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from the General Medical Council (GMC) for past regulatory action, taken against doctors who were convicted under now repealed homophobic laws, represents progress and is the result of concerted efforts by the regulator’s staff. But the historical persecution of LGBTQ+ doctors still looms large—and it continues today, say campaigners.
Carrie MacEwen, GMC chair, said this week (22 February) that the medical regulator was “truly sorry” 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
“The 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.
“Homophobic 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 practitioner’s career. For this we are truly sorry.
“Times 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, we’re committed to championing equality, diversity and inclusivity in all that we do.”
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 “promoting the teaching of the acceptability of homosexuality as a pretended family relationship.”1
“It was repealed during my school years,” says McGregor, “but even after that many teachers still wouldn’t approach topics pertaining to LGBTQ+ issues because of that recent history.” Similarly, he argues, there will be a cohort of doctors alive today who lived in the shadow of GMC erasures. “Some 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.”
Although it refers to historical actions, McGregor believes that the GMC’s apology bears weight today. “There will be many LGBTQ+ doctors who read it and feel profound sadness for those who came before them, for those who were treated poorly,” he says. “But hopefully they will also feel, as I do, a bittersweet sense of progress.”
Upsetting research
The GMC’s chief executive, Charlie Massey, says that the apology is the result of work undertaken by its staff (box 2). “The idea for the apology was sparked by our LGBTQ+ staff network, who deserve a huge amount of credit for shining a light on this,” he says. “It’s 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 people’s personal and professional lives.”
A staff initiative, senior support, and external feedback—the makings of the GMC apology
Xander Warden is a member of the GMC’s LGBTQ+ staff network and the initiative’s project manager. Warden says that in 2018, before he joined the GMC in 2022, the network asked whether there was any evidence in the regulator’s records of historical injustices committed against men who faced conviction under now repealed homophobic laws.
He says, “Members of the network initially did some of their own research, but they quickly started working with the GMC’s 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.”
The LGBTQ+ staff network took their findings to the organisation’s equality, diversity, and inclusion team before presenting them to senior management. “The senior management team was entirely behind the idea,” says Warden. “They 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.”
In light of GLADD’s 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 doctor’s next of kin could approach the GMC and receive a letter of apology.
Warden explains, “We’re 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 didn’t want to out anyone, even posthumously.
“The details of these doctors’ lives were ultimately their business. We don’t want to cause any sort of distress to someone’s family by sending a letter explaining that their relative had a conviction under now repealed homophobic laws when perhaps the family doesn’t know that. So, we’ve chosen to let people approach us.”
Xander Warden is a member of the GMC’s LGBTQ+ staff network and the initiative’s project manager. “What we discovered through our research was really upsetting,” he says. “A lot of these doctors’ lives were affected in very profound ways, and there’s nothing that we can do to change that. But I think it’s important that we’re aware of that as an organisation because that can drive us to do better in the future. I think that’s true of wider society as well.”
Having worked on the project for two years, Warden says that he and his team are glad that they’ve ended up where they have. “We’ve done the best job we could to respect those people and to try to right the wrongs that we’ve done,” he says. “All 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.”
Warden says that the outcome of the team’s work was thanks to the dedication of GMC staff. “There are people in the organisation who care deeply about getting this right,” he says. “There have been times where I’ve stood with colleagues and we’ve been in tears reading the stories of doctors who were affected by these historical injustices.”
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. “The GMC listened to our feedback,” he says. “They came to us with different versions of this project that we weren’t happy with and that we had criticism of. They took those criticisms away, and they improved it.
“Time 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.”
He adds, “It has a genuine heart and a genuine core to it. That’s all very important when we think about the timing of this apology. Why now? Because it’s when the project has come to its conclusion.”
Andrew Hartle, anaesthetist and trustee of the charity Fighting With Pride (box 3), agrees that the apology is important. “Apologies change everything, but they also change nothing,” he says. “It’s an acknowledgment of wrong, but it doesn’t change the hurt and the pain that’s been experienced as a consequence of that wrong. But until you’ve made the apology no one can move on.
“I can’t imagine what it would have been like to no longer be able to be a doctor”—a 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 (“administratively discharged”) 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 families—particularly those most affected by the military’s 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.
“Rather 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 doctor’s story or journey,” says Hartle. “Relationships 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 hadn’t come out. Many were disowned by their families.”
He adds, “Some 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.
“So, the apology from the GMC is a start, but it won’t fix everything. We don’t 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.
“For those that are dead it can’t change their lives, but it may change how they’re thought of by their families—and if there are any who are still alive we can only hope that it brings some comfort that what happened is wrong.”
Shame and standards
Hartle also draws parallels between his own experiences and those of the doctors who were affected by the GMC’s actions. “For almost my entire post-air force life there has been shame in having failed to meet the standards that I lived up to,” he explains. “That has a really big psychological impact, and my mental health has suffered significantly as a result of that, and I’ve needed quite a lot of help with that.
“I at least kept my ability to be a doctor—that wasn’t taken away from me—so 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.
“I can’t imagine what it must be like to have everything taken away. Part of me was taken away, but I can’t 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.
“Most 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 weren’t blameworthy; they couldn’t 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.
“It’s almost as if they were struck off for being left handed or red haired. That’s a bit of an exaggeration, but they had no choice about being gay.”
“I much better understand now why patients want apologies when things go wrong in hospital, because until that first step—the acknowledgment that something went wrong and that you’re sorry—there can be no moving forward. Apologies, done well, can be incredibly powerful.”
Prejudice today
While LGBTQ+ doctors may no longer fear losing their registration, the GMC’s 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.
“When I was applying to medical school I had a mentor who was a gay male doctor,” he says. “He spoke about the times when GP partners would say things like, ‘I won’t have a homosexual working at my practice.’
“I know of people who have chosen not to embark on certain career paths—for example, paediatrics—because of longstanding tropes about gay men being sexual predators. It’s incredibly pervasive, and, while things are better than they were in the past, those fears still linger on for many.”
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 common—but also that 78% of LGBQ+ respondents and 70% of trans respondents said that they hadn’t 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 “other sexual orientation” 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 hadn’t reported their experiences to anyone.
McGregor explains, “One of the concerning things about that report is, when compared with the previous report [published in 2016], a lot of things haven’t changed—and, particularly worryingly, the rates of reporting instances of discrimination have changed precious little.
“That’s 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 don’t feel confident in escalating that. They don’t feel that the system will take it seriously, that the system will be fair to them, or that the system won’t punish them for raising concerns. That’s a great concern.”
Massey says that the regulator doesn’t underestimate the wider impact of its role, including on people working in the medical community today. “That’s why it’s so important we publicly say we are sorry, for today’s LGBTQ+ medical community and the wider public to hear,” he says. “Workplaces must be supportive and inclusive, and we know that discrimination and bias are issues that persist in healthcare. We’re clear that this is unacceptable and must change.”
