Dear Colleague,

Our health services, once again, find themselves under huge pressure and I know the lengths you are going to so that patients get the best possible care.

That pressure, on individual doctors as well as the wider systems, is of great concern to us. We spoke out in the media this month to provide advice to doctors working in demanding conditions and we have been clear that those organisations involved in training and recruitment must act now to avert even greater pressure over the coming years.

Our most recent report, on the State of medical education and practice, described a crunch point for the medical workforce in the UK. We spoke of the increasing importance for health services to recruit and retain doctors and to protect the training environment for doctors.

While it is not for us to determine how taxes are spent, it is clear that the current debate around funding is an important part of that issue.  It is also clear that supporting the doctors who are already working in health services has never been so important; you are holding together services that are struggling with demand and it is vital that you are given the time to learn, train and reflect in order to keep your skills up to date.

Allowing professionalism to flourish

As I enter my final year as Chair, I am determined we will provide even more support locally for you, employers and educators to create working and training environments where professionalism can flourish – a focused drive to reduce harm to doctors and patients and use learnings from mistakes.

We have set out ambitious plans to update what we expect at the end of undergraduate training and for postgraduate training curricula. We are doing more to step up our support for trainers and doctors in training. We are working more closely with other regulators and educational and improvement bodies to identify poor training environments at the earliest possible stage. This combined with the data we receive from our National training surveys will mean we can take a more proactive and evidence-based approach, intervening earlier to prevent systems failures, and therefore preventing doctors getting into difficulty. This year we will work with doctors and other experts to host workshops on promoting and safeguarding the mental health and wellbeing of doctors and extend our work with partners on raising concerns.

Averting the risk of harm, before it happens

We have also significantly refocused our fitness to practise processes and pushed our outdated legislation to the limit over the last few years so that we only fully investigate those complaints involving serious or persistent concerns. Doctors subject to investigation should be supported appropriately and we have invested heavily in our teams out and about around all four countries to support doctors in their day-to-day professional practice, to try and avert the risk of harm before it happens.

And it is working. The number of full investigations is falling, from 2,265 in 2011 to 1,436 in 2016. The number of sanctions and warnings fell by eight per cent in the same period. We’ve seen a 12 per cent fall in doctors receiving conditions or undertakings and a drop of almost a third in doctors receiving warnings.

Those downward trends also apply to full investigations opened against doctors around clinical incidents. Investigations around clinical competence only are down by half and by 56 per cent for full investigations concerning clinical competence and communication and respect.

A culture of openness

I know that we can’t stop all harm from happening, either as individual doctors or as a regulator. We have a duty to protect the public and promote and maintain their trust in our profession.  We will still be called upon to make difficult decisions about a doctor’s fitness to practise. The public is entitled to expect that doctors will be held accountable for really serious or persistent departures from our standards.

Our goal is to learn more from those occasions so that we have the insight to understand how harm might be prevented and the challenge, as ever, is the tension between accountability and no blame/learning. A culture of openness starts with a willingness to listen and learn – that is the bedrock of the work we have done so far and the future course we have set ourselves.

Thank you for your dedication and hard work,

Professor Sir Terence Stephenson
Chair, General Medical Council

The data included in this blog is from our State of medical education and practice in the UK report 2017.