*This blog post was first published on 20 June 2017. It was updated on 6 June 2019 to include our latest data.
Howard Lewis from our regional liaison service has been finding out what happens when someone raises a concern about a doctor.
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?
Around 66% of complaints come from members of the public and around 4% 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 2017 we received just over 7,500 concerns. We decided at the triage stage that around 5,500 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 550 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.
Previously, the remainder 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 improved 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 300 cases that we did not need to take forward, and we identified 188 cases that did need to be investigated more formally following our provisional enquiries.
Syed from our provisional enquiries team explained:
We started using provisional enquiries in 2014, 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 72% of cases following an investigation with no action or with advice given to the doctor, and we refer a small amount to the MPTS.
The majority of MPTS hearings end with the decision to suspend the doctor from practising (around 84 doctors per year), and in the most serious cases, the decision to strike the doctor off the medical register (around 87 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.
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: 2018.
Improving medical education and practice across the UK 
Top tip for doctors being investigated; the GMC managed to conclude both that the doctor I’d complained about had shown insight into the concern I’d raised, and at the same time conclude that he’d denied it had happened. So no matter what you’ve done, it shouldn’t be too much trouble to make it go away. A little vague language in your reply to any concerns and it’ll all be fine. Ok that’s not such good news for patients, but really what do they matter? A few I know harmed by the same doctor I raised concerns about are suicidal due to their suffering, but should they follow through no one will link it to the doctor in question. Be assured the system is working as it ought to
Paul Buckley did not mention any of this when he invited me to help with the GMC website in the EADT. You have improved but you have a long way to go. I will be in contact with you again by the press unless you can convince me that the GMC is not a corrupt social set .
Thank you for explaining the fact. Hope it will be helpful for everyone.
I have no confidence in the GMC. They should not to be allowed to regulate doctors or investgate concerns.
Very interesting and useful article.
Thank very reassuring
GMC destroyed my career that I used to love since I was 6 years of age, I was practicing for 26 years before I started to hate medicine as a career as a result of the GMC series of panels meeting for one year. Now I have to pay one third of my salary to non stream medical indemnity insurance such as tower gate, I am counting the years to retire (2-3 years) from a profession which I loved and never thought of retiring all because of the VERY SLOW investigations process GMC should be abloolised and have more efficient and fairer organisation
I couldn’t agree more with some of my colleagues in medical profession that GMC should not and must not investigate or get involved with doctors.GMC is a body funded by doctors and hence it says that it is to protect the patients and public confidence then money should come from the public to investigate the doctor in concern not from the doctors.I disagree with some of the rules that GMC has set and also I feel it is non of GMC business to get involved in doctors personal life, as long as it has no impact on patient care.
Once I loved medicine and it is all I want to do, today I am counting my days for retirement.GMC is ruining many doctors life.UK is already suffering as a result of shortage of doctors and GMC is making matter worse by encouraging doctors to leave medical profession by investigate and causing stress.there should be better way to deal with the issues arising from doctors and their practice and time it take to investigate is far too long.I agree with shereen and my thoughts are the same
Hello Dr Fernando,
Thank you and apologies for our delayed response to your comments.
As the independent regulator of doctors we have a responsibility to ensure that all doctors registered and licensed by us meet the necessary standards. Our role is to work closely with doctors, their employers and patients, to make sure that the trust patients have in their doctors is fully justified.
We believe the fact that we are not funded by the state, and that we are accountable to the UK parliament – not to government ministers – is important, especially as we operate in systems that are all funded and controlled by governments. Not being reliant on government money is critical to our role as an independent regulator and helps to maintain the high level of trust in the medical professions.
It is vital that we work closely with the profession and with individual doctors to support clinical leadership and engagement, protect doctors in training and promote high standards of practice.
More than 1,000 doctors are involved in quality-assuring medical education, the design and running of our assessments for international medical graduates, and sit on the autonomous tribunals which form our adjudication service.
We continue to expand our support for doctors while keeping our costs down. Our record here is a good one – the annual retention fee paid by doctors is at virtually the same level as it was in 2010. The current annual retention fee (2017/18) is £5 more than it was in April 2010.
We do understand the stress doctors are under and that is why we are developing the way we work to ensure that we are managing concerns sensitively, swiftly and efficiently. Equally there are a lot of concerns that should not be dealt with by us and following the introduction of revalidation and the role of responsible officers, far more issues are now dealt with at a local level.
We want the profession, patients and the public to understand more about our role, the types of concerns we deal with and how we work. This blog is part of our wider work to communicate this message with doctors, patients and employers through our liaison services in England, Scotland, Northern Ireland and Wales.
GMC is institutionally racist and will never change unless the decision makers change. I was referred to GMC by a racist dean who forged some data and submitted an expert report based on forged data (so obviously flawed). After 3 months of referral when truth became obvious the dean was forced to write to GMC and surprise surprise, GMC did not believe him this time and continued investigation for 3 years in to my competency !!! I got indemnity cover over phone from MDU but when I declared the GMC investigation on paper, they refused to provide indemnity. GMC kills more doctors than any medical condition known.
Having been through your system and put up with your utter lack of consideration of doctors under investigation and your uselessness at managing frivolous concerns by emotionally abusing colleagues I cannot understand why you took 4 years to investigate nothing of any significance whatsoever ie I had not made any mistake or had any patient complaint etc . I am just glad to be 60 and out of the stupid system that you perpetuate by your interminable uselessness, idiotic pedantry and lack of ability to actually look at the facts or listen to the doctor in question. Please note everyone that all their drivel above is lies dammed lies the GMC care not one jot about us and are determined to destroy the NHS by their adherence to stupidity.
I agree. Had to put up with a farcical investigation over a nothing complaint from a nutty ( Dentist) patient and was at the same time absolved of blame and warned as to future conduct. Glad I’m retired. No confidence in GMC.
GMC had the audacity to write to me that “you apologised to the patient so it must be your fault” and if you feel suicidal “contact your GP”. One one hand their advise is “apology is not admission of guilt” but I suppose it depends on the colour of your skin.
I work part time now and still working with counselling and medication support but stopped working in the specialty. Unfortunately we cannot leave and register with another organisation.
According to this article, the GMC received just over 9000 concerns in 2015. This represents about 4.5% of all licensed doctors in the UK. Most doctors have spent long years on study and training, so is it not a bit surprising that such a large number of them need to be investigated each year? Moreover, as 80% of investigations result in no action, does that not strongly suggest that something is perhaps fundamentally wrong with the GMC complaints process?
Indeed, my position is that the current complaints process is unbalanced, with no means for punishing patients who abuse the system. Every doctor is familiar with patients who threaten to make a GMC complaint to bully them into concessions they normally would not make. Due to the structure of the current system, doctors are under undue stress that no other profession in the UK has to bear. As a GMC complaint can lead to tens of thousands of pounds in defense costs, and might nevertheless result in being struck off, most doctors feel like they have the sword of Damocles perpetually hanging over their head. It is a permanent worry that the next patient could make one’s life a nightmare.
This is not normal, it is unhealthy for doctors, and it is not good for patients. It is basically an untenable system because it is lacking in a robust safety net of checks and balances.
The GMC takes the position that it must defend the public’s trust in the medical profession. In my opinion, it takes this principle much too far, and the consequence is deeply unfair and damaging to doctors.
Thank you for taking the time to comment on the blog and sorry for our delayed response.
We agree that too many doctors undergo full investigations that result in no action because we find no concerns about their practice. We need the law to change to give us the ability to decide which cases we take forward and we continue to push for these changes. In the meantime, we’re improving the way we work within the limits of the law. For example, we use a new level of filtering – what we call making a ‘provisional enquiry’ – to allow us to make some early stage enquiries in certain types of cases and assess the risk to patient safety much quicker. By doing this, last year we identified just under 400 cases that we did not need to take forward to a full investigation.
We have also done a lot of work to support the profession by providing training through our regional liaison service, and supporting employers and responsible officers in managing concerns locally through our employer liaison service. We also offer various types of support for doctors under investigation and if they have to attend a tribunal.
As you can see from the figures in the blog, we take action against doctors in only very few cases. Our investigation procedures are designed so that unsubstantiated concerns should not result in action being taken or the case being referred to a tribunal, which is typically, where the costs come in. We know that there is more to do. Equally we know that some of the fear doctors have about the GMC and our investigations is misplaced, that is why we are starting to share more information and will continue to explain what we do, how we do it and how doctors and patients can access support.
Fairness in GMC is skin deep. This institutionally racist organisation needs to be abolished and replaced with some thing better or doctors should have a choice of not being regulated by GMC but some other governing body composed of patients representatives/ doctor union representatives and human right lawyers. Absolute power corrupts absolutely and GMC is a very good example of it.
I am not sure what do you do beyond agreeing on paper? GMC is doing XYZ………. for XYZ years. UK is inviting overseas doctors to fill chronic shortages in the NHS and GMC is killing them gently so there is always a shortage.
Doctors under investigation are still killing themselves. We are still forced to pay for a racist organisation just imagine every black person in USA being forced to pay for KKK !!
I have no confidence on GMC investigations. I raised concerns about
Consultant. I was vitcmised which lead I resign from my job. The outcome of my concerns was
Not fair and boring biased and took more than two years to give chance to the consultant on question to retire. I made appeal and complaint. And promised a reply from GMC by Jan 17? No reply to date. GMC investigation is biased
Hello Dr M. – please could you contact us either by email to gmc@gmc-uk.org or call our contact centre on 0161 923 6602 so that we can look into this matter for you.
I was investigated 3 years ago by the GMC following a complaint from a patient’s son. The patient informed me her son was a bully and the GMC enabled this bullying by taking 6 months to complete their investigation. The report produced at the end by a so called expert was not factually correct in its content.
I was found to have acted as ” a reasonable GP” and in the end no action was taken. The entire process was professionally awful and I have absolutely no respect whatsoever for the GMC as an organisation.Working in primary care is extremely hard and believe me there is no support whatsoever from our professional body.
I have arranged to retire as a GP aged 57.
The blog depicts a rather rosy picture of the GMC investigation procedure. I have been investigated after allegations of colleagues. The GMC liaison adviser advised the trust not to investigate at all but to refer to the GMC immediately. After an investigation of 8 months in which half of the time was taken up by the GMC ignoring their own expert report, they concluded that there was no case to answer.
I can only advise doctors to make sure they have legal representation and certainly not to speak to the GMC on their own. Do not be deceived, it is an incredibly adversarial process.
Fear. Fear of a GMC investigation now hangs over every clinician like the sword of Damocles . When started in medicine it was 1metre overhead , now its 1 mm above the heads of overstressed colleagues.
Peter S .(retired GP)
We concur with the post by V. The GMC has an agenda to demonstrate they are overseeing public safety. To achieve this they adopt an adversarial position based on the premise that the doctor is guilty until proven innocent. We have also undergone investigation, and have found that the system is deeply flawed and biased against doctors. Anything you say will be used against you. Moreover, GMC experts realise no benefits from finding a doctor innocent.
In my case GMC quoted two “expert reports”, one of which was based on forged data and forged information (quoting me as a consultant when I was actually a trainee and providing 9 months of data instead of 12, none of which is actually required for my job) and another was an expert who had no idea about my specialty but I am sure both are still working for GMC and destroying more careers (while getting paid from our fee). Fairness in GMC is skin deep.
Hello baadshah,
We appreciate you sharing this feedback with us. We understand that being investigated by the GMC is stressful for all involved and the time it takes for us to get to the bottom of a complaint also has an impact.
We have a responsibility, and a legal obligation, to investigate any allegation that a doctor’s fitness to practise may be impaired. When we carry out investigations, we aim to do this fairly, focusing on the serious issues, and as fast as possible. Our investigation procedures are designed so that unsubstantiated concerns should not result in action being taken or the case being referred to a tribunal.
If a concern involves clinical matters we rely on doctors to provide specialist opinion. We have a process to select an appropriate expert and to quality assure the work they do for us. This includes published standards for our experts, a formal and structured recruitment of specialists, comments from our lawyers and decision makers in every case which we feed back to the expert, a process to flag and address concerns, and quarterly peer review.
We appoint independent research bodies to audit samples of our investigation decisions and we are overseen, and audited, by the Professional Standards Authority. These audits have told us that our decisions are consistent with our published guidance.
We’ve also recently introduced a number of other changes, which aim to address some of the issues that you have raised. For example, we’re piloting a new way for healthcare organisations and employers to raise a concern with us, so that we have more information about the concerns up front, to help us make a more informed assessment at an early stage. Employers also now have to sign a declaration to confirm that they have taken steps to make sure the referral is accurate and fair.
My comment about my own experience of GMC being an institutionally racist organisation were not even published !!!!!!!!
i found the revalidation process an onerous paperwork exercise that was neither beneficial to me nor to my patients, I feel the fees are high, and I have no confidence in the GMC complaints process
Hello dollaly,
We appreciate that some doctors have found revalidation difficult and we are currently in the process of reviewing our advice and guidance for doctors. This work forms part of our broader improvement programme in connection with Sir Keith Pearson’s recent report, Taking revalidation forward.
We are keen to make sure our advice addresses the needs of specific groups of doctors, including doctors new to the register, trainees and doctors working in short-term locum positions. The team working on this would be very interested to hear about your experiences and make sure we fill any gaps in our existing information.
You can email TakingRevalForward@GMC-uk.org if you would like to get involved.
I am also a victim of a gmc ” investigation” 😦
I am UMA,
Both the GMC/MPTS do not appear to serve the doctors’ interest as a regulatory body rather they have turned the doctors as traders for the multitude of lawyers and Medical defense Unions in the country. Insight does not mean one acceptance of guilt for an offense one clearly did not commit.
GMC/MPTS take pleasure in seeing doctors out of work through the imposition of conditions on registration and suspension and erasure.
The performance assessors themselves are not sound in basic sciences and when one corrects the examiner on basic facts, they take offense and fail the individuals and there give a result of poor performance. The GMC/MPTS must exhibit qualities of fairness and honesty and only then will the organizations get back the confidence of doctors.
Delaying investigation is no way to protect the public but to lose the public trust.
The GMC/MPTS must know that the good services of doctors will not come by the delay of investigations but by the promptness and fairness in their judgment.
The GMC/MPTS must show probity and accountability in dealing with the doctors and the public because the doctors are not their pillars but also belong to the public.
GMC is judge and Jury , Doctors pay GMC to get shot in there Head
Some think GMC has Angels protecting Patients hahaheheheh
GMC is a racist organisation
Secretive and non transparent
I fully agree. Doctors do not pay, fee is extorted from them (no choice).
GMC is Lord preacher for doctors like transparency, candour, honesty, fairness, equality and funded racially abusive organisation. If someone thinks this organisation has improved then I could only sympathise with those who dealt with them in the past.
Just another profession. More energy spent in fighting loony colleagues than in doing a useful job. Final fault is with unaccountable incompetent politicians wishing to become dictators whatever the cost to the electorate. Have established themselves as Gods whose word cannot be queried. See solicitor Michael Joseph’s book for details.
Ex health minister Dan Poulter fails to regard the situation to be serious.
Local health authority was not allowed to coordinate patient complaints against a dentist which was causing them considerable problems. The G. Dental Council paid dentists fees to a solicitor to block patient evidence reaching a tribunal.
Paul Buckley does not deny that this was recognised practice.
The General Medical Council is under natural law a criminal organisation. The comments left show this. Led by our leading lawyers lord Denning and Geoffrey Howe. It is part of the culture. Comes under professional self-regulation. Allowed on the dictate that professionals are dedicated to serving their clients and put their own interests second.
I left the question on Dan Poulter’s desk the day he took office 8 years ago ‘On what legal basis can one party in a dispute prevent the other party’s evidence reaching an independent arbitrator’. The retort by councillor John Klaschka was ‘There is no Mafia’. why mention the Mafia if Mafia opportunities were not recognised?.
Dan Poulter has had his constituents decide that he was not guilty of sexual misconduct.
What has happenned to my yesterday submission to this site? Is this submission censored?
Reply required.
The problem here is that the regulatory framework for doctors is inadequate. If we had a regulatory framework similar to that in aviation, the pressure could move from ad hominun criticism of individuals to improving and correcting systems, standard operating procedures and training. In particular we need an anonimised near miss reporting and feedback system. The regulators need to learn from aviation: it is extraordinary for me as a surgeon that there is no equivalent of a sim check, a check ride, crew resource management, CHIPS or GASIL, IR renewal, regular tests of eyesight, hearing, cognition, there is no equivalent of type rating, little use of checklists apart from the WHO effort, nor performance category certification. I might not have done a pancréatectomie for a few years but there is very little formally to prevent me from doing one tomorrow. That would be the equivalent to my hopping onto the flight deck of a747 and taking it for a circuit having not flown a large aircraft for several years. And whereas as a pilot I can live in a happy collegiate atmosphere where everybody is concerned with safety and safety is achieved to a remarkable degree ( les than one fatal accident in 10 million flying hours) and virtually nobody’s career is threatened by an error (because it is recognised that we all make errors and it is the job of the system and the training to mitigate the results of human error) in medicine 4.5 per cent of our colleagues are being investigated by the GMC each year, with disastrous consequences for their well-being. It is not a sustainable situation and the UK GMC needs to have a serious long hard look at itself and try to move away from a tort approach to a systems approach. If this means a tighter regulatory framework, so be it..