An apology from the General Medical Council (GMC) for past regulatory action, taken against doctors who were convicted under now repealed homophobic laws, represents progress and is the result of concerted efforts by the regulatorβs staff. But the historical persecution of LGBTQ+ doctors still looms largeβand it continues today, say campaigners.
Carrie MacEwen, GMC chair, said this week (22 February) that the medical regulator was βtruly sorryβ for taking regulatory action against at least 40 male doctors who, in historical cases, had criminal convictions under homophobic laws (box 1). At least eight of them were struck off the medical register.
The GMC apology in full
βThe General Medical Council has been the independent regulator of the UK medical profession for more than 160 years. During that time, we took regulatory action against a number of doctors because they had convictions based on sexuality. For that we want to apologise.
βHomophobic laws and attitudes that were in place into the 1980s and beyond caused personal and professional harm. We compounded that harm when we also took additional regulatory action against those who were on the medical register. In some cases that meant the end of a practitionerβs career. For this we are truly sorry.
βTimes have changed, and so have we, but more still needs to be done to support LGBTQ+ doctors and patients. We all have a part to play in this. As a regulator and employer, weβre committed to championing equality, diversity and inclusivity in all that we do.β
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The GMC says that, as far as it is aware, no doctors still living today were subject to such erasures. Yet Duncan McGregor, a representative of GLADD (the Association of LGBTQ+ Doctors and Dentists), says that the shadow cast by history is long: he compares it to section 28, a law that stopped councils and schools in Britain from βpromoting the teaching of the acceptability of homosexuality as a pretended family relationship.β1
βIt was repealed during my school years,β says McGregor, βbut even after that many teachers still wouldnβt approach topics pertaining to LGBTQ+ issues because of that recent history.β Similarly, he argues, there will be a cohort of doctors alive today who lived in the shadow of GMC erasures. βSome of our senior colleagues may well have worked during the early years of their careers with doctors who had undergone investigations due to their sexuality.β
Although it refers to historical actions, McGregor believes that the GMCβs apology bears weight today. βThere will be many LGBTQ+ doctors who read it and feel profound sadness for those who came before them, for those who were treated poorly,β he says. βBut hopefully they will also feel, as I do, a bittersweet sense of progress.β
Upsetting research
The GMCβs chief executive, Charlie Massey, says that the apology is the result of work undertaken by its staff (box 2). βThe idea for the apology was sparked by our LGBTQ+ staff network, who deserve a huge amount of credit for shining a light on this,β he says. βItβs deeply shocking that doctors faced regulatory action on the basis of their sexuality, and through the work of our staff network and archivist we have learnt more about the impact of homophobia and discrimination on peopleβs personal and professional lives.β
A staff initiative, senior support, and external feedbackβthe makings of the GMC apology
Xander Warden is a member of the GMCβs LGBTQ+ staff network and the initiativeβs project manager. Warden says that in 2018, before he joined the GMC in 2022, the network asked whether there was any evidence in the regulatorβs records of historical injustices committed against men who faced conviction under now repealed homophobic laws.
He says, βMembers of the network initially did some of their own research, but they quickly started working with the GMCβs archivist Courtney Brucato and found a significant number of cases. As part of that work they then started to formulate the idea of making a formal apology as an organisation.β
The LGBTQ+ staff network took their findings to the organisationβs equality, diversity, and inclusion team before presenting them to senior management. βThe senior management team was entirely behind the idea,β says Warden. βThey were very happy for us to make that apology, and we had pretty much instantaneous support. We then approached some of our external partners, particularly GLADD [the Association of LGBTQ+ Doctors and Dentists], who gave us some really robust feedback.β
In light of GLADDβs feedback the network increased its efforts to find cases of the doctors affected. They also created scoping criteria for relevant cases, as well as a system whereby a doctor or a doctorβs next of kin could approach the GMC and receive a letter of apology.
Warden explains, βWeβre going to put out a call to action for people to approach us if they feel that this project is relevant to them or their next of kin. But we made a decision early on that we didnβt want to out anyone, even posthumously.
βThe details of these doctorsβ lives were ultimately their business. We donβt want to cause any sort of distress to someoneβs family by sending a letter explaining that their relative had a conviction under now repealed homophobic laws when perhaps the family doesnβt know that. So, weβve chosen to let people approach us.β
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Xander Warden is a member of the GMCβs LGBTQ+ staff network and the initiativeβs project manager. βWhat we discovered through our research was really upsetting,β he says. βA lot of these doctorsβ lives were affected in very profound ways, and thereβs nothing that we can do to change that. But I think itβs important that weβre aware of that as an organisation because that can drive us to do better in the future. I think thatβs true of wider society as well.β
Having worked on the project for two years, Warden says that he and his team are glad that theyβve ended up where they have. βWeβve done the best job we could to respect those people and to try to right the wrongs that weβve done,β he says. βAll the digitised historical records [of doctors who faced regulatory action for convictions under now repealed homophobic laws] that we have found will have an apology attached to them, so that anyone who finds these records in the future will see an acknowledgment that the way these doctors were treated was wrong and that it should not have happened.β
Warden says that the outcome of the teamβs work was thanks to the dedication of GMC staff. βThere are people in the organisation who care deeply about getting this right,β he says. βThere have been times where Iβve stood with colleagues and weβve been in tears reading the stories of doctors who were affected by these historical injustices.β
Listening to feedback
McGregor says that the apology came when it did partly because the GMC had been diligent in making sure that it was done properly, with input from stakeholders. βThe GMC listened to our feedback,β he says. βThey came to us with different versions of this project that we werenβt happy with and that we had criticism of. They took those criticisms away, and they improved it.
βTime has been taken to get this done right, not just to get it done for the purpose of ticking a box. The fact that the GMC spent the time and personnel hours in devising this, in delving through the records and identifying all the cases, and in liaising with stakeholders such as ourselves and refining this, is an indication that this is an apology that has been taken seriously.β
He adds, βIt has a genuine heart and a genuine core to it. Thatβs all very important when we think about the timing of this apology. Why now? Because itβs when the project has come to its conclusion.β
Andrew Hartle, anaesthetist and trustee of the charity Fighting With Pride (box 3), agrees that the apology is important. βApologies change everything, but they also change nothing,β he says. βItβs an acknowledgment of wrong, but it doesnβt change the hurt and the pain thatβs been experienced as a consequence of that wrong. But until youβve made the apology no one can move on.
βI canβt imagine what it would have been like to no longer be able to be a doctorββa doctor dismissed from the RAF for being gay reflects
Andrew Hartle is an anaesthetist and professor of practice in anaesthesia at Imperial College London. He was ordered to resign (βadministratively dischargedβ) from the RAF in 1997 after being outed in a tabloid newspaper.
Hartle is a trustee of the charity Fighting With Pride, which supports the health and wellbeing of LGBT+ veterans, service staff, and their familiesβparticularly those most affected by the militaryβs 1967-2000 ban on LGBT+ staff.
He draws parallels between doctors who were dismissed from the armed forces for being gay and doctors who had regulatory action taken against them by the GMC for convictions under now repealed homophobic laws.
βRather like the apology for gay veterans [made by the prime minister Rishi Sunak, on behalf of the British state, in July 2023], the GMC apology is one part of a bigger picture. Whatever action the GMC took, whether it was suspension or erasure from the register, it was only a tiny part of a doctorβs story or journey,β says Hartle. βRelationships would have foundered, relationships with family would have foundered. The process of being dismissed from the military was sometimes the first news that their families had [that they were LGBTQ+] because they hadnβt come out. Many were disowned by their families.β
He adds, βSome veterans never regained contact with their families and friends, and they no longer had a career to fall back on. So, there were financial implications and personal implications, as well as a sense of shame, unworthiness, guilt, and probably quite a lot of other consequences and mental health impacts.
βSo, the apology from the GMC is a start, but it wonβt fix everything. We donβt know how many, if any, of the doctors who were directly affected are still alive. But we can certainly say for each and every one of those doctors that the GMC action was part of something that was life changing. Their lives were never the same again.
βFor those that are dead it canβt change their lives, but it may change how theyβre thought of by their familiesβand if there are any who are still alive we can only hope that it brings some comfort that what happened is wrong.β
Shame and standards
Hartle also draws parallels between his own experiences and those of the doctors who were affected by the GMCβs actions. βFor almost my entire post-air force life there has been shame in having failed to meet the standards that I lived up to,β he explains. βThat has a really big psychological impact, and my mental health has suffered significantly as a result of that, and Iβve needed quite a lot of help with that.
βI at least kept my ability to be a doctorβthat wasnβt taken away from meβso I was still able to earn a living, and a lot of my self-respect was retained. I probably compensated quite a lot by trying even harder to have a better career, to try to show that I was better than they thought I was.
βI canβt imagine what it must be like to have everything taken away. Part of me was taken away, but I canβt imagine what it would have been like to have actually lost my registration, to no longer be able to be a doctor and do the thing I trained to do.
βMost of these doctors [who were removed from the GMC register] had no comeback and would never have practised again. They were punished for actions which really werenβt blameworthy; they couldnβt help being gay. They could be and probably will be criticised for having done things that were unlawful, but we have to remember that the laws that they broke have now been changed, and they could now seek pardons or have those convictions set aside.
βItβs almost as if they were struck off for being left handed or red haired. Thatβs a bit of an exaggeration, but they had no choice about being gay.β
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βI much better understand now why patients want apologies when things go wrong in hospital, because until that first stepβthe acknowledgment that something went wrong and that youβre sorryβthere can be no moving forward. Apologies, done well, can be incredibly powerful.β
Prejudice today
While LGBTQ+ doctors may no longer fear losing their registration, the GMCβs past actions are part of a wider culture of prejudice and persecution that LGBTQ+ doctors still feel today, says McGregor. And LGBTQ+ doctors still make life and career choices based on a fear of prejudice and persecution.
βWhen I was applying to medical school I had a mentor who was a gay male doctor,β he says. βHe spoke about the times when GP partners would say things like, βI wonβt have a homosexual working at my practice.β
βI know of people who have chosen not to embark on certain career pathsβfor example, paediatricsβbecause of longstanding tropes about gay men being sexual predators. Itβs incredibly pervasive, and, while things are better than they were in the past, those fears still linger on for many.β
In 2022 the BMA and GLADD conducted a survey2 to understand and improve the experiences of LGBTQ+ medics in education, training, and the workplace (box 4). It found that experiences of homophobic, biphobic, and transphobic behaviour in medicine were still commonβbut also that 78% of LGBQ+ respondents and 70% of trans respondents said that they hadnβt reported their experiences to anyone.
The experiences of LGBTQ+ medics in education, training, and the workplace
A survey by the BMA and GLADD in 20222 received 2490 responses and found that:
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Of those who responded, 364 identified as gay, 140 as lesbian, 257 as bisexual, and 92 as queer. A further 1443 identified as straight or heterosexual, 73 selected βother sexual orientationβ or preferred to self-describe, 81 respondents chose not to say, and 40 skipped the question.
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71% of lesbian, gay, bisexual, and queer (LGBQ+) respondents said that homophobia and biphobia were an issue in medicine, which compared with 26% of heterosexual respondents. Only 5% of heterosexual respondents thought that this was an issue in their own workplace or place of study, which compared with 30% of LGBQ+ respondents.
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Over 43% of LGBQ+ respondents had directly experienced homophobia or biphobia at least once in the past two years.
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These experiences ranged from derogatory language, social exclusion, and having their professional competence questioned to overt hostility, threats, and violence. There were also reports of medics demonstrating this behaviour towards LGBTQ+ patients.
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Over 29% of LGBQ+ respondents and 59% of trans respondents considered their experiences of homophobic, biphobic, and transphobic behaviour to be serious enough to amount to unlawful discrimination, abuse, or harassment.
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78% of LGBQ+ respondents and 70% of trans respondents said that they hadnβt reported their experiences to anyone.
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McGregor explains, βOne of the concerning things about that report is, when compared with the previous report [published in 2016], a lot of things havenβt changedβand, particularly worryingly, the rates of reporting instances of discrimination have changed precious little.
βThatβs a really alarming trend, as not only are LGBTQ+ doctors and medical students being discriminated against on the grounds of their sexual orientation or gender identity but they also donβt feel confident in escalating that. They donβt feel that the system will take it seriously, that the system will be fair to them, or that the system wonβt punish them for raising concerns. Thatβs a great concern.β
Massey says that the regulator doesnβt underestimate the wider impact of its role, including on people working in the medical community today. βThatβs why itβs so important we publicly say we are sorry, for todayβs LGBTQ+ medical community and the wider public to hear,β he says. βWorkplaces must be supportive and inclusive, and we know that discrimination and bias are issues that persist in healthcare. Weβre clear that this is unacceptable and must change.β