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Independents' Day

Doctors 'to be scapegoated' under GMC fitness to practise plans, says Gerada

GPs could be ‘scapegoated’ for fitness to practice (FTP) issues they have little control over, under GMC proposals for more harsher sanctions for doctors who fail to raise concerns about patient care, a group set up to support doctors with mental health issues has said.

A proposal to remove or suspend doctors from the medical register for failing to raise concerns is ‘deeply worrying’ and would see doctors punished for failings that ‘largely derive from political management decisions’, the Practitioner Health Programme, led by former RCGP chair Professor Clare Gerada, has said.

In its reponse to the ongoing consultation on GMC sanctions guidance, the PHP also accuses the regulator of ‘responding to political pressure’ in the wake of the Mid Staffordshire hospital scandal and questions whether its focus on ‘maintaining public confidence’ is about basing its decisions on ‘what the tabloid newspapers might think’.

The consultation, launched in August, is aimed at updating GMC’s ‘indicative cautions guidelines’, used by panels to decide the outcome of cases at fitness to practise hearings. It is also examining the role of apologies and warnings in its processes and changes to the guidance on suspension.

The consultation document, ‘Reviewing how we deal with concerns about doctors’, proposes a number of changes that will allow the GMC to ‘take appropriate action to protect the public interest without being influenced by the personal consequences for the doctor’.

However the PHP says the proposals ‘are intended to enable the rights of the doctor to be disregarded if sanctions are imposed solely to maintain public confidence’, adding that the case studies it uses to support the proposals are too ‘extreme’ and detract from the real issues.

In response to the regulator’s proposal ‘to guide panels to consider more serious action where cases involve a failure to raise concerns’, the PHP said: ‘This proposal is deeply worrying as it would enable sanctions against almost all doctors for omissions in matters that are not under their direct control, which may often be identified only with hindsight, and which are more properly the direct concern of other health professionals, management and various inspectorates.’

‘It increases potential for doctors to be scapegoated for failings that largely derive from political management decisions.’

Leader of PHP and former RCGP chair Professor Clare Gerada said: ‘Focusing on the detail that’s contained in this consultation, for example, whether or not doctors should apologise – detracts from the much larger issues. The GMC needs to looks at all its systems and process because so much of it needs to be reformed if we are going support doctors and patients.’

‘The case studies in the consultation that are given are so extreme and in reality doctors which are referred to the GMC are referred for much more mundane issues and associated with more complex issues.’

Niall Dickson, chief executive of the GMC, said: ‘Doctors are among the most trusted professionals and they deserve to be treated fairly. In the vast majority of cases one-off clinical errors do not merit any action by the GMC. But if we are to maintain that trust, in the small number of serious cases where doctors fail to listen to concerns and fail to take action to protect patients, they should be held to account.’  

‘We normally only investigate the most serious concerns. Many of the complaints we receive are closed because they do not call into question a doctor’s fitness to practise or we refer them to their employer to be dealt with locally. We have had an excellent response to our consultation so far and we want patients, doctors and other professionals to give us their views - this consultation is a chance to make sure the action we take is fair to doctors but always protects the public.’

The consultation runs until 14 November.


Readers' comments (31)

  • I just keep thinking why clare didn't do more during her time in office as RCGP chair. What continues to happens is this: the GMC decide something, holds a 'consultation' and then does what it wants anyway. I for one feel the present symptoms is heavily biased against the doctor and you simply cannot say what you feel or it is decried that you 'lack insight' what is the point of the system if at the outset you are presumed guilty?

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  • Totally agree with the above. I have mixed views about Clare - on one hand she is excellent and fights our corner more than almost all others but on the other has pursued some potentially quite damaging policies around federation etc.

    It's also true to say that the GMC appears to pay little attention to the "consultations" - it was similar when it came to policing social media - there were view robust responses but they did what they wanted to anyone. The GMC should be publicly funded IMO as it is now extremely far from 'self-regulation'.

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  • Bob Hodges

    If one accepts that a 'profession' has in it's definition an element of 'regualtion by peers', then medicine in the UK has long been reduced to a 'technical trade'.

    Can you imagine the legal validity of the regulators of any other technical trade extending their remit (unilaterally) into the regulation of 'tradesmen's' private lives and social medial accounts?

    The BMA should be using some of that dry powder to explore challenging the GMC's charity status (which in itself prevents it from legal challenge and redress after it has been proven to be wrong), and also how it fits in with the ECHR (European Convention on Human Rights) which does not specifically subject ANY group of people to different standards of rights, least of all doctors. The perverse and quasi-judicial machinations of the organisation, performed at our expense, are manifest. 'Making examples' and 'getting tough' in the vain hope that some hack at the Daily Mail might notice and write a story saying how 'hanging's too good for 'em' and praising the GMC, is not the right way to go about business. The 'public confidence' in our regulator (as dictated by the Daily Mail et al) should not be the only measure of it's worth. The long-lost confidence of the profession should be of equally value.

    As doctors we deserve and should expect to have confidence in our regulator, especially if we're paying for it.

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  • The BMA need to seek an urgent judge-led independent public enquiry of the GMC. This would be hugely popular with the profession and in all likelihood, the public.

    Over regulation is becoming a bloated self-serving industry which is driving doctors to emigrate or retire early and putting the public at risk by 'wasting doctor's time'.

    Confidence in doctors is at an all time high, whilst confidence in politicians (to whom the GMC seem to be at the whim of) is at an all time low. Failings in regulation are at fault in affecting patient safety (eg Shipman, Mid Staffs and current doctor shortages). Yet, UK doctors are the most heavily regulated by the most punitive regulator in the world. And its going to get even more punitive and has no evidence base whatsoever.

    There needs to be a judicial process to replace what clearly is no longer self-regulation and a regulator that no longer has the profession's confidence.

    We live in a democracy and it is not acceptable that doctors are not affectively subject to the same rule of law to which any other members of society. "Trial by village elders" which ignores doctors' Human Rights on the basis that 'any decisioin can be appealed' (when most doctors have no legal representation whilst being forced to pay for their own prosecution at hearings) requires prohibitive resources to take the GMC to the High Court. We are denying our doctors justice whilst the regulator thinks it has the right to intrude on our personal lives.

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  • The GMC does not need to be reformed it needs to be closed.

    Over the last decade a rapacious industry has grown dramatically to take advantage of medico-legal claims. It is not really interested in protecting patients but targets the large pots of insurance money available.

    We already have strong laws in this country to protect the public from people who abuse their positions and punish criminal behaviour. The judicial system has checks and balances to prevent people being made scapegoat for other institutional failings.

    The GMC lacks the scrutiny of statutes but has created an extra-judicial process that places doctors in a situation of multiple jeopardy. What constitutes 'good medical practice' is often a grey area but the GMC have sought to hold doctors accountable to an ever more complex set of regulations that are almost impossible to follow and trample over doctors basic human rights.

    For democracy to work, we all need to be treated equally under the law. Doctors should not be held to an ideal that is unobtainable by the rest of the public.

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  • Imagine if the BMA after consultation with members were to start this as a campaign?:

    "Doctors seek an end to self-regulation to be treated the same as the rest of society."

    Come on BMA.

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  • I'm not sure I would trust judges in this country any more then the GMC.

    Unfortunately we need to factor in we are heading towards a very defensive approach to all parts of our practice

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  • Josh, this is well worth a read:

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  • thanks for your comments. I did address this issue when Chair of RCGP. Its just much of what the Chair does is behind the scenes. I think the BMA needs to address this issue asap - before the GMC regulates more of what we do outside the consulting room. They must not invent more ways of regulating us - but use the ones they have more fairly

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  • Anonymous@10.47 - thanks for the Ciivitas article- at last some research into the nightmare that is GMC investigation. How did I miss this when it came out? Did it make the headlines at the time?

    I think we would stand a better chance of justice under high-court judges - I've seen one protracted torture of a GMC FTP decision overturned with scorn by a judge in a matter of hours.

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