Anthony Omo, the GMC’s Director of Fitness to Practise and General Counsel, looks at new reforms to improve our investigations and what more needs to be done
The work that we do is essential to protect patients. However it can be controversial and the circumstances under investigation are often disputed. It is inevitable that in most cases those on different sides, most often doctors and patients, will not agree with the outcome.
However it is important to put this into perspective. Most doctors provide safe and compassionate care and few ever find themselves before a tribunal hearing. In fact despite a rise in complaints since 2007 the number of doctors given a warning or sanction has not increased [PDF]. There are over 260,000 doctors on our register and in 2014 just 71 were erased following serious concerns about their practice.
There are over 260,000 doctors on our register and in 2014 just 71 were erased following serious concerns about their practice.
That said we do recognise that our investigation processes could and should continue to improve. We are determined to deal with complaints as fast as we can and reduce the stress for all involved, not least the doctors who have their fitness to practise called into question.
Over the last 12 months we have been developing new reforms to make our investigations faster and more focused while remaining fair to all concerned. From this month we will start to implement some of these reforms.
Speeding up our investigations
Investigation times for up to 250 doctors a year could be cut from eight months to just two following a change being introduced from September.
After a successful pilot [PDF] we are now making wider use of provisional enquiries at the earlier stages of our investigation process.
Provisional enquiries involve gathering one or two discrete bits of information, such as medical records or a local investigation report. This information can help us decide much earlier whether or not we need to investigate a complaint.
Our pilot found that doing so could lead to a 70 per cent cut in the average length of an investigation in some cases. It could also avoid the need for around 250 full investigations that would otherwise have taken place.
During the pilot a complaint had to meet three criteria to be eligible:
- The allegation is ‘unclear’ and/or;
- It is unclear whether it is serious enough to raise a question of impaired fitness to practise; or
- It is doubtful that the evidence will support a finding of impairment.
We are going to undertake a further pilot to see whether we can use provisional enquiries more often in the future, such as in cases involving an isolated clinical concern where a high proportion of our investigations close with no action.
Protecting the public and confidence in the profession
We are here to protect patients and public confidence in the medical profession. These two important principles have guided our work since the GMC was established in 1858. However following a change in the law these principles will now be strengthened with a change to our objective.
Up until now we have been required to promote, protect and maintain the health and safety of the public. Our updated objective will make it clear that this involves the following three limbs:
- protecting the health and well-being of the public
- promoting and maintaining public confidence in the profession
- promoting and maintaining proper standards and conduct.
Fairness is at the heart of our procedures and of effective regulation. Independent research has found that our decisions are fair to doctors but this will also now be strengthened further. The changes to the Medical Act also introduced a new ‘overriding objective’ that our rules will be drafted to make sure we remain fair and just in dealing with cases. While this is an aim we have always worked to, this objective has been formalised in our legal framework.
Changes to our guidance
Last summer the Council consulted on changes to guidance used by our senior decision makers and tribunal panels when deciding what action to take when serious complaints about doctors are upheld. Following strong support for the proposals in the consultation the new guidance [PDF] is now being used by panels and our investigation decision makers. The guidance was developed by a group that was chaired by His Honour David Pearl, involving GMC and MPTS staff.
We have revised the documents that outline what restrictions we can place on a doctor’s registration when we have a concern about their practice or behaviour. Following positive feedback, we have also now implemented these changes.
The Council has also published the results of a consultation on new and amended fitness to practise rules that will streamline investigations and hearings. The changes proposed in this consultation will reduce the time it takes us to deal with complaints, make investigations faster, focused and fair and will support the MPTS in their modernisation programme. The changes will be introduced when parliament approves them.
The need for legislative change
So there is much we have done, but there is still much more to do. We want to deal with complaints faster and to become a more responsive and effective regulator for both patients and the profession. However we are prevented from doing this because our legislation is outdated and no longer fit for purpose.
For a long time now we have been campaigning for a comprehensive change to the law. The Professional Accountability Bill (developed by the Law Commissions) would allow us to introduce a range of important reforms that would improve patient safety and reduce the burden and cost of regulation.
The government is committed to taking forward this important legislation as soon as parliamentary time allows. We hope that it will take the opportunity to do so in the near future. Without it we can’t make the important reforms to processes that doctors, patients and the health service need.
Anthony Omo is the GMC’s Director of Fitness to Practise and General Counsel