Putting mental health safety at the heart of the fitness to practise process

Professor Louis Appleby talks about his recent work helping to identify what changes could be made to GMC processes to help make investigation procedures more compassionate.

Four months ago I began working with the GMC, reviewing the fitness-to-practise process with the aim of reducing the risk of suicide in doctors facing investigation. During this time many people have written to me about the effect of investigation on their emotional health, sometimes long-term, and on their careers, even when no restrictions were placed on their practice in the end.

I have also met people at all levels in the GMC who recognise this distress and want to make their procedures more compassionate. And I have heard from patients who feel that a process that can be protracted and hard to follow may leave them, as victims and witnesses, just as traumatised as the doctors.

Prof Louis Appleby at the GMC's office in London

Prof Louis Appleby at the GMC’s London office to discuss the draft proposals with stakeholders

Two principles have guided my approach to this work. First, doctors who are ill need to be treated, not punished – investigation is frequently punitive in effect, even if that is not the intention. Secondly, suicide is not confined to those who are known to be mentally ill – it can be those who are thought to be coping that are most at risk – so reducing risk is a task for the system as a whole.

Doctors who are ill need to be treated, not punished – investigation is frequently punitive in effect, even if that is not the intention.

Detailed proposals have now been drawn up. There should be fewer investigations – the current rate of 2750 per year translates into a 40% chance that doctors will come before the regulator at some time in their careers. Yet only 13% of investigations lead to any sanction – such a low figure does not justify the impact on individuals. Most complaints from patients about a doctor’s performance could be dealt with by the doctor’s employer. Cases in which health is the root of the problem should avoid full investigation whenever possible, moving instead to early treatment. A new senior medical post will help ensure mental health expertise has a stronger influence on these decisions.

Most complaints from patients about a doctor’s performance could be dealt with by the doctor’s employer.

But in all cases, whether or not the doctor is seen as vulnerable, the process should be sensitive. Doctors can be distressed by the tone, timing and frequency of letters – they may become avoidant, reluctant to open letters from the GMC who therefore assume they are not co-operating. In future, one person in the GMC should co-ordinate communication with a doctor and ensure a more personal approach. The extent of scrutiny – contacting past employers, checking case files – should be proportionate to what has gone wrong. Meetings with the doctor should help clarify what will happen next and give the GMC a human face. Agreement should be the preferred outcome.

Employers have a crucial part to play, ending the use of GMC referral to resolve conflicts with medical staff and tackling their high rate of referral of BME doctors.

Not everything that is needed can be brought about by the GMC alone. Employers have a crucial part to play, ending the use of GMC referral to resolve conflicts with medical staff and tackling their high rate of referral of BME doctors. The GMC should fund an expansion in the availability of doctor support services – the 11% who attend tribunals unsupported are a particular concern. The patchy provision nationally for doctors who need treatment for mental illness or addiction should finally be addressed. Comprehensive data on doctor suicides should be routinely collected to feed future improvement.

The GMC can now turn a tragic problem into positive steps that others can follow. It can make mental health safety a thread that runs throughout the organisation, influencing training, standards, leadership & culture. A permanent focus on mental health safety will help doctors who might otherwise be at risk of suicide but it can go further – in time it can extend the potential benefits of these proposals to patients and staff.

Headshot of Professor Louis Appleby

Louis Appleby is Professor of Psychiatry at the University of Manchester where he leads a group of more than 30 researchers at the Centre for Mental Health and Safety.

 

Related posts

Anthony Omo, the GMC’s Director of Fitness to Practise and General Counsel, writes about our work to improve investigations for doctors and patients

Anna Rowland, Assistant Director of Policy, Business Transformation and Safeguarding at the GMC, outlines changes to the way we communicate to better support doctors during FTP processes

 

12 responses to “Putting mental health safety at the heart of the fitness to practise process

  1. This is long overdue
    The GMC has for too long failed to see that patients are not helped by persecuting doctors, and that this failing is aggravated when the doctors themselves may be patients.
    The lack of humanity demonstrated by the GMC over the last few decades is shameful
    My thanks to those individuals who have worked hard to bring about these changes

  2. Having worked in industry for some time and with experience of disciplinary processes on both NHS and industry, I agree there needs to be a more balanced approach. I suggest a much shorter investigation in the first instance, with a focus on learning and avoidance than punishment.
    The current process is too complex, too detailed, not compassionate enough and is frightened of pragmatic decisions. Even in serious cases, the process should be quick, succinct and be on the basis of ‘balance of probability’ and should be handled locally.

  3. Thanks prof. Appleby most welcome. I work with NHS staff and see the results of heavy handed treatment. You are quite right in much of what you say; We would not treat vulnerable patients in this way. Caring for the carers is essential and humane.

  4. Prof Appleby

    I totally agree with your views. However when something has gone wrong and you ask the employers what they have done or are going to do about the conduct of their member of staff and are told that they will not discuss the matter with you at all, then you are left with no alternative other than to make a complaint to the GMC in order to be sure that something does happens.

    I decided to complain to the GMC and the investigation started over two years ago and they have informed me recently that they may deal with it at a hearing in the autumn. Why the delay.

    There is a complete lack of communication between the GMC and the person making the complaint. I have had to constantly email and phone them. I have had numerous case workers. Perhaps retention of staff at GMC is an issue.

    The process is far too long for all concerned and needs to be streamlined and shortened.

  5. “And I have heard from patients who feel that a process that can be protracted and hard to follow may leave them, as victims and witnesses, just as traumatised as the doctors”- I love how this comment is just dropped in at the start and then completely ignored for the rest of the article. I can well understand the trauma that many good and moral doctors undergoing GMC investigation may feel. But what about the sheer scale of the trauma, damaged mental health and suffering that poor clinical practice can cause to patients? Or does that not matter since it has not been audited? To blithely conclude that the solution to this is to leave most complaints the doctor’s employer is to completely ignore the purported purpose of the GMC. Either there exists a body there to uphold medical standards and protect patients or there does not.

  6. Pingback: University expert concludes doctor suicide review – MHS News Hub·

  7. No evidence yet of any improvement . 4 years of hassle for doing nothing wrong. I wait for any glimmer of improvement but there is none in this utterly dysfunctional organisation. They try to drive even those of us without mental health problems to utter despair. There is no justice no sense no reasonableness no sense of proportion just endless unreasonable dysfunctional rubbish. Retirement or leaving is the only way out clearly of the never ending institutionalised emotional abuse that we are forced to face daily. Clearly the effects of emotional abuse are significant but does the GMC care ? No of course not they just continue to beat us over the head all the time .

  8. Am I reading correctly? Compassion, we mustn’t have any of that at the GMC. Having figure heads interested in seeing things from the practitioners’ viewpoint is one thing. Having the admin staff at the GMC do that is something else. They have become institutionalised over the last ten or more years. Do what the regulations say needs to be done; wash your hands and wash away any doubts regarding the suffering at the other end; and finally make sure there is time for pleasant thoughts over lunch. Recent dealings over licence renewal suggest to me that old attitudes remain alive and well. Appointment of a senior adviser is but a start on the road to a more equitable relationship, doctor vs GMC.

  9. Pingback: Easing the pressure: reviewing our fitness to practise procedures | General Medical Council·

  10. Pingback: Fitness to practise reforms: a step towards better protection for whistleblowers in the NHS | General Medical Council·

  11. Pingback: Q&A with David Pearl – outgoing Chair of the MPTS | General Medical Council·

  12. Pingback: Support for doctors appearing before a tribunal | General Medical Council·

Leave a comment

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s