Referral of Dr Peter Mansfield to the GMC

The referral by Worcestershire Health Authority of Dr Peter Mansfield to the General Medical Council raises some important issues for doctors and patients. Dr Mansfield is a retired general practitioner who works with a charity (Desumo) that offers separate rubella, measles, and mumps vaccines to the children of parents who do not wish to have the combined MMR vaccine because of fears about its supposed side effects (principally, the alleged risk of autism).¹ Dr Mansfield holds some unorthodox views about health and illness, which many doctors (including myself) will disagree with. I also disagree with his view that MMR is potentially unsafe. I believe that it is a safe and effective vaccine and that health professionals should encourage its use. Despite this, I believe that the health authority was wrong to refer Dr Mansfield to the GMC and that his referral sets a dangerous precedent.

What has happened in Worcestershire is that several hundred parents have decided that they do not want their children to have the combined MMR vaccine but still wish to have their children immunised and are willing for them to have the single rubella, measles, and mumps vaccines. Dr Mansfield is providing medical support to the charity that has organised this immunisation programme. The health authority's director of public health, Dr Brian McCloskey, was quoted as saying that the reason for the referral to the GMC was that Dr Mansfield “puts the health authority in a position that a doctor is doing something clinically inappropriate in their area.”² I believe that the decision to refer Dr Mansfield to the GMC was wrong for two main reasons.

Firstly, if a child does not have the combined MMR vaccine he or she is clearly better off having the single rubella, measles, and mumps vaccines than no vaccine at all. Secondly, if patients make an informed decision about their health care, or that of their children, does the state have a right to interfere in that decision when it does not fit with what the state perceives to be best medical practice?

Doctors are faced daily with patients who decline what we consider to be the most appropriate treatment for them. For example, in the case of a 75 year old man with atrial fibrillation and a history of thromboembolic disease, evidence from randomised controlled trials suggests that treatment with warfarin would reduce his risk of having a thromboembolic stroke. Let us assume that, after discussion about the risks and benefits of possible treatments, he declined to be treated with warfarin because of the risk of haemorrhagic complications but would be willing to take aspirin. If his general practitioner went ahead and prescribed him aspirin (a “second best” treatment) then, by Worcestershire Health Authority's definition, the doctor would also be doing something that was “clinically inappropriate.” According to the health authority's logic, this general practitioner should also be referred to the GMC.

Doctors should supply patients with sufficient information to reach an informed decision about their health care. After we have done this, patients may sometimes not take the treatment that we consider to be the most appropriate for them, but doctors should not be punished when this happens. Health authorities and the Department of Health are understandably worried about the fall in MMR uptake that has occurred over the past few years. However, the way to address this problem is not through the persecution of individual doctors but through education campaigns to reassure the public that MMR vaccine is safe and effective. Any remaining gaps in our knowledge about the risks and benefits of MMR vaccine should be filled through the government's current research programme. The fact that the government does have a relatively large research programme in this area suggests that there are still some issues about the safety of the MMR vaccine that need to be clarified.³

One of the reasons Worcestershire Health Authority gave for referring Dr Mansfield to the GMC was that there was no other method for investigating private practitioners. But there are other steps the health authority could have taken, both formal and informal, before making a referral. Further, referral to the GMC will be a major psychological and professional trauma for any doctor. Because the GMC will inevitably give greater weight to a referral from a public body than from an individual, health authorities should not make a decision to refer a doctor to the GMC lightly. Many doctors will feel that the referral of Dr Mansfield has been made because he is doing something that is against the government's public health policy. This will inevitably raise concerns among doctors that they too may be referred to the GMC when they implement health policies that contradict those of the government or of their local health authority. The referral of Dr Mansfield sets a potentially dangerous precedent. In defence of its action Worcestershire Health Authority is likely to point out the complications of measles and rubella infection, particularly among vulnerable groups such as pregnant women. However, I do not accept that this is sufficient reason for referral, as patients are placing themselves at increased risk of complications whenever they do not accept the most clinically appropriate treatment for themselves.

Worcestershire Health Authority is abusing its power in referring Dr Mansfield to the GMC. It is important for doctors and patients to take a stand on this issue, irrespective of whether they agree with Dr Mansfield's opinions on the safety of the combined MMR vaccine.