Assistant Registrar, wrote to Dr Barton inviting her to appear before the IOC on 21 June. The letter suggested that the information received from Hampshire Constabulary was“of such a nature that it may be both in the public interest and in your own interest that your registration to be restricted whilst those matters are resolved” (GMC100917, p606).
Dr Barton attended the Committee hearing on 21 June. It was the GMC’s submission that Dr Barton’s registration should be suspended on an interim basis (GMC101057, p60).
Dr Barton’s representative had more information because the same firm of solicitors was instructed in the criminal proceedings. He was able to tell the IOC that independent expert opinion had been sought by the police, but he did not know what that report said (GMC101057, p61). He made the submission that “this case may have been brought here prematurely” before an expert report had been provided (GMC101057, p62).
Dr Barton’s solicitor submitted that, on the evidence provided, “there is no conceivable basis here for suggesting that the drugs that were prescribed and administered to this lady were inappropriate” (GMC101057, p61).
As noted in paragraph 6.12, Professor Livesley’s report had not been disclosed to the GMC by the Hampshire Constabulary. It was not available to any party during the hearing. That report had concluded:
“… death occurred earlier that it would have done from natural causes and was the result of the continuous administration of diamorphine, haloperidol, midazolam and hyoscine which had been prescribed to be administered continuously by a syringe driver for an undetermined number of days.” (GMC100096, p163)
The legal assessor reminded the IOC that an order could only be imposed if it was “necessary for protection of the members of the public, or otherwise in the public interest, or in the interests of the practitioner”. He went on to say: “in this particular case, I simply draw your attention to the absence of any independent specialist medical expert opinion indicating fault of any kind on the part of Dr Barton” (GMC101057, p65).
The IOC considered the case in private before calling all parties back into the hearing room. The Chair announced:
“Dr Barton, the Committee have carefully considered all the evidence before it today. The Committee have determined that they are not satisfied it is necessary for the protection of members of the public, in the public interest or in your own interests that an order under Section 41(A) of the Medical Act 1983 should be made in relation to your registration.” (GMC101057, p66)
The documents show that, in accordance with normal practice, no reasons were given because an order was not made.
On 21 June, a note from the Department of Health’s South East Regional Office to its Ministerial Private Office provided an update on Dr Barton’s case. The GMC had indicated that it “was aware that asking IOC to consider the case, while the CPS was considering the police report, carried some risk but was of the view that an early reference was required. The GMC will obtain the appropriate expert report and liaise further with the police” (GMC100891, p141).
Legal assessors are experienced barristers or solicitors appointed to advise the tribunal on questions of law as to evidence or procedure. The legal assessor provides advice to the tribunal, including when it is deliberating in private, but takes no part in the decision-making process.