J. Meirion

The GPs’ revenge

My hospital, the Royal Marsden, chose to cave in to angry GPs – and leave patients in my final study feeling abandoned

The GPs’ revenge
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On 31 March, I walked out of the Royal Marsden Hospital in London for the last time, after 28 years as a consultant cancer surgeon. At the age of almost 69, I had given six months’ notice of my wish to resign my contract by Easter, but to remain on staff in order to complete a research project on malignant melanoma.

That request was initially considered favourably, then withdrawn after I wrote a series of articles in The Spectator and the Daily Mail about what I thought was wrong with the NHS. One, in which I said that ‘GPs are part of the NHS’s problem, not the solution’, triggered a particularly vitriolic response. Doctors demanded that I be punished and attacked me on social media. The Marsden caved. I was told I had brought the hospital into disrepute; that I had behaved irresponsibly. My offence was considered unforgivable and deserving of a ‘clean break’. There was to be no contract renewal.

What was so bad about what I wrote? I had said: ‘Despite the heroic efforts of individual doctors, too many GPs no longer try to provide an even remotely personal service, to offer appointments at a convenient time or to take effective responsibility for continuity of care… General practice, as structured, is an anachronism and not fit for purpose.’ I gave examples of how the treatment of most patients, those with long-term illnesses such as asthma and diabetes, could be transformed.

Others have put forward similar proposals. In a debate in the House of Lords, health minister Lord Prior said that the ‘cottage industry GP model is broken’ and that more care needed to be delivered through health units working together. Perhaps his words were more emollient than mine, but no objections from GPs were recorded; there was no lynching on social media.

Before I started writing articles, my standing at the Royal Marsden had been high. I was its lead surgeon between 2008 and 2013. In writing for The Spectator and the Mail, I was not in breach of my contract, which stated: ‘You shall be free, without our prior consent, to publish books, articles etc., and to deliver any lecture or speak whether on matters arising out of your NHS service or not.’

What, then, caused my downfall? The arrogant, vicious and bilious response of some GPs whose professional comfort was being challenged. The senior managers at the Marsden were not courageous enough to withstand the onslaught. Professor Azeem Majeed, who runs primary care at Imperial College London, wrote to my chief executive implying that GPs might not continue to refer patients to the Marsden unless action against me was taken. Other GP trolls posted an unprecedented volume of vitriolic abuse on Twitter and Doctors.net.

The net drew tighter. Dr Maureen Baker, chair of the Royal College of General Practitioners, emailed her 40,000-strong membership to denounce my article. Dr Lucy Gaden, a GP from Nottingham, started a petition to have me reported to the GMC for unprofessional conduct. An aggressive letter arrived from Imperial College stating that my honorary professorship was being withdrawn.

I was summoned to the medical director’s office at the Royal Marsden. He demanded that I resign, accept disciplinary action or take ‘gardening leave’. I refused, arguing that I had the right to free speech. I explained that I had never quoted the name of my hospital in any of my articles and that my clinical reputation was unblemished.

The director imposed ‘authorised absence’ until a further meeting. I was not allowed to attend the hospital, nor any of my five clinics during that time. I was not allowed to perform my operating lists during the next week, which included two patients with complex cancers. Was this action taken in the best interests of my patients? Hardly.

At the second meeting with the medical director, I was told that I could return to work but that I would have to sign a document from the medical director which included the following sentence: ‘I made it clear that it is important that you do not write any further press articles, or if you do, then you must show these in advance to the chief executive so that she is reassured that the content will not affect the Royal Marsden’s reputation by association with your personal views.’ The trust does not consider this statement a ‘gagging order’; indeed when The Spectator wrote an article about me calling it such, the trust threatened this magazine with legal action.

I delayed signing the document until a reminder arrived from the medical director. The message was clear: I’d been excluded once: if I did not comply, they could do it again. By this time I was in bad way. My resilience and self-confidence had been tested and even I was beginning to believe that I had committed a terrible heretical sin by writing the article. I signed the document.

I still believed that my contract would be renewed in order to continue with my research project. Ninety patients were involved in the trial, all of whom I had looked after for five years, and a further two years were needed to complete the research.Understandably, some of these patients feel abandoned. I was absolutely forbidden to write to them to explain the circumstances of my unexpected departure.

At a meeting with the chief executive and the chief operating officer in February, I was told there was to be no reprieve. They wanted a ‘complete break’. My last working day would be 31 March. With the help of an employment lawyer, I issued a bullying-and-harassment complaint against the chief executive and medical director. It was dismissed by the board chairman, who refused my request for an independent investigation.

Earlier this year, Robert Francis QC published his ‘Freedom to Speak Up’ review, which concluded that there was ‘a culture within many parts of the NHS which deters staff from raising serious and sensitive concerns and which not infrequently has negative consequences for those brave enough to raise them. I heard shocking accounts of the way some people were treated when they have been brave enough to speak up.’ So pressing are the concerns that in a recent editorial in the British Medical Journal, Dr Kim Holt called for a public inquiry to tackle ongoing problems with bullying, intimidation and reprisals in the NHS.

If the NHS can treat a senior cancer surgeon this way, what chance does a nurse or a junior doctor with grave concerns about the health service have?