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Independents' Day

GMC launches internal review of suicides among doctors facing fitness-to-practise investigations

The GMC is conducting an internal review of cases where doctors have committed suicide while under a fitness to practise investigation, in an effort to see if it can do more to support vulnerable doctors.

The move comes as it emerged that at least 96 doctors have died while facing a fitness-to-practise investigation since 2004, though it is not clear how many of these cases were suicide.

The GMC said that it would consider for each case ‘whether our current process for reviewing each of these cases can be improved’.

But the GPC warned that such cases represented the ‘tip of the iceberg’ and called for the whole process - from GMC letters to hearings - to be reviewed.

The regulator has already said that it will adjust its communications with GPs involved in fitness-to-practise proceedings if they are deemed to be at high risk of self-harm.

But now a report from chief executive Niall Dickson to the GMC Council, published this month, reveals that: ‘[The GMC] will examine those cases where a doctor has committed suicide while under a fitness-to-practise investigation, and consider whether there is more we can do to support vulnerable doctors in our procedures.’

The review will be led by Sarndrah Horsfall, formerly interim chief executive of the National Patient Safety Agency, Mr Dickson said.

He added: ‘I have also asked her to consider whether our current process for reviewing each of these cases can be improved.’

The GMC was not able to say how many cases it would be investigating, or how many cases it was aware of which involved the suicide of a doctor under fitness-to-practise investigation. Figures released by the regulator in response to a Freedom of Information request from Dr Helen Bright, of the campaign group Doctors4Justice, show that between 2004 and 2012 some 96 doctors died while facing a fitness-to-practise investigation. However it is not clear how many of these cases were suicide and how many deaths were from other causes.

Dr Bright has launched a petition on the Government’s e-peititon website based on these figures, calling for a confidential inquiry into the deaths of doctors subject to fitness-to-practise investigations. It has 1,176 signatures to date.

GPC chair Dr Chaand Nagpaul told Pulse there was a ‘pressing need’ for a wider review of fitness-to-practise procedures.

He said: ‘GPC does receive complaints about the whole process and there’s a need to look at this to ensure these tragedies don’t happen. It’s the smallest issue that can make a huge difference.’

‘We need to look at the entire process, from the tone of letters to the fitness-to-practise hearing. There’s a real pressing need to do that. Even the wording of a letter can have a dramatic impact on a doctor’s life. We need to have a system to support doctors.’

He added: ‘Most GPs live in fear of a GMC complaint. There’s a culture of fear. It’s important this review looks at the entire breadth of concerns.’

‘I think suicide is the tip of the iceberg, because we have many doctors suffering stress, depression, distress to their personal lives. In addition to suicides, we should not forget the distress as a result of fitness-to-practise proceedings.’

Mr Dickson said the GMC had already introduced an ‘ambitious programme’ to reduce the anxiety of fitness-to-practise proceedings.

He said: ‘Our priority though must always be to protect the public whilst at the same time being fair to the doctor - sometimes that does mean having to take immediate action when we believe patients may be at risk.’

‘When we do take forward concerns about doctors, we aim to do this as quickly, fairly and as sensitively as we can. To reduce the anxiety of fitness-to-practise proceedings we have in place an ambitious programme to speed up the process and we have set up the Medical Practitioners Tribunal Service, a separate adjudication service headed by a judge which is committed to fair and effective decision making.’

‘At the same time we are piloting meetings with doctors to hear their side of the story earlier and we have commissioned the BMA’s Doctors for Doctors service to provide confidential emotional support to any doctor involved in a fitness to practise case who wants it. We have also set up a support programme for witnesses, whether they are appearing for the GMC or for the doctor.’

He added: ‘Some of the doctors are referred to us because they have serious mental health problems, including severe depression and various forms of addiction. We recognise that these can be very vulnerable individuals and that being part of a fitness-to-practise investigation is almost always a stressful experience for everyone and especially for the doctor involved.’

‘Doctors with mental health problems in our procedures all have a supervising doctor in their place of work. They are also regularly examined by two practising psychiatrists. Our aim is to get them back to safe effective practice whenever that is possible.’

A Department for Health spokesperson said: ‘Regular fitness to practise reviews bring increased trust in doctors, safer care, fewer claims for clinical negligence and positive cultural change in the profession.

‘The General Medical Council is conducting an internal review to examine whether the process can be improved.

‘Fitness to practise investigations must be robust but fair and doctors should receive support throughout.’

Readers' comments (79)

  • Vinci Ho

    Two issues:
    (1) fitness to practise investigation cannot be the same as police investigation . Even so , the spirit of Common Law must be respected- person under investigation is presumed innocent NOT presumed guilty. This is not China or Russia
    (2) for those who are not fit, they need help more than prosecution . Question is - Is there enough help around for colleagues who are struggling ? We all know the answer and more importantly the government does not give a damn.

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  • The problem is the GMC was set up in a different era when we didn't have so much litigation going on and patients were not encouraged by the government to be consumers. In the past only more serious matters got through and now 60% of complaints are rejected at triage. How can today's doctors have confidence in such a draconian process? The GMC is an archaic and antiquated institution which is really is an anachronism in these modern times of instant communication and highly complex medicine. It has lost sight of its original purpose and is slowly rotting becoming increasingly cruel and inhumane in a desperate attempt to shore up its power. Whilst the GMC are right to shine a light on the way both doctors and patients are treated by 'the machine', the bottom line is it needs to be replaced by something better.

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  • I think the whole process of fitness-to-practice investigation is only creating serious confusions, starting from the referral sources to the GMC informative letters to doctors involved in the issue. Dispatching intimidating letters to doctors simply generates tension and anxiety to the unfortunate doctor, most of the time international doctors, comprising those from other European countries. The strange thing is that most of these cases for which some of these doctors are referred are minor cases which the NHS is supposed to be able to deal with without involving the GMC. I think a thorough review of the precess is needed.

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  • "so maybe you need to put the spotlight on your own issues"

    A worth effort at deflecting criticism but unfortunately to no avail. This is a story about colleagues who choose to / feel forced into harming themselves due to the manner in which the GMC undertakes its investigations. It is totally unrelated to ATOS examinations and the like, and the fact that you would twist one story towards another actually says more about you than anyone else.

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  • Given that the way these investigations are carried out has encouraged some doctors to commit suicide, I wonder if the GMC has given due consideration to the clinical risks that patients may face from a doctor who has something rather pressing on his or her mind?

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  • Perhaps we should have a sub-GMC mediation panel for independent resolution of the bulk of lower level complaints? This could be done on a more local level with appraisal teams. I'm sure this would be kinder to all parties concerned and highly cost-effective. The GMC would then have more resources to manage cases of more serious misconduct such as criminality.

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  • Sudheer Surapaneni

    As soon as the investigation process starts, the GMC effect will start ruining the doctor.
    1) The employment the doctor is in will be terminated in haste by the locum/NHS /agency with no explanation or compensation unless the employer is sysmpathetic to your situation and he/she is strong in the management heirarchy.
    2)Informal networks disappear instantly, as people suspect you 'guilty'.
    3)The GMC calls you to the Interim Order Panels, where the complainant need not be present, except an allegation in the hands of the GMC solicitor/counsel which raIses questions ( vague/unproved) And the panel can do anything they seem fit to maintain the public confidence!!!(suspend/restrict licence without even doing a proper trial) See videos by me below:-

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  • 2.51 If what you are saying is correct, this is ethically wrong and needs to be stopped immediately.

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  • If someone acts out of freewill and commits suicide why blame the GMC?You cannot allow incompetent doctors loose on the patients.Patient safety has to come before anything else.

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  • So there should only be patients safety. How are managers and other politicians who cause vast number of scandals and deaths dealt with. Most of the time, it's the system issue. Not the doctor's fault. Most of the time, it's not the clinical competence of the doctor which is in question. It's how the referrers frame the allegation vaguely and damagingly against the scapegoted doctor. Most doctors are very good in clinical issues and are good at heart. betrayed by collegaues or the managers.

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