For decades I have written that research misconduct and financial fraud by doctors is concealed by a code of silence.1,2 I have shown that even repeated findings of misconduct and harm to patients did not prevent a senior doctor receiving a national honour from the UK Government “for services to patient safety”.3 I believe that the impunity of senior doctors guilty of misconduct is similar to the cover up of sexual abuse committed by celebrities and by priests, because those who protect perpetrators considered them too valuable for their organisations to lose.4
Summary
In this article I describe how sexual misconduct by senior doctors is also concealed by the organisations that should protect the vulnerable. I report:
- The UK General Medical Council (GMC) and healthcare providers have allowed doctors with convictions for sexual offences to continue to work and treat patients who are unaware of the criminal convictions.
- After the GMC received complaints about sexual abuse by a general practitioner, it took the GMC a decade to strike the doctor off the medical register. Later the doctor was sentenced to more than ten years in prison for sexual abuse of children and women over a period of 23 years.
- A gynaecologist was given a Silver Clinical Excellence Award (CEA) a year after he was placed on the register of sex offenders and was later nominated for a Gold CEA.
- One of the six medical members of the GMC made a series of statements about some of these events, which were found to be “completely untrue” and the GMC refused to investigate concerns about the honesty of its member.
- The Advisory Committee on Clinical Excellence Awards (ACCEAs) changed corrupt practices after I questioned why members of regional sub-committees who themselves applied for a CEA were allowed to grade the applications in their region at the level at which they were applying.
My motivation for writing
Initially I was reluctant to write about the events in case readers thought that I was motivated by a sense of grievance. However I changed my mind because in 2023 the GMC published guidance for doctors on identifying and tackling sexual misconduct and stated that there should be zero tolerance for sexual harassment. My experience suggests that there is a chasm between the GMC’s guidance and the GMC’s failure to deal with sexual misconduct particularly when senior doctors are involved. In addition, I was encouraged to publish an account of these events by colleagues that I told about them and by a past member of the National ACCEA committee who was shocked by what I described. I am grateful to female medical academics that read the article and made helpful comments.
The Clinical Excellence Award Scheme
Because some readers of my blog are not from the UK, I will first explain a little about the NHS CEA Scheme and its predecessor, the Distinction Reward Scheme.
The Distinction Reward Scheme was introduced at the foundation of the NHS to incentivise and placate the objections of the most highly reputed and influential consultants who expected to lose income from reduction in their private practices. It is claimed that these awards are given to doctors whose contribution to the NHS is considered “over and above” what is expected according to their contract.
There were four levels of award (C, B, A & A+) with increasing amounts of money being added to a consultant’s salary. In 2004, the scheme was changed and renamed Clinical Excellence Awards (CEA) with the awards being renamed bronze, silver, gold and platinum. (Since these events, the awards have been renamed National Clinical Impact Awards.)
Consultants and senior medical academics of similar status could apply for a CEA in the annual awards round by completing an on-line application. Applications were then sent electronically to the applicant’s hospital chief executive, who graded each aspect of their contribution to the NHS (“domains” on the application include developing clinical service, research, teaching and management) and provided a testimonial. Then each application was sent to the doctor’s regional advisory committees (there are 15) for further grading and a decision about which applicants should be referred to the national awards committee.
Regional sub-committees have a lay chair and a medical vice-chair. Each vice-chair usually has a gold or platinum award. About half the regional sub-committee members are doctors: most of them work in major teaching hospitals and most hold CEAs themselves.
Each year every regional advisory committee is given “an indicative number” of how many applicants at each level it should put forward for consideration by the national awards committee. The national committee then decides who will receive an award.
In recent years, 300 national awards have been made each year and at any one time about 2,500 consultant hold national awards. The largest number have bronze awards (1378 in 2018), and fewer have silver (816 in 2018), gold (264) and platinum (143) awards.5
In 2010 a bronze award added approximately £35,000 to a consultant’s annual salary, silver about £46,000, gold about £58,000 and platinum £76,000.6 Awards were pensionable. (The value of awards changed little between 2010 and 2018.) In recent years, the Clinical Excellence Award Scheme has cost the NHS about £130 million each year.5
The major problem with the CEA Scheme and its predecessor, the Distinction Reward Scheme, is that it rewards a minority of senior doctors with large sums of extra pay. The awards have gone predominantly to white men working in the major teaching hospitals with disproportionate large numbers of awards to some specialties.
It is difficult to escape the conclusion that the white male employees of teaching hospitals that sit on regional advisory committees believe that the people who most deserve an award are doctors that are most similar to themselves.
Disclosure of interest
Here, I must disclose a conflict of interest, because I had a national CEA and still benefit enormously from the money I receive. Like the majority of those with a CEA, I am a white man. When I received my CEA I was working in a district general hospital, not a teaching hospital.
I originally applied for a Distinction Award because I was angry that a professor of medicine, who I had reported to the GMC and who the GMC found guilty of serious professional misconduct, was permitted to keep his A+ award and the extra money that accompanied it. He had concealed the research fraud by one of his research fellows for a decade and he had put his name as a co-author on research publications that he knew to be false. The GMC found the allegations proved. Despite the GMC finding of serious professional misconduct, the professor continued in his university post, remained a member of the hospital research ethics committee and kept his A+ award, which had the highest remuneration.
I complained to the national committee that made the awards that allowing him to keep an award was inappropriate because his research output was one criterion for gaining the award and part of his research output was fraudulent. I also submitted a protest application, in which I said because the professor had been permitted to keep his A+ award and because I had been the one that reported him to the GMC, I thought that I deserved a cut of the money. I was surprised to receive a C award.
Some years later, after the Distinction Reward Scheme changed to the CEA Scheme, I received notification that I could apply to switch to the CEA Scheme by applying for the next higher award. I did so and was pleasantly surprised to get a silver award.
Four years later, ACCEA informed me that I needed to reapply for renewal of my silver award for a further five years. When completing the on-line form, it said that I could also be considered for the next higher award, a gold award – all I needed to do was to put a cross in a box. So I did. Months later I was pleased to hear that my silver award had been renewed. I was not given a gold award.
A few weeks later, I received an anonymous message that my application had not been considered fairly. The message must have been from someone involved in the awards process because only my chief executive and I knew that I had applied for renewal of my award.
I looked at the ACCEA website. It said that there was an appeal process. So I appealed.
The information on the website said that appellants would be notified of the outcome of their appeal within 6 weeks. After 3 months, I had received no notification. So I looked up the ACCEA website. It stated how many appeals were submitted for each level of national award and said how many appeals at each level were successful and how many were unsuccessful. For bronze, silver and platinum awards the number of successful plus unsuccessful appeals was equal to the number of appeals. The websites stated that only one appeal was unresolved. It was for a gold award. I contacted ACCEA which confirmed that my appeal was the only appeal that had not been decided.
I contacted ACCEA repeatedly over the next few months asking when I would hear the result of my appeal. More than 6 months after I submitted my appeal I was told that it was unsuccessful.
The combination of the original anonymous message and the 6 months taken to tell me the outcome of my appeal, which contrasted with 6 weeks for all other appeals, made me suspicious about the process.
I looked again at the ACCEA website. It said that if a written appeal is unsuccessful, one can ask for an oral hearing. So I did. The response from ACCEA suggested that nobody had asked for an oral appeal before, because ACCEA said that they would need to decide on the process to be used.
ACCEA came back to me with the process to be followed and they disclosed a bundle of documents so that I could prepare for the oral hearing.
The first document in the bundle was a letter from ACCEA to Professor Dame Deidre Kelly, the medical vice-chair of the West Midlands Regional Sub-Committee that considered my application. It asked her why, when my application had scored third highest of the applicants for a gold award in the region, my application for a gold award had not been selected by the regional sub-committee as one of the 4 applications it had put forward according to the “indicative number” provided by ACCEA.
The reply from Professor Kelly gave 4 reasons. She said that the committee considered that my application was too soon after I got the silver award, it did not have support from my trust, it did not have support from professional organisations and, most damning, the committee questioned the “probity” of my entry in the domain relating to research. In that domain I cited my own research but I also wrote that my main contribution to research was working to get dishonest publications retracted. So ironically Professor Kelly was questioning my probity in the domain in which I claimed that I had worked for probity of research.
Subsequently the appeal panel decided that my application had not been considered fairly. It specifically said that there were no issues of probity in my application and that my attempts to correct the research record were very important. They also said that my application was not too soon. Rather it was at the mode time for applicants getting the next higher award and similar to the interval since the award of silver awards to the 4 doctors who had been put forward for a gold award by the West Midlands Regional Sub-committee in the year I applied. The panel also said that the claim that I did not have support from my trust was “completely untrue”. The panel noted that the chief executive of my trust gave me the highest score for every domain and an outstanding reference.
Subsequently the lay chair of the regional sub-committee said that the sub-committee had no concerns about the probity of my application and she would have remembered if that had been raised. That suggests that Professor Kelly (the medical vice-chair) had simply made up that excuse.
Professional Jonathan Montgomery, then the chair of ACCEA, travelled 200 miles from Southampton to Shrewsbury to see me. He told me that he had no concerns about my probity and he also put that in writing. Subsequently he asked me to provide some advice to one of his PhD students whose thesis was about GMC procedures. (My contribution is acknowledged in her thesis and she invited me to her inaugural lecture when she was made a professor.)
It appeared to me that Professor Kelly make up a series of false excuses to justify the failure of the regional sub-committee to nominate me, the applicant for a gold award with the third highest score, as one of the four supported for an award.
Professor Kelly was one of the six medical members of the GMC as well as holding other senior roles on national organisations. She was a Board Member of the Care Quality Commission and of the Health Research Authority.
After I complained to the GMC about Professor Kelly, the GMC said that it is not surprised that I was upset by the inappropriate use of the word probity by Prof Kelly. Professor Kelly has subsequently claimed that she had used the word “probity” in error. I do not believe that someone in Kelly’s position could use such a defamatory word by mistake. I believe that Prof Kelly had used the word probity to insure that the chair of ACCEA, Professor Montgomery, did not enquire further about why the person who got the fifth highest score was put forward as one of the four supported by the regional sub-committee.
The regional sub-committee put forward for a gold award the candidates whose scores were first, second, third equal with mine and fifth. It did not know anything about any of the four. So I looked them up on the internet. Each of the four doctors worked in teaching hospitals. Some medical members of the regional sub-committee were employed by the same organisations as the four doctors put forward. I worked in a district general hospital. At that time, no medical member of the regional sub-committee worked in a district general hospital.
Internet searches of the names of the three with the highest scores took me to their university hospital website and showed that each was a white male professor.
Rewarding a convicted sex offender
I was naturally most interested in the doctor with the fifth highest score, because he had a lower score than me but had been put forward for a gold award instead of me. When I did an internet search for him, the first links that came up were not to his hospital website. They were links to national newspaper reports about him being placed on the Register of Sex Offenders for accessing child pornography. (Being placed on the Register of Sex Offenders indicates that an individual has a criminal conviction for a sexual offence.) Next items in the search were reports in a local newspaper about a press statement by his hospital saying that he had been taken off some of his duties as a gynaecologist. Specifically he is not allowed to treat young women. It was difficult to see how he could be contributing “over and above” the expectation for an NHS clinician.
The documents showed that he got his silver award 18 months after being placed on the Register of Sex Offenders. The timing of the press release from his hospital showed that the hospital management were aware of his criminal conviction at the time when his application for a silver award would have been graded by his hospital’s chief executive. The members of the regional subcommittee that put him forward for a silver award included doctors from his teaching hospital and gynaecologists from his region. My enquiries to doctors in his hospital and other gynaecologists in the region suggested to me that it was probable that some doctors on the regional subcommittee would have been aware that this doctor was on the register of sex offenders when they put him forward to the national committee for a silver award.
He got a silver award the same year as me. Four years later he applied for a gold award. The regional sub-committee that put him forward for a gold award did not consider his application too soon, as Professor Kelly stated mine was. At that time some of the regional subcommittee members were employed in his teaching hospital and were likely aware of him being on the register of sex offenders.
After the appeal
After I won my appeal, ACCEA set up an ad hoc panel to consider whether I should get a gold award. They decided not to give me one.
Professor Montgomery travelled 200 miles from Southampton and informed me that had the decision been his, he would have given me a gold award. I said that I would have been happy to accept a gold award without any remuneration attached.
Professor Montgomery also gave me the scores of the ACCEA panel that considered whether I should get a gold award. He said that he was concerned because there was a major and unusual disparity between the scores given by the four lay panel members (all hospital managers) and four medical members of the panel. All four managers gave me high scores, which would have justified a gold award. The scores from the 4 doctors, all of whom had platinum awards were much lower. One of the four doctors was a consultant cardiologist at a London teaching hospital who had referred me patients for second opinions, which I thought was odd if he had a low opinion of my contribution. I discovered that another medical member of the ad hoc committee set up by ACCEA has a criminal conviction. I thought it strange that a platinum award holder can have a criminal record.
However my appeal did result in two changes to processes at regional sub-committees. First, it was decided that if a regional sub-committee nominates a doctor for a national award for any reason other than on the basis of the score that they achieve, the sub-committees must keep a written record of the reasons. That safeguard depends on whether the written record is more truthful than the post hoc reasons provided by Professor Kelly to ACCEA.
Second, I had discovered that the members of some sub-committees were permitted to apply for higher awards but they were still allowed to remain in the assessment process and score the applications at the level for which they were applying (i.e. scoring their own and their competitors’ applications). This corrupt practice was banned four weeks after I wrote to ACCEA about it. ACCEA told me that this change had nothing to do with me raising concerns about the process of sub-committee members applying for higher award. I therefore made a freedom of information request for the committee minutes when this change was discussed. I was informed that there were no minutes of discussion of this change in practise. Because the CEA scheme costs the NHS £130 million per year, I am not reassured that ACCEA makes decisions that are not properly documented.
More on regional sub-committee processes
Comparison of the activities of different regional sub-committees suggested attempts to manipulate the process at the time Professor Kelly was the medical vice-chair of the West Midlands sub-committee.
As stated earlier, regional sub-committees have the function of short listing applicants for awards to be considered by the national committee. Each regional sub-committee is given an indicative number of applicants that they can short list for each level of award. For nearly all sub-committees the number of applicants short listed for each level of award exactly equalled the indicative number provided by ACCEA.
During Professor Kelly’s tenure, the West Midlands sub-committee consistently short-listed far fewer applicants for bronze awards than the indicative number supplied by ACCEA. One presumes that the West Midlands sub-committee did not believe that doctors in that region were less worthy of awards than doctors in any other region.
The sub-committee members know that not all the applicants they short list will receive an award from ACCEA. They also know that ACCEA tries to make sure that awards are distributed equitably between regions of the country. By providing a limited short list of applicants for a bronze award, the West Midlands sub-committee was restricting the choice available to ACCEA. If the West Midlands sub-committee could manipulate those who got an entry level bronze award, they could control higher awards, because it is very difficult to get a higher award if a doctor does not have a bronze award.
Thus my experience of the ACCEA scheme suggests to me that the procedures for awarding CEAs are open to abuse.
Doctors with criminal convictions for sex offences
I was also concerned that a doctor with a criminal conviction for sex offences was allowed to remain on the medical register. Therefore I asked an employee of the General Medical Council how many practising doctors were on the register of sex offenders. I was told that there were about 100.
The failure of the GMC to deal with sexual misconduct by doctors is illustrated by the case of Alan Tutin. I was interested in him because he worked in the Merrow Park Surgery in Guildford, Surrey. Dr Andrew Dowson had his private practice in the same surgery. Dowson appeared before the GMC on two occasions (2006 and 2014-2015) and was found guilty of misconduct in research on both occasions. Dr Dowson’s second GMC hearing followed my complaint to the GMC and he was suspended from the medical register. Details are available in one of my earlier blogs https://drpeterwilmshurst.wordpress.com/2022/12/29/correspondence-with-circulation-about-retraction-of-the-mist-trial-publications/
I was interested that in one small general practice surgery, there were two doctors whose conduct was judged to be unacceptable in different ways.
We now know that Tutin started sexually assaulting female patients, girls and women, in 1981. Concerns about his conduct first became known in about 2000. In 2005 a GMC panel acquitted him of eight counts of sexually assaulting patients. At a second hearing in 2009, the GMC struck Tutin off the medical register for multiple counts of sexual misconduct dating back to 1984. The GMC found he had sexually abused patients as well as a trainee doctor and a community midwife. However it was not until 2019 that a criminal court sentenced him to ten years and six months in prison for 15 counts of sexual assault dating back to 1981. I spoke to a Surrey police inspector involved in the investigation who stated that he could not understand why the GMC had taken so long to strike Tutin off the medical register and to get a criminal conviction.
In writing this, I have reflected on what I knew of sexual misconduct in medicine over the years. Much of this is based on what I have been told and I cannot substantiate, but there was a consistent message.
As a medical student in my late teens and early twenties, a number of female medical students claimed to have had sexual relationship with senior and much older doctors and medical academics, some of whom were married. It seemed that some relationships with senior doctors were common knowledge. It was my impression that the women believed that it was a sign of their maturity that they had relationships with older and worldly wise men. I thought that there was an abuse of power by the senior doctors.
In the early years after qualifying as a doctor, I meet two female junior doctors, who had sexual relationships with senior doctors at different medical schools to mine, which suggested that this issue was not confined to my medical school. One of the female junior doctors, who I worked with for some months, had started a relationship with a consultant who was a department head at a major teaching hospital when she was a medical student in her early twenties and he was more than twice her age and married. When she qualified, he appointed her to be his house officer (in her first appointment). Their relationship was common knowledge and she was open about it. He subsequently directed her career, although I thought that she was good enough to get on well without his support.
A few years later I met another woman who had started a relationship with a consultant who was the head of her department. He was also twice her age and married. When she tried to end the relationship, he threatened to destroy her career. She left the NHS to work in the pharmaceutical industry.
I met other women who claimed they were bullied into having sex by senior male doctors.
By the time that I was more senior, I realised that there was general and institutional recognition that sexual harassment by some senior doctors was a problem, but not one that organisations wanted to do anything about. I discovered that appointments committees were instructed not to appoint female doctors to train in the department of one medical professor. That obviously had implications for training and career progression of women in that hospital. Another professor was jokingly referred to as “the man who got sexual harassment a bad name”. People knew there was a problem and thought it was amusing.
It is clear that in sexual misconduct there is a power imbalance. Just as with other types of misconduct by senior doctors, those with the power to act turn a blind eye to protect their friends and organisations.
References
- Wilmshurst P. The code of silence. Lancet 1997;349:567-9.
- Wilmshurst P. Institutional corruption in medicine. BMJ 2002;325:1232-5.
- Wilmshurst P. Poor governance in the award of honours and degrees in British medicine: an extreme example of a systemic problem. BMJ 2016;352:h6952. doi: 10.1136/bmj.h6952.
- Wilmshurst P. No doctor should be untouchable. BMJ 2013;346:f2338.
- Essex R, Talagala I, Dada O, Rao M. Clinical Excellence Awards—time for a fairer NHS rewards scheme. BMJ 2021;373:n876. doi: 10.1136/bmj.n876.
- Stephenson J. Clinical excellence awards. BMJ 2010; 340. doi.org/10.1136/bmj.c1961.
Dr Peter Wilmshurst 
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