For any doctor who finds their professionalism or ability to do their job under question, it is going to be an anxious time, particularly when you’re working in a highly pressurised environment.
Although I work for the GMC, I can appreciate that the fitness to practise process is complicated. I hear this when I meet with doctors at all stages of their career, their employers and patients.
Some doctors feel that we cause unnecessary stress to doctors, others feel we take too long to do our job, some feel we favour patients and others feel we favour doctors.
So, I have been speaking with the people responsible for our fitness to practise process and policies, to find out how it works and what we’re doing to make it better.
The GMC is not a complaints body. We have a legal obligation to investigate any allegation that a doctor’s fitness to practise may be impaired. We try to establish whether the doctor poses a risk to the public right now and in the future (which may not be the case if a doctor has shown insight into a mistake they have made and taken steps to avoid it happening again).
When we carry out an investigation, we gather information from a number of sources to help us make a decision on the right course of action. The information we might need includes expert medical opinions, medical records, coroners’ reports, criminal case files and witness statements.
Sometimes there can be delays in us receiving this information and that is why some investigations take longer than we would want them to.
Who raises concerns with us?
The majority of complaints (around 70%) come from members of the public and around 6% come from doctors’ employers. We are also alerted to concerns about a doctor’s practice by other organisations that we work alongside, such as the Care Quality Commission in England, Healthcare Inspectorate Wales and the police.
What happens when a concern is raised with us?
First, we triage the complaint – this involves reviewing all the concerns we receive carefully to see if there are issues that we need to investigate.
All doctors should follow the GMC’s Good medical practice guidance (GMP) – which sets out best practice in the UK context. We know that within a health care system – especially one that is under real pressure – not all doctors will be able to meet the expectations in GMP every day. Sometimes wider issues within the healthcare system have an impact on the care patients receive. We look at whether there has been a serious or persistent breach of the standards we expect doctors to follow.
Looking at our latest state of medical education and practice in the UK report, in 2015 we received just over 9,000 concerns. We decided at the triage stage that around 5,400 of these did not require us to investigate them further because there wasn’t a serious or persistent failure or because these were concerns about another healthcare professional.
There were around 560 concerns where we took no further action, but we notified the doctor’s responsible officer or employer about the concern. This happens in cases where the complaint could raise concerns if it formed part of a wider pattern – we share this with the doctor, so they can learn from this as part of their appraisal. We also do this when we have received a valid concern – but not a critical one – that the healthcare providers’ complaints processes should manage.
Leaving us with around 2,800 concerns that we needed to investigate…
In previous years, all 2,800 would have gone through the formal investigation route. However, we can now use a level of filtering – what we call making a ‘provisional enquiry’ – before we get to that stage.
This new step in the process allows us to make some early stage enquiries in certain types of cases – such as one-off clinical mistakes. We ask for information such as any local investigation reports and complaint responses, as well as an expert opinion.
By doing this, last year we identified just under 400 cases that we did not need to take forward, and we identified over 100 that did need to be investigated more formally following our provisional enquiries.
Syed from our provisional enquiries team explained:
We started using provisional enquiries about 18 months ago, with a fairly limited number of cases, now far more cases are going through this route. We want to speed up our approach, though there will always be some cases that need a full investigation.
There are some cases where we take immediate action to prevent doctors from continuing to practise while we carry out our investigation, due to the very serious nature of the allegations and the potential risks posed to the public.
How do we work with doctors when the issue relates purely to their health?
If a doctor has a health concern, which is being managed and does not pose a risk to patient safety, the GMC does not need to be involved. There are however occasions when we do need to get involved. For example, if a doctor doesn’t seek treatment or doesn’t follow medical advice and poses a risk by continuing to work.
What do we do if we think there is a potential risk to the public or the reputation of the profession?
At the end of the investigation, two case examiners, one medical and one non-medical, will review all the evidence collected and decide whether to:
- Conclude a case without any action (in some cases, they may provide advice to the doctor which is not a formal sanction)
- Issue a warning – where a doctor’s behaviour or performance shows a significant departure from the standards set for professional practice, but a restriction on the doctor’s registration is not necessary
- Agree undertakings – restrictions on a doctor’s practice or behaviour, such as being supervised or undergoing retraining
- Refer the case to a Medical Practitioners Tribunal (MPTS) hearing
We close about 80% of cases following an investigation with no action or with advice given to the doctor. We take some form of action in just under 10% of cases and we refer about 10% to the MPTS.
The majority of MPTS hearings end with the decision to suspend the doctor from practising (around 95 doctors per year), and in the most serious cases, the decision to strike the doctor off the medical register (around 72 doctors per year).
Alex from our investigations team commented:
We actively encourage doctors under investigation to talk to us and share information during the process. This helps to speed up the investigation, which eases the burden on the doctor and patient, but also as way to explain whether they have taken steps to prevent this happening again.
During an investigation, our focus is on assessing whether a doctor is safe to treat patients. How a doctor responds when something goes wrong is an important factor when we’re assessing this.
Investigations take time to complete, are stressful for all involved and if a sanction is applied, it can have an impact on a doctor’s career. The GMC wants the law to change to allow more discretion and flexibility in how investigations are carried out.
Over the summer, we will be sharing more about the impact of these developments.
If you are a doctor who is undergoing investigation, you can get free and confidential support from the Doctor Support Service. Call 020 7383 6707 now.
The data included in this blog is from our state of medical education and practice in the UK report: 2016.