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.
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.