Kris Matuszczak, Investigation Manager for Triage, Complaints and Liaison at the GMC, describes the success of a project which piloted a change to the investigations process for one-off clinical mistakes and explains how the improvements to this process will reduce stress for both patients and doctors.
Our first priority is, and remains, to protect patients. We fully investigate cases where we are concerned that patient safety is at risk. However, we know that full investigations can be a stressful experience for both doctors and patients. One way we’re trying to improve this is by ensuring we only undertake a full investigation where necessary. For the past two and a half years, I’ve been involved in a pilot project looking at cases of one-off mistakes by doctors. Before the pilot, all these cases went through a full investigation, with the majority closing with no action taken. The pilot has shown that key pieces of information help us assess the risk to patients, which is the main deciding factor in whether we open a full investigation or close the case at the outset.
What did the pilot involve?
We’ve been using a method called ‘provisional enquiries’ to decide whether a full investigation is needed for cases involving one-off mistakes by doctors, known as single clinical incidents. We look at key pieces of information at an early stage to assess the incident and, if the doctor made a mistake or omission, what actions the doctor has taken to learn from it and minimise the chance of it happening again. This helps us to assess whether the doctor presents an ongoing risk to patient safety and decide whether a full investigation is needed.
To do this we look at as full a picture as possible, with information such as:
- views of the patient and his or her family
- comments from the doctor and any actions they’ve taken
- any local or other third-party investigation(s), including responsible officers and employers
- the opinion of independent clinical experts
Benefits of making this our usual process
From the start of this year, using provisional enquiries for cases of one-off mistakes by doctors has become a standard process.
Since the pilot started in July 2016, over 300 cases of one-off mistakes have been assessed using provisional enquiries. Two thirds of these concluded without the need for a full investigation.
This process usually takes just over 60 days, compared to the average of six-eight months for a full investigation.
Before the pilot, all of these cases underwent a full investigation. But the majority closed with no action taken against the doctor. Going through a lengthy investigation process only to close with no action isn’t in the interest of doctors or patients. Ensuring we only carry out full investigations where necessary also means we can focus our resources on complaints which do need a full investigation, that is where the doctor presents a risk to patients.
Wider reform for our fitness to practise processes
We still face challenges of working responsively within the constraints of the existing legal framework. We also know that being involved in a complaint is stressful, no matter what the outcome is.
The decision to close a case without a full investigation won’t always satisfy everyone. Likewise, I am conscious there are still a significant number of cases which lead to a full investigation, which is stressful for a doctor. But making a decision on these cases within nine weeks has to be an improvement on the longer timescale of a full investigation, while the GMC still fulfils its statutory obligation to protect the public.
I believe the improvements we’ve made to this process are a further step in making our processes less stressful for everyone and ensuring they remain fair.
We know this isn’t a solution to all concerns about our investigatory processes. But we hope it shows our commitment to working with employers, patients and doctors to provide outcomes to these difficult situations as quickly as possible.
This is part of our drive and a comprehensive programme of reform to speed up our fitness to practise processes, reduce the stress of investigations for doctors facing allegations, and support patients when they have concerns.
You can read more about other improvements we’ve made to our investigation processes on our website.