Allowing investigations to drag on places an unacceptable burden on doctors' mental health, argues RCGP chair Dr Clare Gerada
Doctors don't make good patients. We often self-medicate or ignore important symptoms. The uncomfortable role of doctor as patient becomes even more awkward when the problem is with mental, rather than physical, health. Fear of having to disclose illness to someone who knows you is ever present.
The need for a standalone GP-led support service is clear, and in November 2008 the Practitioner Health Programme (PHP) was set up to look after doctors and dentists in London with mental health or addiction problems. We've seen 450 health professionals so far, and have just been granted a stay of execution after a period of great financial uncertainty.
The health professionals who use our service are very unwell. Many have had years of distress, pain and addiction, often with concomitant financial, employment and family problems. We see new-onset schizoaffective disorder, depression, anxiety, eating disorders, substance misuse and alcohol dependence. One-third have been, or are about to be, referred to the GMC.
In the two years since the PHP was set up, perhaps the most important thing we have learned is the role played by the regulatory authorities. These bodies have a duty to investigate when concerns are raised over a professional's fitness to practise. By necessity, however, these processes impose additional burdens on the sick doctor. The day the white GMC envelope lands on a doctor's mat can be the start of years of distress, assessment and scrutiny, often with no end in sight.
Of course, the GMC must do its job, but there are many parts of the process that could be improved without endangering patients. It can take five years, sometimes longer, from the whistle being blown to proceedings being closed. It takes at least 18 months just to fix a hearing date.
And there can be huge delays even after a hearing has started. One of my patients had a hearing postponed for several months because a panel member forgot he had a pre-existing appointment.
The phrase ‘justice delayed is justice denied' is all too appropriate. Even if proceedings conclude there was no case to answer, delays can lead to doctors being required to take compulsory re-training, which is difficult to organise and can mean months or years of additional psychological pain, family distress and financial insecurity. In some cases, it can lead to bankruptcy or even homelessness.
The intolerable time doctors can be under investigation brings into play the issue of multiple jeopardy. It is not uncommon for my patients to have decades of multiple investigations following a serious untoward event, with information from one inquiry not used for subsequent ones. Often one investigation will only start after another has finished – and this sequential process can go on for years, causing great distress to the doctor concerned. The process, unquestionably necessary, could be improved.
The GMC currently spends over £43 million a year on its Standards and Fitness to Practise directorate, which covers investigations, hearings and sanctions. But the question remains, is there a need for a national confidential service to support doctors undergoing investigation?
When the PHP started, we expected to see about a hundred professionals a year – but we see twice that figure and our referrals continue to rise. As a country, we spend many hundreds of millions of pounds regulating, investigating and monitoring doctors, but only a few million on treating them.
It is about more than money – it is about protecting the public. Healthy doctors mean healthier patients. In this financially challenging climate, ensuring doctors have access to good mental health treatment, and receive help before coming under the heavy hand of regulation, is surely a cost-effective investment.
Dr Clare Gerada is chair of the RCGP and medical director of the PHP (www.php.nhs.uk). She is a GP in Lambeth, south London
Dr Clare Gerada
