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GPs go forth

Break-down in patient communication behind a third of allegations about GPs, show GMC figures

GPs are complained about by the general public more than other doctors, with a third of those originating from a specific allegation linked with a breakdown in patient communication, show official GMC figures.

The GMC’s third annual State of Medical Education and Practice in the UK report found GPs had a 17% chance of receiving a complaint compared to 11% for specialists and 4% for other doctors.

But they were at a lower risk of having a complaint investigated. Although GPs accounted for nearly half (46%) of all complaints, they accounted for only 35% of all sanctions or warnings issued.

The number of complaints against doctors has been growing since 2007, a trend which continued last year. The GMC received 8,109 complaints last year - up 24% since 2011 and a rise of over 100% since 2007.

The report found that male doctors were around twice as likely as female doctors to be complained about with 22% of male GPs receiving a complaint compared with just 11% of female GPs between 2007 and 2012.

The proportion of doctors over 50 years old who received a complaint was higher than for doctors aged 30–50 years and the report said that this was ‘particularly true for GPs.’

International medical graduates also received a higher proportion of complaints than UK or EEA graduates and again this was likely to be particularly true for GPs where 25% of international medical graduates received a complaint compared with only 15% of UK graduates and 17% of EEA graduates.

The report says: ‘GPs received more complaints during 2007-12 than specialists or other doctors, accounting for 46% of all complaints. This is not surprising, given the large number of interactions between GPs and their patients - there were 303.9 million GP consultations in England between 2008 and 2009.’

It added: ‘Of the complaints we receive about GPs that have an assigned allegation, 29% were linked to their communication with patients. GPs may therefore need more support, guidance or resources to ensure that their engagement with patients is appropriate.’

The GMC report also found that only 1% of all cases merited a sanction or warning but that for male international and EEA qualified GPs aged between 30 to 50 years that chance was doubled.

Commenting on the report GMC chair Professor Sir Peter Rubin said: ‘Overall the standard of care that patients receive in the UK is good and doctors continue to deserve the trust and respect of the public.’

Readers' comments (18)

  • “In 1971 … the Government announced its intention to introduce a Bill to reconstitute the GMC. At the same time about 8000 doctors, with support from the BMA, refused to pay the annual £5 retention fee.

    It was submitted in Parliament that the GMC had asked for amendments of the Medical Act 1956 in order to secure a striking off from the register of any doctor who did not pay the levy.” (Medical Act 1983 : Wiki)

    In 1990, 147 cases were dealt with by the Preliminary Proceedings Committee (PPC) of the GMC. In that year, 46 cases were referred to the PCC , the Professional Conduct Committee.

    “In 2000 there were 333 hearing days held at the GMC by 2010 that had risen to 3,493 hearing days” (FTP Reforms Consultation Paper)

    In 2012, the Annual retention fee was set at £390 with a Certificate of Eligibility for GP Registration of £1,500, representing a contribution of around £17,500 for each GP to the registered charity of which 80% is spent on Fitness to Practice.

    Around 50% of interventions by the GMC are on GPs with an annual increase of 20 – 25%. With 60,000 GPs on the register and on currents trends and calculations (by the power expansion series), within 15 years, 115% of GPs will have received sanctions by the GMC such as the imposition of conditions, suspension or erasure.

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  • "GPs may therefore need more support, guidance or resources to ensure that their engagement with patients is appropriate.’"

    How about GPs need more time to deal with the increasingly consumer led patient agenda? How about accepting that trying to deal with 5 or 6 problems in TEN minutes unsurprisingly leads to complaints.

    Isn't it time to recognise that the current system of an £80 per year all you can consume healthcare buffet is not sustainable. It's time for patients to have ultimate control over who they want to see with payment at the point of delivery based on a fee for service model.

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  • I doubt GPs have become 100% worse since 2007, we are just being crushed under the weight of remorseless demand. What this report really means is the current NHS is not fit for purpose. Patients are no longer dumb pawns to be pushed round the system but consumers who's desires must be met. It's time the government released doctors from the NHS straight-jacket and allowed co-payments so people can actually get what they want rather than be fobbed off in a 10 minute GP consultation.

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  • 90% of NHS consultations occur with GPs. I suspect that might have something to do with the professional bias. I suspect there is also a bias of female to male working part-time and hence having less overall patient contact.

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  • You don't say ( fixed stare at computer screen ) . .

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  • Vinci Ho

    (1) it is always 'juicy' for tabloids to have such a headline. The fact is complaint is a mix bag. Different types of complaint should be categorised . You cannot say they are all to do with causing harm . That is exactly why GPs are actually lower at risk to receive warnings from GMC .
    (2) communication problem. Why? How much time do we have to communicate with our patients? Ten minutes , ladies and gentlemen , ten minutes, wow! That also includes ticking boxes on QOF , Choose and Book. If the GP was conscientious and took his/her time , the surgery would overrun and these patients in waiting room would moan and what happen then? They could complain. Of course , it is about more support to GPs. That is common sense but we are dealing with a government which does not respect as well as insulting GPs every day. Ladies and Gentleman of the public , please be fair .
    (3) that also leads to my third point- while female GPs certainly have an important role in NHS (even the figures above supported that), it is totally insulting that ignorant health minister of this government came out and said female doctors were 'burden' of NHS.(consider she is a woman as well).

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    In order to improve the regulation of complaints in everyone's (or almost everyone's) interest I would suggest the following:

    1. Give all your patients a leaflet and a business card on how to complain about you. Include there your permanent email, and other relevant contact details. Get the receipt from the patient that they got it. Remember, that you must have email address which is not an NHS address as you could be sacked or move to another job and then lose communication means with your patients. Do not give anyone a chance to say: I could not contact you.
    Give realistic means of time response.

    2. State in your complaints policy that you expect to be the first person the complainant should discuss the complaint with. Some of your dysfunctional patients, relatives, friends, spouses (of patients and yours), your staff, colleagues and regulator would go behind your back in order to stab you. Yes, ask all your patients to sign up to this policy as well as your staff/colleagues. Is that too revolutionary? Why not be business like?

    3. Record how you dealt with complaints and ask complainant to sign the record, date it, time it. If they refuse, record that and asked them if they want to sign a refusal notice and state why.

    4. Create a website on "how to complain" that would have links of conflict resolution and mediation, relaxation, anger management, descriptions of dysfunctional core features: lack of intimacy, addiction to chaos and fear of conflict. Give some examples of good and bad complaints handling and disastrous consequences. Self-respect, assertiveness etc could feature there. Indeed, there is so much to write about. Your complaint policy should refer to such a website. Why not join with other practices, doctors to pull the resources to create it. Do not depend on medical regulator, please.

    5. Medical regulator has millions of your money so why they have not ensured better standard of business practice? Because medical regulator
    a) engages in unlawful policies such as targeting of particular groups of doctors (locums and doctors in private practice, for example) rather than providing a business solution in doctors' and public interest.
    b) regulators employ human beings who do not have management or psychiatric competence and have vested interest in going on and on with their business (addiction to chaos)

    6. Of course, there are reasons why some groups of doctors are more likely to be complained about: GPs are under a lot of pressure to see a lot of patients in a short period of time, psychiatrists have patients who have problems with fear and surgeons have patients in pain who are very irritable sometimes. It is incredible what minefield can be activated by people who feel they have not had enough attention. I suggest you read Emotional Vampires book if you have not done already and Snakes in suits (on psychopaths in business world).

    7. There is also xenophobia, ageism and primitive rivalry (male doctors most likely to be victimized) reminiscent of how animals attack for power or dominance.

    8. Changing business practice may not change dysfunctional people but you can show them up to the world for what they are.

    9. Take legal action against your tormentors promptly and give prompt remedy to those you wronged.

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  • >Take legal action against your tormentors promptly and give prompt remedy to those you wronged.

    I think there is some sense in this. Where complaints are vexatious or stupid (and can be manifestly shown to be) we should have a right to pursue complainants for loss of time and emotional suffering. Rights should come with responsibilities.

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  • The rudeness and anger in Society is what dismays me. You cannot fight fire with fire. We need to find ways both personally and as a profession to cope with the enormous pressures we work under and vexatious behaviour of some patients. How about some support from the politicians first? No, I thought not. Come on BMA & GPC, get the finger out in our time of need....

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  • Well I had a recent complaint.

    A patient turned up 10min late - I didn't refuse to see the patient. Wanted to discuss several problems and I declined given the late arrival. Patient didn't like this and complained.

    Only in general practice you have people demanding unreasonable service and they think they are entitled to whatever they want. Could you imagine the response if you turned up at Ryan air counter 10min late for you flight what kind of response you'll get!

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