Raising heart rates

Raising heart rates

By Michael Pickard
December 18, 2023


Malpractice writer Grace Ofori-Attah and star Niamh Algar discuss the making of the ITV medical thriller, in which an A&E doctor comes under investigation and spirals into a dangerous conspiracy.  

Grace Ofori-Attah

For her first original television series, former doctor Grace Ofori-Attah hadn’t imagined writing a medical drama. But after making its debut on ITV earlier this year, Malpractice has now been renewed for a second season – while Ofori-Attah recently won the Women in Film & TV’s writing prize for the five-part thriller at a recent awards ceremony.

“I wouldn’t have thought I would go from being a doctor to just writing medical dramas,” she tells DQ. “Growing up, I did watch things like ER and Casualty but as I went to medical school and then practiced as a doctor, the last thing I wanted to do was watch any medical show on TV.

“With this, what I really enjoyed was being able to show a more truthful version of what it’s like [as a doctor]. It’s not glamorous, it’s not always fun. It can be really stressful and there’s pressure not just from your day job but external things, while constantly not wanting to make a mistake because there is this whole other machine that can come down on you. That is quite unique to medicine and can make the day job really tough.”

With Malpractice, Ofori-Attah drew on her experiences both working in A&E and as a consultant psychiatrist to tell the story of Dr Lucinda Edwards, who endures a nightmare shift that ends in the death of an overdose victim. When an investigation is launched into Lucinda’s actions, she comes under intense pressure at work and at home as difficulties in her personal life emerge while she becomes entangled in a dangerous conspiracy.

Malpractice stars Niamh Algar

Pitched by the writer as “medical Line of Duty,” the five-part drama is produced by that show’s producer, World Productions, and went on to become ITV’s most watched new drama of 2023 following its launch in April.

“It’s just surreal to make the show, especially coming from a medical background,” Ofori-Attah says. “But having my first original show be about my former day job seemed like quite a natural choice. What was quite nice for me was being able to use real life events to inform the drama and give it authenticity.”

As a doctor, she worked in A&E, as well as a number of other departments, before choosing to specialise in psychiatry and later addiction psychiatry. “Unsurprisingly, when you dig into a lot of a patient’s stories and try to figure out what’s going on, that kind of detective work and storytelling lends itself to someone who probably wants to go on and write stories,” she says.

Initially, she had thought of writing a book but found her writing better suited the format of a screenplay. Writing a script based on her day job during her spare time, it would serve as her entry into the world of screenwriting, first being accepted onto Channel 4’s 4Screenwriting programme and then as a writer on Idris Elba comedy In The Long Run. That early spec script also became the foundation of what would become Malpractice, a series with a central character that Ofori-Attah says isn’t an obvious hero.

Dr Lucinda Edwards becomes deeply affected by the pressures of her job

“Often doctors on TV are depicted as saviours. They come in and save the day, and everyone loves that,” she says. “I just wanted a more human, flawed character who despite all of the things that are probably not that likeable about her, you root for her. I hope people were rooting for her.”

Lucinda is also someone who has been deeply affected by the pressures of her job, damaging her mental health and impairing the decisions she makes, as viewers will discover.

“It was really central just to show what it’s like to be a doctor within the current system and why I think so many people that I went to university with, who were practicing doctors, have maybe left the profession, and just try to just give a different narrative of what it’s like to be a doctor in the NHS,” she says.

Notably, there are numerous references to the Covid pandemic, which was a contributing factor to Lucinda’s problems, having taken time off and returned to the frontline before she was ready.

“It’s a profession that doesn’t necessarily take into account the wellbeing of the people who work within it, because you just want to get to the end of the shift and just keep going,” Ofori-Attah says. “I thought it was really important to show that aspect of them.”

Edwards’ own flaws are revealed as the series progresses

Another aspect of being a doctor the writer wanted to highlight was their role in coroner’s inquests, which are held to determine a person’s cause of death when they die from a reason other than natural causes. Doctors are often called to give evidence, and though a coroner’s verdict does not attach blame to anybody, “how can you not feel that you’re having every aspect of your practice scrutinised,” says Ofori-Attah, who dedicated most of episode three to the court process.

“At one of the first coroner’s inquest I went to, a father was asking questions of the doctors, and I had never realised the family were allowed to do that,” she continues. “I really wanted to show as bad as it can be and how everything just flies out the window because it’s just you against that courtroom. Even though there is your team, you’re meant to be professional and you want to all stick together, you feel under attack. There are no winners.”

Broadly speaking, Malpractice goes on to highlight the practice of illegal prescription medication and the number of drugs wasted by hospitals each year, while one character goes on to explain the pitfalls of a system that fails to help the majority of addicts end their reliance on drugs.

“That was my own little rant about the NHS,” Ofori-Attah admits. “There’s a lot of goodwill within the NHS but in addiction services it can be quite frustrating because you’re limited in what you can provide for the patient population. There’s not necessarily enough funding and there are few treatment programmes so you do get these ‘revolving door patients’ who you manage for a bit, they fall off the scheme and then they come back in again. As a doctor, being able to identify a problem but then not having the tools to fix it can be really frustrating. This problem is perpetuated in society and it’s not the fault of the patients. It’s not necessarily the fault the doctors. But there’s a systemic problem.”

Taking the lead in the series is Irish actor Niamh Algar, who is known for roles in drama The Virtues, true crime series Deceit and heist thriller Culprits, which have all offered her the chance to appear in exciting stories while working with directors she admires.

In the case of Malpractice, she was interested in the fact it was written by a former doctor and was keen to partner with director Philip Barantini, who is best known for his one-take film Boiling Point and the BBC series of the same name.

“I’d seen Boiling Point and I checked out a bit more of Phil’s work, and I could see it’s high-paced, high-drama. And a story written by a former doctor really intrigued me because reading it, it was so detailed and intensive in regards to this doctor’s experience,” Algar says, speaking to DQ while taking a break from filming her latest project, ITV drama Playing Nice. “You could tell it was coming from a very real and raw place. Paired with Phil, who is quite raw and real in his direction, I thought like that would be a really great team to jump on board with.”

Medical investigators Norma Callahan and George Adjei return for season two

Before filming, Algar shadowed an A&E consultant to get a real taste of what the role was like in real life, one where you never know who what might be come through the door next. That experience is recreated in the opening of the show, as Lucinda comes face to face with an overdose patient and then a man wielding a gun.

Lucinda also has her own personal problems to handle, but doesn’t realise she even has a problem until events during the series shine a light on her own flaws.

“That was actually really interesting to play and to balance correctly because all these lies just keep building and building, but she cannot see the truth, nor can she see that she needs help,” Algar explains. “At the end of it, you just see this doctor who’s realises that she can’t cope. That for her was probably the hardest thing, having to admit that she’s not cut out for it and having to own up to her mistakes.”

Algar was under pressure herself, appearing in almost every scene across the series, which is distributed by ITV Studios. “It was definitely full on,” she says. “I had one day off. But it’s easier when you’re in it [so much] to keep track of your character’s arc.

“I loved the challenges of trying to make sense of the medical procedures, and it was a joy to be forced to research what A&E doctors go through and the different departments. I found it absolutely fascinating. It was a 10-week shoot and we shot it during the heatwave last year, so it got warm in that hospital.”

That hospital was built at a disused tax office in Shipley, where production designer Adam Tomlinson recreated every aspect of an A&E department. “It did feel like you were walking into the real hospital,” Algar notes.

To prepare for filming, the actor also practiced applying sutures to oranges under the supervision of her sister, who is a vet. More support came from her mother and sister-in-law, who are both nurses.

“When I first got sent the script, I was at home in Ireland and I would call out the different procedures and they’d be like, ‘Oh, yeah, this is how you do this,’ so I had people within my family chipping in, making sure that I got suturing right.

“When it came to filming, you have to make it look like you’ve done it a thousand times while at the same time saying dialogue that to you makes no sense, but to this person makes complete sense. Hats off to doctors. It’s amazing what they can do.”

One thing Algar didn’t end up doing was a one-take sequence, though she did discuss the prospect with Barantini.

“There was an emergency thoracotomy in episode two, and me and Phil got really excited by the idea of carrying out the procedure from beginning to end, which would essentially have taken under five minutes,” Algar says. “We were like, ‘We can totally do it,’ but we got outvoted by the producers.”

Now working on season two, Ofori-Attah will bring to the screen a new malpractice case facing another doctor, with Algar not set to reprise her role. Instead, returning medical investigators Dr Norma Callahan (Helen Behan) and Dr George Adjei (Jordan Kouamé) will provide the link between seasons.

“We were always open to it being a completely new story in a different hospital and as season one evolved, what seemed most natural was the investigators coming back for a different case, and that would give us more story to explore,” she says. “There’s just so many different areas within the NHS and healthcare you can have them dig into.”

After the success of season one, the writer says she has also learned she can be less “pernickety” about medical details. “I was constantly being told, ‘We can’t sacrifice the drama for reality,’ but it is a fine line because as a doctor, I don’t want to do a disservice to doctors or the NHS. I want to portray something that’s quite truthful but not damaging,” she says. “I’ll try and have a bit more fun with the drama of it.”

For Algar’s part, she felt Lucinda’s story had been told. “It’s really nice that people respond to what you’ve done with the character, and it’s exciting and a huge compliment when they want you to come back. But when you feel like that’s the end of the story, it’s always best to leave on a high.”

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