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GPs go forth

BMA calls for review of GMC and CQC processes

Doctors have called for the GMC and CQC to review how they process complaints and inspections.

Delegates at the at the BMA’s annual representative meeting in Belfast last week passed two motions calling for a review of the regulators' processes. 

One motion voted in favour of the BMA calling on the Government and public bodies to review how complaints impact the wellbeing of GPs, and the other demanded that the Government reduce the CQC inspection system, which has been 'causing stress' and GP burnout according to delegates. 

Doctor's leaders have said there is no evidence to suggest that 'our system of regulation at a personal level or provider level actually leads to improved safety'.

Speaking for the first motion, GP burnout expert Dr Clare Gerada argued that a lack of support and the poor handling of complaints led to a GP committing suicide.

She said: ‘Sophie was only 26 years old when she ended her life. A few weeks before she had received a complaint. She was left demoralised, ashamed and felt she had failed as a doctor. She feared she would lose her job. Instead, she lost her life. Her parents, who want me to speak about her, believe that poor handling of her complaint the delays, the assumption of blame and lack of support – practical and emotional - were major contributors to her suicide. And she is not alone.'

A spokesperson from the GMC said the doctor Dr Gerada mentions was not subject to a complaint to the GMC.

However, Dr Gerada added that GMC referrals from complaints harms doctors ‘needlessly.’

She said: ‘Distress, not surprisingly increases with the complaint severity, with the highest levels after a referral to the GMC. Now of course, correlation doesn’t mean causation. But there is sufficient evidence from a number of sources that complaints, and more importantly the process we subject doctors to, harms them needlessly.’

A GMC spokesperson said it knows fitness to practice complaints can distress doctors and is reviewing each stage of the investigation process to 'reduce pressure and anxiety' for doctors.

They said: ‘We know investigations into fitness to practice complaints can be distressing for doctors, and we share a desire for complaints to be resolved as quickly as possible, and with as little stress as possible for all concerned.

‘We have already implemented a wide range of reforms, and have worked with leading mental health expert Professor Louis Appleby to review each stage of our investigation process, accepting all of his proposals to reduce pressure and anxiety for doctors.

‘We have also significantly reduced the number of full investigations, by instead obtaining the key information needed for a provisional enquiry before then deciding if a full investigation is necessary. And we have improved the way we write to doctors; ensuring our communications are clear and sensitive in tone.'

Proposing the second motion - motion 76 - which looked at the bureaucracy around assessments and CQC inspections, GP Dr Mary McCarthy said: 'Doctors are leaving, retiring or dropping sessions and part of that is due to the bureaucracy that surrounds their work. There is evidence from the commercial world that this inspection is counterproductive. Many areas have given up on repeated appraisals because of lack of evidence that it improves performance and in Scandinavia, they call it the price of mistrust.'

BMA council chair Dr Chaand Nagpaul said: ‘I attended an international conference on regulation and the NHS, the UK is probably the most heavily regulated system in the world and probably one of the most. There is absolutely no evidence that our system of regulation at a personal level or provider level actually leads to improved safety.

‘In fact, if I just read out our survey findings around CQC, 79% of doctors saying the whole inspection process that takes weeks in a hospital and days in a GP surgery, takes resources away from direct patient care. 71% say they worry and fear amongst the staff in the system.’

CQC deputy chief inspector of general practice Ruth Rankine said the CQC is working to minimise the impact regulation has on practices.

She said: 'As laid out in our strategy and recent consultations, CQC is committed to an intelligence-led approach to regulation and working with others to minimise the impact that regulation has on providers.

'This includes the recently rolled out annual regulatory review (ARR) for practices rated good or outstanding – which has received positive feedback from practices so far and was developed in discussion with BMA, RCGP and a number of providers – so that we can take a more proportionate approach. Using the ARR, we can focus our resources where risk is greatest while supporting practices to improve and ensuring patients have access to the high-quality care they deserve.'

Both motions were passed by the majority.

Last week, the BMA's ARM rejected the proposal to put the GP contract out to a ballot of the profession, despite a Pulse survey finding that less than one in five GPs would have voted for the contract if balloted

Motions in full

74 Motion by THE AGENDA COMMITTEE (TO BE PROPOSED BY LONDON REGIONAL COUNCIL): That this meeting asks the BMA to call on the relevant bodies to review within twelve months the impact on doctors of the involvement in an NHS complaints procedure, in particular with regard to:-

i) impact on the health of doctors;

ii) impact on patient care;

iii) the part played in complaints by unrealistic expectations and how this can be addressed;

iv) BMA council working with BMA patient representatives to review and propose a fair and streamlined complaints procedure;

v) raising awareness of the pressures on the NHS and realistic expectation of the service and its staff.


76 Motion by WEST MIDLANDS REGIONAL COUNCIL: That this meeting is concerned by the increasing numbers of doctors that are suffering from burnout and demands that HM Government:-

i) reduces the bureaucratic burden of assessments during training;

ii) reduces the bureaucracy created by appraisal and revalidation;

iii) reduces the CQC inspection system which is causing stress to medical and other healthcare staff;

iv) recognises that constant inspection does not produce improvement unless funding, staffing and appropriate resources are also improved.

Readers' comments (3)

  • As a former GP appraiser, I have no doubt from my first hand experience that the A&R processes and the CQC’s style of inspections have been and continue to be major contributors to the workforce crisis and the transition from partner model to salaried GP.
    Only last week, I heard from a local practice manager about an inappropriately hostile CQC inspection of a local practice, in which I have appraised several GPS and which provides really excellent primary care. One of the partners, in their late 50’s is now seriously considering retirement, which sadly will not be followed by any Locum work.
    We have allowed the progressive destruction of our discipline, general practice, which has been done under the banner of regulation and inspection. The situation is now unrecoverable and as a patient I fear for the continuity of my care and for the care delivered to my relatives.
    Collectively, we are complicit in a national tragedy.

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  • Pulse should do a freedom of information and see how long GMC investigations take to see if they breach their own professional standards. I see colleagues being unnecessarily afcing prolonged stress due to their lousy slow system. The system is out of balance and far too pro complainers, just like the petition brought by Sir Cliff Richard. Guilty before trial, if it happens after a few years.

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  • 1.I think patients should be required to apologise to Doctors and nurses when the staff are found NOT guilty of failure. Make them eat "humble pie".
    2.I think patients should be told to pay the cost of the NHS investigation e.g. 4 hours of GP time costs the UK taxpayer £360 and 15 patients were not seen.As a UK taxpayer I am not happy to pay it. I encourage all colleagues to join the Taxpayers Alliance and lobby the new Right wing Conservative MPs to change the system.
    3.This is a very bad system that is unfair, unbalanced and biased against NHS staff. Such "investigation fees" would help stop the nonsense of "no win , no fee" claims and the "money for nothing" culture.
    4.The UK compares badly with other countries and is unfavourable. I would not recommend colleagues from other countries to come and work here.

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