Dr Alexandra Simone Jacqueli Freeman BM (GMC No. 3296060)

Nice lady doctor at the GMC
Her name is longer than her salary at the GMC

CLIENT: GMC
MATTER: Independent External Review
FILE REF: MLS/G3352/18/EWS
DATE: 12 September 2002

Dr Alex Freeman said that she had been involved in the medico-political scene since 1990, initially in relation to the doctors' hours campaign. She had a pedigree through the BMA junior doctors' committee in that respect. She had always had an interest in the GMC, in the sense of getting young doctors to be heard. She had stood in the 1999 election as an independent candidate and a bit to her surprise had been elected. Her election address was light-hearted but she said that she would represent the interests of doctors on the GMC.

She was at the time of her election a Registrar in general practice. Since qualifying she had become a part-time principal in general practice.

When she was first elected to the GMC she was invited to attend for an induction day. She met the President and the chairs of the various committees. Alex Freeman had started at the GMC in November 1999 and her membership lasted until the end of October 2004. However, the recent suggested changes at the GMC which would be voted on the next day might bring that forward to June 2003. She would vote against those proposals as she thought they would curtail the amount of representation which she could offer to her electorate.

The GMC had various unofficial groupings. One was a grouping of general practitioners. They went to dinner at the Royal College of General Practitioners and it was a completely informal affair. Another group which Alex Freeman was involved with was the Womens' Group, which she organised.

Alex Freeman could not recall who was present at the meeting of the General Practitioners informal grouping. She thought that Donald Irvine was there, Dr Goss, Sir Denis Pereira Gray and Dr Rennie amongst others.

Alex Freeman was not politically-motivated to speak before her peers, she felt that she spoke for doctors who had elected her. She had the impression that Donald Irvine had tended to listen mostly to lay members and appointed members, rather than elected medical members in any event. In order to speak to a Council meeting one had to try to catch the eye of the President or the Chief Executive. The Chief Executive would then write names on a list, who were then called upon to speak.

Alex Freeman said that she and Dr Edwin Borman had been good friends for some time.

Alex Freeman had sat on the ARC, PPC, the Interim Orders Committee, had been invited to sit on the Registration Committee (although she had never actually sat) and the PCC. She had been asked to sit on panels of all the fitness to practice committees except the Health Committee. In relation to other members there was never a question of whether somebody should be co-opted. People were just asked whether they were available or not.

When Alex Freeman had been elected, there had been a 50% turnover of membership. She had been sent a pack containing the rules and other documents. She had not really been trained in how to sit on Committees, but simply learned while she sat on the job, as it were. She was in a sense thrown right in at the deep end. However, when external associates were appointed, the GMC organised some training for them including about cultural awareness etc. However, Alex Freeman had still not received cultural awareness training although she had participated in training for the new associates as an ‘experienced’ PCC panelist. The same system appeared to operate with other committees, such as interim orders where, again, Alex Freeman had never received any formal training.

Alex Freeman had been elected to the ARC and sat on that committee. The oddity was that every member had to put a preference either to sit or not to sit on any particular committee or whether they were indifferent about the matter. It was possible that a person could be voted onto a committee even if they had positively said that they were not interested in sitting on it. All the forms were returned to Peter Pinto de Sa.

Alex Freeman described the PCC committee room. It was a sort of horseshoe arrangement. The result was that a member of the panel might end up virtually opposite or next to the defendant doctor. That could be very intimidating, especially for a woman.

Alex Freeman had sat on three GMC committees where recusal applications had been made - one in the ARC, and two in the PCC. She herself had offered a recusal when sitting on the Preliminary Proceedings Committee because she practised in the same geographical area as the doctor under investigation. The rest of the panel had asked her to withdraw her offer of a voluntary recusal because she was the only doctor on the panel from the same specialty. She had seen other recusals where a panel member had, for example, taught a particular doctor under investigation. Recusals were not unusual, and nor were applications. For example, the President himself was challenged during the Bristol case.

Alex Freeman was not "pitched against the GMC". That was not the case at all. It was simply that as an elected member of the GMC she felt concerned that it appeared many decisions it made were made before members had even seen them or asked to consider them. The recommendations made in Council papers were rarely defeated or amended. Lots of the items were presented by the Chief Executive or members of staff, although sometimes they were also presented by Committee chairs. Often members were presented with a series of recommendations and sometimes there was very little discussion about them. There were moves to push them through to a vote before they had been discussed sufficiently. There was an ethos of the bureaucracy managing the Council, which in Alex Freeman’s view was wrong.

George Staple asked whether a certain amount of management of the Council was not necessary to get the Council's business done. Alex Freeman said that the problem was that the standing orders were not followed. Some members were quite naive and just voted in the way they were asked to. That applied to both lay and medical members. It was inevitable that some members would simply be lobby-fodder. Elections threw up all sorts of different people.

Dr Borman asked some questions about it and Alex Freeman wanted to know what the expenditure on the President was. Dr Borman therefore asked his questions and also asked about the President's position. It was the first time a lot of members found out about the President's honorarium and the fact that it was equivalent to a consultant's A+ merit award. Alex Freeman had presumed beforehand that the President would merely be reimbursed for his expenses. The award seemed to be high as she imagined that Donald Irvine's annual income before he became President of the GMC would have been that of a GP, possibly around the £80,000 mark and that he would be reimbursed to cover lost earnings. She also discovered for the first time how much was given to screeners as honoraria. All that amounted to £800,000. Consequently there was a gap of about a missing £1 million. She could not understand where the rest of the money had gone as she could do a rough calculation of the expenses involved in running one or two panels of the PCC. The explanation for the accounts only covered half of the £1.7 million expenditure on members' fees and expenses included in it. That had set Dr Colman on the trail of the expenses issue and the whole issue about the GMC being a charity and its members being trustees. Alex Freeman had wanted to find out what was in the accounts because she was now a trustee she would be financially responsible as a trustee for any gaps in the accounts. She was fully behind Dr Colman in finding the root of the expenses issue. She thought it was important. There still had not been a full explanation of the issue. She and a lot of other members had not known about the President's honorarium and how the attendance allowance had appeared out of thin air to benefit lay members.

The whole episode left a very bad taste in Alex Freeman's mouth. GWS explained he did not wish to put words into Alex Freeman's mouth but wondered whether she would agree with the following. The way in which the GMC had been operating was if you kept your head down and your nose clean you were rewarded. If you did not you were not rewarded. People tried to find ways to stop members saying things. One ex-member of the GMC had told Alex Freeman that they had been threatened that if they did not do certain things certain consequences would occur. He was a Freemason and the person who was another member who was also a Freemason had made this threat. Freemasons tended not to declare themselves. That had all been about the Bristol case. The only way it was possible to talk to other members of the GMC was via membership of committees. An awful lot of business was done informally and if you were not in the in-group you were not involved. Alex Freeman found it very worrying that the staff at the GMC knew more about its business than she did. When you had a two-day council meeting and members were presented with several inches of papers to read it was not surprising that they became swamped and did not know everything that was going on. Somebody else had told her that when they first became a screener it became apparent to them that there were a whole load of complaints in respect of practice procedures which had simply been dropped and never considered. That meant that the GMC was taking it upon itself to decide things and that the complainant became immaterial.