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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)

  • GMC has never been courteous to the doctor in question.All they do is write to you to ask to mention all the places you work and send letters to everyone before even any investigation begins.The doctor in question might not even be at fault and i have never heard if member of gmc ever contact the doctor initially to hear their story or give some advise or reassurance or act with sympathy with the doctor.

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  • Gmc procedure lengthy stressful and lack of support for doctorshttp://www.firstpracticemanagement.co.uk/images/uploads/deputy_PM.doc
    always doctors left alone without support
    Gmc Do more to support Doctors and speed up process

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  • It is highly unlikely that suicides are a simple matter. Independent confidential enquiry should be able to make recommendations that would lead to public benefit. The case of Dr LI is a very good illustration, perhaps.

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  • Is this the case? Interesting and makes me think the gmc spends an awful lot of money defending itself.

    http://publicregulatoryblog.ffw.com/tag/fitness-to-practise-panel

    And are you the same Helen who started the petition and enlightened us? If so I hope there have been no repercussions for you.

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  • Hats off to Helen Bright for the e-petition requesting an inquiry into the deaths of drs awaiting fitness to practice investigations.

    Helen - you have my respect.

    http://epetitions.direct.gov.uk/petitions/54034

    there is often a lot of moaning and flapping of wings on pulse but it is refreshing to see someone taking action.

    I've just signed the petition and I encourage all drs and interested parties (family/friends) to do the same. It is a chance to send a message.

    as for repercussions mentioned in the previous post have a read of the current headlines - we are all stuffed anyway so we may as well take an opportunity to fight back for a change.

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  • In memory of those doctors who've died, please sign. All the petition is asking for is a proper enquiry -

    http://epetitions.direct.gov.uk/petitions/54034

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  • Helen.......How does the suicide rate compare with other groups who have been through disciplinary/investigatory procedures?

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  • Yes Helen that would be interesting if you have any figures?

    I looked at the FOI requests on https://www.whatdotheyknow.com. It seems that it's not always simple to extract the information.

    This site suggests collating survivors' experiences of gmc proceedings:

    http://www.badmed.net/bad-medicine-blog/2013/08/dropping-flies.html

    And I found this:

    http://www.bmartin.cc/dissent/documents/Bright10.pdf

    - a very interesting read. It would be interesting to know the proportion of whistleblowers who have found themselves in proceedings.

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  • I have a friend - no, not me! - who is being investigated by the GMC for a ridiculous, spiteful, malicious complaint from a neighbour! I've found this thread v interesting reading and would agree with 'anonymous' above -"GMC has never been courteous to the doctor in question.All they do is write to you to ask to mention all the places you work and send letters to everyone before even any investigation begins.The doctor in question might not even be at fault and i have never heard if member of gmc ever contact the doctor initially to hear their story or give some advise or reassurance or act with sympathy with the doctor."
    How very sad but unsurprising that so many have committed suicide.
    Do GMC have no 'duty of care' to doctors?

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  • I was referred to the GMC when I was seven months pregnant and suffering pre-eclampsia. The referral was initially for ? personality disorder but then changed to probity - i was working in an aesthetics clinic while a GP trainee. Despite my GP trainer having provided a reference for this post, she denied all knowledge of this and said it was dishonest.
    I was assessed (due to the personality disorder allegation) 3 months post partum, having had an emergency caesarean at 36 weeks. My daughter was 4lb 6oz at birth, so she was still needing fed pretty frequently, and I was breast feeding. Despite my protestation that I was unfit for anything, the MDDUS advised i should comply with the GMC psychiatric evaluation sooner rather than later. I followed their advice and was assessed and "an exhausted mother".
    fast forward two years, and the GMC decided I should be sent to an FTP hearing. By this point I had totally lost interest in the entire situation, as my life no longer revolved around medicine. I can easily see were I older, single, or at the peak of my career my reaction would have been very different.
    I was suspended for twelve months, for dishonesty. At my review hearing, I had my registration reinstated with conditions "because I had been out of work for so long". My mother died, after a prolonged illness, two days before the hearing. It was made perfectly clear to me that non atendance was not an option an would liekly result in my being struck off.
    Ive been seen by a psychiatrist recently, in an attempt to gain access to Safehaven counseling. He said unfortunately there was nothing wrong with me other than grief.
    Points I would like to make
    (1) the GMC proccess at no point takes into acountt he effect it may have on its doctors
    (2) they use criminal law to try cases and require a civil burden of proof
    (3) they do not distinguish between well, working, maternity leave, sick, disabled... so i suppose one could say they are unbiased; they treat everyone equally dreadfully...
    (4) they need to change
    Helen Bright, I salute you

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