As a Clinical Fellow, the State of Medical Education and Practice in the UK 2014 report (SOMEP) is an acute example of the crossover between my year with the GMC, and my “other life” as a doctor in training. Because I am a member of the profession that the report is about, as part of the organisation that produced it, I’ve gained a unique perspective that makes it a fascinating read.
Particularly compelling was the information on the demographics of the workforce, and how these are related to complaints. Aside from curiosity at seeing how I, and my specialty, fare in terms of relative risk of investigation, there are important issues raised by the data that go far beyond individual self-interest.
Complaints to the GMC
Most obviously, there is the matter of the sheer number of complaints received by the GMC. Complaints continue to rise, and although the trend is slowing, it represents an increase of almost two thirds between 2010 and 2013. A previous blog has discussed this trend, identifying that, in part, this reflects wider social changes, whilst also considering additional factors specific to the GMC.
In an ideal world there would be no cause for complaints; however, doctors are human, patients are human, and things go wrong. Sometimes the less-than-ideal outcome is unavoidable, it is part of the inherent unpredictability of health and illness. However, at other times, problems could have been prevented, or the right outcome was achieved in the wrong way.
If we accept that things can go wrong, having increasing numbers of complaints could be seen as positive. It can reflect that more people are feeling able to raise concerns, and highlight instances where patient care was not what they expected. However, it could also mean that the numbers of events where people feel the need to complain are increasing.
It is particularly interesting to look in further detail at the outcomes of complaints. Although numbers of complaints have increased, in 2013, a greater proportion of complaints were closed without further action, either immediately or after investigation, than in 2010 . In contrast, the much smaller proportion of investigations resulting in suspensions or erasure has stayed fairly static during this time.
It is, on one hand, positive to note in real terms, how few doctors were actually deemed to need suspension or erasure. It was less than 140 in 2010, and less than 170 in 2013 (although this includes modelled outcomes for the cases that were not closed in July 2014)1. However there are much higher numbers of investigations which eventually closed without the need for further action. For the doctors involved these investigations will potentially have wide reaching professional and personal implications, often over long periods, irrespective of the final outcome. The impact of these processes on the individuals involved cannot be taken lightly.
The GMC has a clear duty to consider all complaints it receives, and investigate where appropriate. However, there is an obvious need to address the fact that large volumes of complaints are closed without action from the GMC, perhaps suggesting they would have been more appropriately directed somewhere else. There are benefits to patients, doctors, and the GMC if complaints are directed to the most suitable place from the outset, whilst also being aware that this will reduce the direct oversight the GMC has of some issues. Guidance for those seeking to make a complaint [PDF] helps to highlight the different organisations to consider, and an interactive guide explores the processes the GMC follows when complaints are received.
It is also interesting to see the different sources of complaints in recent years. The majority of complaints in the last four years came from the public (64% of all complaints in that period) but only one out of five of those complaints reached the threshold for investigation. In contrast, complaints that came from doctors and employers formed a relatively small proportion (11% and 6.9% respectively of all complaints in the last four years) but these were more likely to be investigated. Nine out of ten complaints from employers and over half of complaints from doctors in the four year period to 2013 met the GMC’s threshold for full investigation.
The report also sheds light on the outcomes of the investigations, and shows how they varied depending on the source of complaint. Nearly a quarter of the complaints from doctors or employers that the GMC investigated ended in a sanction or a warning for a doctor. In comparison, less than one in 20 complaints from members of the public that were investigated resulted in a sanction or a warning.
This only serves to strengthen the importance of doctors, colleagues and employers speaking up when they see problems, as it seems that often these concerns are justified. There is increasing focus on the importance of raising concerns, and the GMC has developed a range of resources, recognising that doctors need support with this. As well as a confidential helpline, there is also a guide for health professionals and a series of online tools and case studies.
What has been reassuring during my placement within the organisation has been the clear intention to address these issues. As the new strapline suggests, there is a determination to work with doctors, to help prevent complaints and support doctors with areas where problems commonly arise.Additionally there is clear information for those seeking to make a complaint or raise a concern, to ensure it is directed to the most appropriate place, and to explain how it is dealt with if sent to the GMC.
There is a difficult balance between reducing the numbers of complaints where no action is taken, whilst supporting and encouraging people to raise concerns when they arise. From my time here so far, I have seen that the GMC does have clear aspirations to improve the situation from both perspectives, and those aims resonate with me as both a GMC employee and a doctor.
Katie Smith is an ST2 in Public Health based in the North West of England. She is currently a Clinical Fellow at the General Medical Council, as part of a 12 month out of programme placement through the National Medical Director’s Clinical Fellow Scheme.
The National Medical Director’s Clinical Fellow Scheme provides doctors in training with the opportunity to work in national healthcare organisations for a year. The scheme, run by the Faculty of Medical Leadership and Management, aims to develop a range of skills, including leadership, management and strategy development.
1. The 162 figure for 2013 is based on modelling what the likely level will be, given that a high proportion of 2013 complaints being investigated were still unresolved at the time the State of Medical Education and Practice report was produced in mid 2014: 1289 out of the 3055 investigations opened in 2013 were still being investigated (see chart on p63 of report).