Sophie and Mij are members of a newly formed team at the GMC that works with doctors with health concerns. Sophie has worked at the GMC for four years and Mij has worked for the GMC for just under two years. Here, they explain how the GMC now works with doctors who have health concerns.
There is usually no need for us to be involved where a health concern is being treated and does not impact on patient care.
So far, we’ve made a number of improvements to the way we work, including:
- using early stage enquiries to gather more information, to help us decide if we need to formally assess a doctor’s fitness to practise
- providing a single point of contact for the doctor within the GMC, in relation to fitness to practise matters
- a dedicated team to assess concerns about a doctor’s health, in a more personal and sensitive way
- improving the tone and content of the communications we send to doctors where we have information to suggest they are unwell, clearly setting out key steps of the process and the support available
- in some cases, offering doctors the option for us to pause our processes so they can seek treatment without being regularly contacted by us.
There is usually no requirement for us to be involved where a health concern is treated and does not impact on patient care.
Where the health of a doctor has an impact on patient care, we will need to put arrangements in place to protect the public. In order to reduce the impact on the doctor, we aim to do this by mutual agreement with the doctor where possible.
There is a wide range of support available to help doctors manage their health, so they can continue to practise and provide a good and safe level of care to patients. You can find out more in the managing your health section of our website.
Why would the GMC need to look into a doctor’s ability to practise safely because of a health concern?
The types of health concerns we need to be aware of vary from person to person, as it is affected by what help the doctor is receiving, how much insight they have into their condition (for example, not working while they are unwell) and the support network they have both at work and at home.
Occasionally, there are instances where it appears from the information we have that a doctor’s health may be affecting their ability to practise safely and there is a lack of detailed information about the health concerns.
Our aim is to help support doctors to practise safely and get back to full health.
In these circumstances, instead of formally assessing the concerns, we may make some early stage enquiries (provisional enquiries as we call them), to help us decide whether we need to look into the matter further.
We’re likely to make provisional enquires where we think there may be evidence or information available (for example, from a doctor’s GP), which would help us better understand how a doctor is managing their health and if there is a potential impact on patient safety.
This helps to make sure that we only formally assess concerns where it is absolutely necessary. We work with doctors to gather this information to make sure that we handle this confidentially. We also want to be clear that we would always ask for the doctor’s consent before seeking access to any medical records.
What happens when we have a concern about a doctor’s health, which may be affecting their fitness to practise?
We formally assess concerns about a doctor’s health for only a small number of doctors each year (187 cases in 2016: some doctors had more than one case) and some doctors refer themselves to us (51 in 2016). This includes doctors who have drug or alcohol problems, mental health conditions or a physical health condition.
We work with doctors as sensitively as we can and our aim is to help support doctors to practise safely and get back to full health.
We also ask the doctor about the best way to communicate with them throughout the process – they may prefer us to speak with a member of their family, the healthcare professional who is treating them or their medical defence organisation, depending on the circumstances. The doctor can also let us know if they would prefer letters or emails. Either way, their single point of contact will take note of this and follow this throughout.
We have introduced the option to pause our processes in some cases, where there is no immediate risk to patients, if the doctor would find it helpful to have some space and time to come back to us.
After the initial call or email, we do have to send the doctor a formal written communication with the details of the concern, the process we are going to go through, and the support the doctor can access. Through the initial call, we will have prepared the doctor and explained what the letter will contain.
As a member of the team who works with doctors at this stage, Mij said:
We have been trialling this new approach to our communications over the last few months and the feedback has been very positive. I have definitely had more doctors feeling able to call me to ask about key parts in the process.
I think doctors had previously been nervous about contacting us, but now they have a single point of contact, they feel far more confident to just give us a call if they have a question.
We adapt our approach depending on the doctor’s personal circumstances and vulnerability. For example, if a doctor is not able to engage with us themselves, we may communicate through their family member or healthcare professional with their consent.
We have also recently introduced the option to pause our processes in some cases, where there is no immediate risk to patients, if the doctor would find it helpful to have some space and time to come back to us.
What emotional support is available to doctors in this situation?
The Doctor Support Service offers free, emotional support to any doctor in our fitness to practise process (not just where there are concerns about health) and can be accessed at any point during that process by a doctor.
This is funded by the GMC and run by the BMA – it’s a confidential service and the BMA doesn’t share any information with us about their discussions with doctors. Doctors have said they find it beneficial to have someone to talk to who is also a doctor, not part of the process, and completely separate from their day to day lives.
What else happens during the process?
We aim to speak to the doctor directly every time there is a significant step we need to take in the process (unless they have told us at the start that they would prefer us not to do so).
The majority of doctors will have a health assessment, which is naturally something doctors may be nervous about. We reassure doctors about this by talking them through it and providing them with a factsheet, which includes key information about the process.
We want to carry out our role to protect patients effectively, while having as little impact on the doctor as possible.
The assessment is a meeting with two doctors appointed by us. If the condition is related to an addiction or mental health, these doctors will be psychiatrists. For others, the doctors will have clinical experience relevant to the health condition.
The health assessors will provide:
- a diagnosis of the doctor’s health concern, using an internationally recognised classification system
- an assessment as to whether the doctor is fit to practise either generally, on a limited basis, or not at all
- any recommendations about the doctor’s practice.
Their recommendations may include allocating a medical supervisor to report on the doctor’s progress. Two GMC case examiners will review the recommendations from the health assessment and the evidence provided through other sources to make a decision on the outcome.
Find out more about health assessments in the Your health matters section of our website.
What are the likely outcomes?
We try to avoid referring concerns purely about health to a tribunal, as we know that this would add further stress and pressure to a doctor who is already in a potentially vulnerable position. We want to carry out our role to protect patients effectively, while having as little impact on the doctor as possible.
In most cases, where health is thought to be affecting patient safety, doctors make a voluntary agreement with us (called undertakings) and very few concerns purely about health are referred to a tribunal.
At any time during the process, and before a doctor decides to agree undertakings, we recommend they contact their medical defence organisation or legal representative.
Examples of the type of agreements we make include:
- agreeing to remain under the care of a psychiatrist
- limiting the number of hours a doctor works
- agreeing to attend a support network
- agreeing to testing (if the concerns involve alcohol or substance misuse).
You can read our case studies for more examples of the typical outcomes for doctors with different health concerns.
Do you keep updated on the doctor’s progress?
Doctors with undertakings will have a medical supervisor, who will oversee their progress and they will update us on this. They will also monitor the doctor’s return to work or how they’re managing in their current working arrangements, and help with their communication with their employer.
Once we have sufficient evidence that a doctor is safe to return to work without any restrictions, we will revoke the undertakings and the doctor can return to full practice.
Many doctors speak highly of their medical supervisors and the support they are able to offer. If you would like to find out more, one of our medical supervisors has answered the questions they’re often asked by doctors on our website – monitoring and supervision process frequently asked questions: doctor to doctor.
All of these recent improvements are helping us to deliver the proposals developed with Professor Louis Appleby to reduce the impact of the fitness to practise process for all involved.
You can read more about other improvements we’re working on in our blog about what happens when someone raises a concern.
Improving medical education and practice across the UK 
I think this approach is right and proper; supportive and respectful in relation to the doctor with a central aim of protecting patient care. It would be wonderful if more upstream work was done around the catalysts of stress and mental health problems in general practice
This is hugely overdue and very much welcomed. Half the challenge is getting doctors to recognise the have a problem and seeking support. I know from first hand experience over 15 years ago how aggressive, threatening and undermining the previous approach was. Very much making the ability to work in consultation to address health issues, in particular mental health issues extremely challenging and in some case adding to the problem. I personally feel that the GMC still has a long long way to go to build trust with doctors but this helps.
Sorry to hear about your experience, but thank you for sharing it with us. We are committed to improving the support we offer all doctors and we will keep updating you on our progress.
Agree that the GMC has got an awful lot of work to do- an organisation which is not fit for purpose
How do two people with only six years gmc experience between them and little life experience have the qualifications to do this job.
They are part of a team and we have no guidance on their prior experiences or areas of expertise. Before we disregard the efforts I would hope the approach will have time to bed in, be reviewed and then conclusions drawn. The GMC have so far to go with this and need to be given the opportunity to show their ability to change. If they don’t then I am all for calling them out as being not fit to practice as a regulator.
Dear Joy,
Mij and Sophie are just two members of a bigger team made up of people with different levels of experience. All members of the team have been specially trained to work with doctors who have health concerns and who may be vulnerable.
After a trial period, we’ve already noticed an increase in the number of doctors engaging with us around health concerns through this team. We hope this will continue so we can better support doctors, and we will keep updating you on our progress.
I am very proud of GMC and it is so good to see huge transformation in GMC as an organisation in last 6 to 8 years and want to congratulate and thank GMC. However, GMC is only a tip of the iceberg of professional regulation and GMC can only be a proactive regulator which means can only deal with doctors who are referred to it by Medical Directors, HR Directors or public or anyone. In such a system many good doctors suffer and many good doctors may be referred to GMC by families, by other doctors or social services or anyone.
This is the fundamental flow in our current professional regulation. Any regulation which doesn’t protect patients but makes good doctors suffer is not a regulation but a bureaucracy!. I have been referred to GMC twice and first time by a mother (I am Paediatrician), 7 years after the event! Thank God my documentation saved me and GMC handled it brilliantly.
The second time by a doctor I had dismissed! This was very painful as GMC deferred my revalidation and didn’t even inform me that I was being investigated! When I rang the GMC I was told the reason and once again after I contacted the GMC it was handled very well and case was closed.
It is not the GMC I am worried about but what happens locally. In a culture of bullying, club culture, old boys network and no accountability for senior leaders and managers of NHS and perverse incentives like Clinical Excellence Awards where CEO has to sign the forms, there is huge injustice, unfairness in the system and sadly cover up goes on and many patients, staff and NHS suffers.
In Wigan, when I was the Medical Director (2010-2017) the Trust reduced harm to patients by 90% and received 45 awards and for staff happiness the Trust improved from being bottom 20% in 2011 to the third best place to work.
I had to dismiss 6 doctors (4 were locums) and 8 have left the organisation as I was not willing to put up with their behaviour or poor care! 70 staff have come to see me in confidence to raise concerns and we have been able to deal with all of them.
If we really want to protect patients then we got to focus on culture, values, value based leadership, good governance and excellent staff and patient engagement and duty of candour.
Sadly, in a culture of bullying, harassment, victimisation, poor team working and poor governance and accountability for senior managers and leaders, patients, staff and NHS will continue to suffer.
I have now resigned from Wigan to write my books. Patient safety and their quality of care must be the priority for all of us as doctors but sadly culture of management bullying, harassment and victimisation means, NHS will not be safer or better until and unless we tackle these cultural issues in our NHS.
Seems like a good idea but there is no detail on how GMC will collect the information on if there is a risk to the patient? No wonder it varies from person to person.
Allows the trusts to put further pressure on a doctor and provide one more avenue for absurd GMC referral like “communication issues” or “team working issues” which are specially designed for a certain category of doctors.
To be a fair process there should be substantive evidence of harm to the patient not “concern”. Self referral/ patient referral/ GP referral are all welcome but it will never happen as the aim is to put more pressure on doctors with mental health issues so they make mistakes or clinically insignificant harm which is a near miss is also reported to GMC and concern is finally realised.
Thank you for your comment, Rajendra. We’re sorry for the delay in replying to you.
When assessing risk we will look at a range of information – usually the original referral or complaint, any information provided by the doctor and their employer and evidence from a suitable health professional, such as the doctor’s GP or treating physician. The doctor may also be asked to have a GMC health assessment.
If the evidence shows that we need to investigate further or take action in a case purely about health, we will work with the doctor in a personal and sensitive way and try to agree an outcome, where appropriate.
The law (Medical Act) requires us to investigate matters that raise a question about a doctor’s fitness to practise and this includes where there are serious concerns about a doctor’s health.
We know that health concerns can often be properly managed by the doctor, with support, and so it’s only where it appears there may be an impact on the doctor’s ability to practise safely that we need to take action to protect the public. We agree that any action we do take in relation to a doctor’s registration should be based on substantive evidence and our fitness to practise procedures reflect this.
The provisional enquiries process we’ve introduced now allows us to get more information about risk at the outset, before we decide to investigate, so that we can reduce the impact on doctors, where possible.
We hope this helps to explain how we assess risk to patients.
As I referred back to Dr Prabhu’ s idea , “for poor care I had to dismiss 6 doctors ” , keeping other side blind ,as Medical Director has some responsibility to take care of the doctors with bad attitudes towards patients . Counseling , retraining or open to discuss any other issue interfering this kind of attitude .Keeping in mind lot of energy , money and sweat involved to become a star (doctor) , so show some sympathy to your colleagues.