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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)

  • Are there any stats available , based on race, nationality and sex of these unfortunate fallen 96 colleagues? I bet a ` dark shadow` will be cast over our collective conscience if the stats are revealed, so, the national security act probably will need to be evoked to keep it under wraps for 50 years or so. I hang my head in shame and helplessness. R.I.P and God save those 96 families.

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  • From a Freedom Information Act request

    Names of doctors who died following referral to GMC and ethnicity

    Asian or Asian British = 4
    Mixed = 1
    Other ethnic group = 3
    White = 19
    Unknown = 64
    Black or Black British = 1

    https://www.whatdotheyknow.com/request/names_of_doctors_who_died_follow

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  • If the 96 were anybody else but doctors there would be a public outcry. To put this into perspective 444 members of the British Forces and MOD civilians died in Afghanistan between Oct 2001 to April 2014. Those are people who were involved in a war and they were repatriated with full military honors. The GMC prefers to hide its dirty little secrets out of plain sight unless its hand is forced. It is shameful to claim to be our moral guardian without acknowledging the collateral damage it has done to the UK medical community.

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  • We welcome this review, which is very timely. Indeed we (RM) had suggested going even further by creating a new Never Event for such suicides(http://www.hsj.co.uk/opinion/columnists/staff-should-be-protected-from-never-events/5052598.article), and more recently we have started a piece of work to identify the extent of the problem and support provided by regulators and trusts to healthcare staff involved in investigations, and to explore the necessity and feasibility of such a Never Event. It should also be noted that this problem does not just affect doctors, but all clinicians, as recent cases have sadly demonstrated.
    We have already written to the GMC, and will follow up again to explore collaboration on this really important issue.
    Judith Strobl, Rajan Madhok

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  • I wonder how many ethnic minority doctors will have to go through unwanted stress and victims of revalidation.

    They have already gone through the hoops of PLAB IELTS Membership exams.......... and I am sure history will repeat.

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  • Pleased to hear this JS and RM. I note Clare Gerada is mentioned in the HSJ article as having an opinion. However she has been remarkably quiet on the issue since it was raised on here and by some (eg the good Dr Phil Hammond on Twitter). It feels rather like the cosy club... She's happily tweeting to a GMC employee (who are also at RCGP conference). I notice the BMA are deafeningly silent too? It seems as if they're all mates together: 'We're alright Jack, the GMC is never going to get us. Tough luck on you lot who are on the outside'. Nice glass of wine, bit of a Tweet, turn a blind eye - actually that's what Peter Rubin says happened at Mid Staffs...

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  • 6.36 am - yes good point 'victims of revalidation' because while in theory it is a good idea to keep up standards (in a properly thought out and fair way I mean!) it is yet another process open to abuse and a means of essentially bullying doctors out of the profession.

    @ 10.31 yes, we must remember that all health professionals are subject to the misuse of FTP proceedings. Let us not forget medical students too:

    http://www.theguardian.com/education/2008/jun/03/highereducation.students

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  • This comment has been moderated

  • The GMC get about 8000 complaints per year; Only 60 are erased.
    The processes to find this tiny number are too draconian. Those who have supported doctors say that everyone of their acquaintance who has been though the process and cleared were never the same afterwards - withdrawing form practice, emigration, confidence for ever more damaged, but no mention of suicide (I would not have expected them to say anyway) . The future risks of this professional and personal damage remain unrecognized and unquantified as one person above has alluded to. This need urgent investigation by an outside independent body who can apply both quantitative and qualitative rigor.
    The comment about local procedure -where are they now? Another failing of the new local area teams that needs urgent attention by NHS England. This needs action ASAP.We need a local system for these lesser problems that will deal with issues in a more appropriate way.

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  • Doctors it seems, don't have human rights. The problem is if the BMA, the RCGP and NHS England won't take it on who will? Perhaps a Letter to The Times or writing to MPs? Anyone got any better ideas?

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  • Qui tam action

    from the Latin for "who as well," a lawsuit brought by a private citizen (popularly called a "whistle blower") against a person, company or state agency who is believed to have violated the law.

    In a qui tam action the plaintiff (the person bringing the suit) will be entitled to a percentage of the recovery of the penalty (which may include large amounts for breach of contract) as a reward for exposing the wrongdoing.

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