Today, we have published the results of an independent study into the perceptions of the GMC. It canvassed the views of doctors, medical students, patients, members of the public, employers, educators, key interest groups and parliamentarians. Niall Dickson, Chief Executive and Registrar of the GMC, writes about the results and why we commissioned the research.
Media coverage is not always positive, and every year a small but significant number of doctors have the stress of being subject to an investigation. Patients and their relatives also experience the anxiety of making a complaint which can take time to investigate.
Do different groups – doctors, patients, educators, employers – feel differently about the organisation and, given the massive changes at the GMC, what do they feel has been the impact of those changes?
To answer those questions, the GMC commissioned an independent study last year which is being published today. It canvassed the views of 3000 doctors and medical students, 1500 patients and members of the public, plus employers, educators, key interest groups and parliamentarians. Our plan is to repeat it every two years to explore how views of the GMC change.
Regulation is only effective when it is respected – there is plenty of talk about how we take action against individual doctors, or remove doctors in training from unsuitable placements or approve revalidation deferrals, but in reality our effectiveness comes more from how we can work with others to influence and improve, than the direct actions we have to take when things have gone wrong.
And for that to work we need to understand how the system operates and how we can work in partnership with individuals and organisations. How we are perceived will affect how effective we are – in short we cannot protect patients in isolation and we must actively engage with doctors, patients and employers much more than in the past.
Positive results
Taken as a whole the survey results are encouraging. There does appear to be strong confidence in GMC regulation across most of the groups we engage with.
- 75% of doctors said that they were confident in the GMC’s regulation of doctors.
And, perhaps unsurprisingly, most patients and members of the public personally felt confident in the UK medical profession.
- 88% of patients and members of the public expressed confidence in the UK medical profession.
Doctors with overseas qualifications tended to be more positive about the GMC than those who trained here and were also more likely to feel they would be treated fairly in our procedures.
- Less than one in seven UK qualified doctors were ‘very confident’ in the GMC’s regulation, while this was the case for more than a quarter of non-UK qualified doctors.
We need to understand this better – and act upon it not just by communicating more effectively but also making sure our procedures are fair and seen to be fair.
The survey had some encouraging views about specific areas of GMC work too. Doctors who have been through revalidation are reflecting more on their practice, and have a greater understanding of our core guidance.
- Compared to 12 months ago, 34% of doctors who had been through revalidation said they are reflecting more on their practice and 29% are more aware of how to apply the principles of good practice to their work.
Room for improvement
But it would indeed be a shock if this was all good news. It is clear from the survey that we have to improve levels of understanding about how our role has changed, especially in medical education and in helping to raise standards of practice.
- Just 49% of doctors identified ‘sets the standards for medical practice in the UK’ as one of the GMC’s roles and responsibilities.
It may be no surprise that the results show doctors were most aware of our work investigating and acting on concerns but we are keen to see a greater awareness of our other functions.
The survey also suggested that employers and educators feel that we need to improve how we engage and communicate with them.
Some doctors, including older doctors and those who work in the private sector, tended to be the most negative about the GMC across the survey.
- When asked if the GMC treats everyone fairly, doctors aged over 55 and those aged 36-54 were significantly more likely to disagree that the GMC is fair than their younger counterparts. The percentages were 27% and 25% vs. 17% aged 35 and under.
- In terms of sector, 32% of doctors working privately disagreed that the GMC is fair, in contrast to 23% of doctors working in the public sector.
We will be looking to make improvements in these areas by the time of the next survey.
What’s next?
We are committed to working more closely with doctors, medical students and patients on the frontline of care, and last year we met with 16,000 doctors and 8,000 medical students and educators through our Regional Liaison Service and Devolved Offices. We will use the survey results to inform that active engagement.
If you did, thanks for taking part in the survey.
Niall Dickson is Chief Executive and Registrar of the GMC
Improving medical education and practice across the UK 
This study did not examine the opinions of the doctors who had an investigation done against them by the GMC. This is an important ommission, as the perceptions of the GMC among these doctors could be much different from practitioners who never had the misfortune of being ‘under the GMC investigation’.
The GMC investigation and the processes and procedures followed need to be examined by an independent body in terms of ‘relevance’, ‘proportionality’ and ‘evidence of effectiveness’
The process of offering ‘voluntary undertakings’ to doctors which they cannot refuse, needs to be reexamined.
The problem of ‘sick doctors’ committing suicides while under GMC investigation cannot be addressed without changing the current practice of conditions, suspensions, Undertakings and Fitness To Practice proceedings.
While the current format of functioning allows the UK public to feel confident of the GMC regulation, the doctors are increasingly disillusioned with the burocracy and the heavy handed regulation.
And the conclusion and action plan are generic and non specific.
1. If future research is planned, please address the above issues.
2. Leave the competency assessment to the Royal colleges
3. Address providing limited legal advice to ‘unrepresented’ doctors , who are present in atleast 40-49 % hearings.
4. Use the services of the Occupational Health specialists in case of ‘health concerns’ about doctors, who can help the professionals’ instead of the current ‘traumatising’ procedures.
5. And finally, a realistic break up of the GMC into local medical councils, which can do the regulation more effectively. This will leave the GMC central body to keep the register and focus on education and engagement of the profession.
Thanks for your comment
It is not correct, though, to say that ‘this study did not examine the opinions of the doctors who had an investigation done against them by the GMC’. The perceptions study included doctors who had previously been through our fitness to practise procedures. It did exclude doctors currently being investigated, or who were currently suspended from the register, due to the potentially significant negative impact on the doctors themselves of being contacted at what we know is a difficult time.
We recognise the critical importance of understanding the views of doctors who have been investigated. Last year we published independent research exploring the experience of doctors who have been through the GMC’s complaints procedures. That study was specifically focused on exploring experience and areas for improvement. Broad findings were that doctors wanted better communication during an investigation, including face to face communication with the GMC. We published an action plan alongside the research identifying how we are responding to the issues raised.
Have I read the ‘positive’ comments correctly?
25% of doctors have NO confidence in the GMCs regulation of doctors and over 85% have LESS THAN full confidence.
Seems as bad as the ‘room for improvement’ :
25% of senior doctors think the GMC is unfair.
Perhaps spend less ‘proper doctors’ money on ‘spin doctors’? Or at least employ better ones…..
When will the GMC stop collecting money from doctors? Why should it not get its funding from the government and the public. As it is a charity which serves the public, it should consider raising funds through donations, charity events, sponsored walks and other ways instead of regulating the subscribers.
How can any organisation that feels guilty until proven innocent ia acceptedable in todays society based on vexatious complaints be taken seriously? The GMC needs to reflect much much more and change. Give doctors the same rights as normal citizenns. How difficult is that? Innocent until proven guilty! Change the wording of your letters and make the doctors who pay you feel valued and not feel like criminals despite being innocent.