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GPs go forth

GMC to introduce 'emotional resilience' training after finding 28 doctors under investigation committed suicide

The GMC will introduce ‘emotional resilience’ training and a national support service for doctors after an internal review found that 28 doctors committed suicide while under investigation by the regulator.

The report, Doctors who commit suicide while under GMC fitness to practise investigation, also recommends the appointment of a senior medical officer in charge of overseeing health cases and establishing a culture where doctors feel they are treated as ‘innocent until proven guilty.’

This comes after calls from former RCGP chair Professor Clare Gerada and the BMA among others to publish the findings of the internal review after it was launched in September last year in an effort to see if the GMC can do more to support vulnerable doctors who are undergoing fitness-to-practise investigation.

The internal review identified 114 doctors who had died during 2005-2013 inclusive and had an open and disclosed GMC case at the time of death, and found that 28 had committed suicide.

While it found that the GMC had instigated ‘significant improvements’ to its processes over the past few years, such as using more sensitive language in its letters, it said there was a perception that the GMC focuses on ‘protecting the public’ and that the doctor can become ‘marginalised’ – subsequently receiving little support or compassion.

It said there were a series of recommendations that the GMC could implement to improve processes further, including:

  • Making emotional resilience training an integral part of the medical curriculum;
  • Exposing GMC investigation staff to frontline clinical practice;
  • Supporting the establishment of a National Support Service (NSS) for doctors;
  • Reducing the number of health examiners’ reports required for health assessments;
  • Introducing case conferencing for all health and performance cases;
  • Setting out pre-qualification criteria for referrals from NHS providers and independent employers;
  • Developing a GMC employee training package to increase staff awareness of mental health issues.

Chief executive of the GMC Niall Dickson, said the GMC understands that a fitness-to-practise investigation is a ‘stressful experience’ but he is determined to make sure the regulator handles such cases with sensitivity.  

He added: ‘We know that some doctors who come into our procedures have very serious health concerns, including those who have had ideas of committing suicide. We know too that for any doctor, being investigated by the GMC is a stressful experience and very often follows other traumas in their lives. Our first duty must, of course, be to protect patients but we are determined to do everything we can to make sure we handle these cases as sensitively as possible, to ensure the doctors are being supported locally and to reduce the impact of our procedures.’

Mr Dickson said that a GMC referral will ‘always be a difficult and anxious time for the doctor involved’, but the regulator were determined to make sure they are ‘as quick, simple and as low stress as we can make them’.

He added: ‘We have made some progress on this but we have more to do, and that includes securing legal reform. We will now review our current process for dealing with doctors with health problems and identify any further changes that may be needed.’

Professor Gerada, who leads the Practitioner Health Programme (PHP), which supports doctors with mental health issues, said she ‘applauded the GMC’s openness in putting in the public domain the issue of doctors’ suicides whilst under their process’.

She added: ‘Going forward they need to continue to show their commitment to reducing the impact of fitness to practise investigations on vulnerable doctors whilst always maintaining patient safety - a substantial task.

‘Doctors are sometimes patients too and supporting vulnerable doctors is a shared responsibility. It is important that in taking forward the recommendations in the review the GMC works in partnership with everyone who has an interest in this area including the Practitioner Health Programme, the Royal College of Psychiatrists and the BMA.’

The report states that many of the doctors who committed suicide during this period suffered from a mental health disorder or had drug and/or alcohol addictions.

Meanwhile, other factors which followed on from those conditions that may also have contributed to their deaths include marriage breakdown, financial hardship, and in some cases police involvement as well as the stress of being investigated by the GMC.

Last month, Professor Gerada argued that the GMC’s recent consultation on new sanctions guidance focused too much on ‘maintaining public confidence’ was about basing its decisions on ‘what the tabloid newspapers might think’. 

Related images

  • GMC plaque  Ralph Hodgson - online

Readers' comments (375)

  • When will the MPS/MDU and GMC provide warnings to patients that malicious complaints seeking compensation for groundless accusations will be met with the severest of legal responses and claims for defamation against the doctor? Even convicted criminals get legal aid when a miscarriage of justice has been proven. Shows the nature of politics, the GMC and vote buying.

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  • Vinci Ho

    I think there is a difference between .....' our first duty must , of course, be to protect patients....' and ' our first duty must , of course , be to investigate to see if GMC rules are broken....'
    This is important as a politically correct statement from ND. Otherwise , it is presumed guilty instead of innocent.

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  • To remain anonymous must be a very carefully weighed up personal decision not influenced by other's 'bravery'....they have mainly come out the other end having survived the nightmare......everyone will not and the stress of 'coming out' can exacerbate fear and stress. The suggestion of going local is someone does not belong in the club...the bullying from networks can be horrendous and if resignation is the outcome it will be difficult to remain in the same area ..Why has the college taken so long to speak out - they have been part of the culture perpetuated by the GMC...the organisation set up by Una with those who have been through it is a better takes more than promises for old dogs to change their spots. There have been some admirable people working in the GMC but how far could they possibly have a real influence apart from taking the risk of speaking out..,nobody has as yet.,including those who were given fill in jobs doing admin for FtPafter leaving university some years ago.hope that has changed.Clare G. is well intentioned but expensive short courses are not the answer for the majority.....they anyway need to be run completely independently - it took an independently run campaign by Una and others to get the issue addressed . Obviously serious issues need to be addressed but the GMC nonsence makes it as difficult for complainants...tinkering with the GMC won't be the answer it needs to be replaced. L
    Lastly but not least a huge thanks to Pulse for having the guts to run articles such as much exposure would it have gained otherwise

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  • I think the whole complaints process has been pretty awful so far. Where else in the world can you just make up random complaints which may not even be true, and not get sanctions for wasting police time etc?

    Make the complaints procedure both ways. We're far too poitically correct to recognise the damage that this perverse system has on our doctors.

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  • Una Coales. Retired NHS GP.

    I have now read the GMC report. Sadly the majority (54%) of doctor suicides were from GMC referrals by employers and NOT patients. Surely employment disputes are better handled in employment tribunals?

    And some suicides were by doctors still under GMC investigation after 5 YEARS! Although the majority ended their lives at 1-3 months, 7-12 months and 2-5 years. I don't think even criminal court cases last this long?

    Of the 114 doctor deaths, up to 28 were classified as suicides. I would like to know how the other 86 died. If they had a heart condition, surely chronic stress may have aggravated this.

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  • Although going about my usual business about 7 years ago I was reported to the GMC for treating friends and family. I was travelling with a non blood relative who was also a registered patient. Just before I left home he telephoned and asked me to bring a prescription to the airport in case he needed something for a rash.
    I fully explained this to the airport pharmacist because I wanted to prescribe Trimovate, as he had none in stock, so I chose to prescribe Dacktacort, and I thought nothing further of it other than surprise at the offhand way in which we had been dealt with, and I wondered why I felt a void in the usual professional Pharmacist to GP relationship .
    Weeks later I received a letter saying that he had telephoned the fraud hotline. He specifically commented on the way "I whipped the prescription out of my pocket" as this was an indicator of something amiss. Although no fraud was suspected this triggered an automatic referral to the GMC and in turn an investigation and automatic vetting of me by the GMC. The tone of their letters was awful and unhelpful, and speaking to them on the telephone was a negative experience.
    Despite simply going about my normal duty and doing my best under the given circumstances, it took months for the GMC to see this and officially exonerate me, and I never received an apology.
    I have always thought it possible that there might have been a malicious element motivating this on behalf of the pharmacist. Hence we need more protection from this kind of thing as it is so easy for someone to make an allegation for the wrong reasons, which can cause many waves, using a quick two minute phone call.

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  • As far as I am aware, the GMC publishes all on their website, some redacted if health matters granted, the Press pick it up, local news at least, colleagues likely to disown the doctor. You would be pretty lucky if it can remain anonymous.

    Doctors are generally well-intentioned, caring and sensitive people who "soldier on" for sake of patients out of sense of duty. 4 in 10 GPs have or are likely to burnout soon according to PULSE survey.

    Will all these GPs get referred to the GMC for potential risk to patients? Burnout goes hand in hand with Anxiety & Depression. Even if mistakes are made, all for want of trying their best, can ANY doctor say they have not made a mistake which harms a patient in some minor (or major way)?

    How many GPs go to work with a "heavy cold" and may be imparied that day? There are not enough GPs, and half partner posts are unfilled, some VTS post are at 40% only.

    How many doctors who happen to make a mistake "happen" to be on an SSRI to try and keep well? They would be stuffed then by the GMC...

    For God's sake some GPs have 6,000++ patient contacts per year. Why take the risk? Let's all have 20-30min appointments, give patient a better deal and not risk our livelihoods and mental health.

    Let the RCGP, MDU/MPS, NHSE back every doctor who is "forced" to consult at unsafe work rates. Patients need telling what exactly the risks their doctors are taking to provide care for them as best we can.

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  • I want you to imagine that the trade union UNITE had discovered that 3 members per year were committing suicide whilst in their employer's disciplinary procedure.
    What do you think Len McCluskey's reaction would be? What would the political parties' reactions be? Imagine the front pages of the newspapers. The police would start criminal investigations to examine if the employer's behaviour had contributed to the deaths.

    Now look for the GPC's reaction. I bet they send a polite letter asking the GMC to hurry up a bit old chap.

    So why are doctors abandoned, why don't they fight this awful state of affairs? Why do doctors tolerate being abused so much, in a way no other workers do?

    The only way this scandalous behaviour by the GMC will be sorted is to make the top management very scared. It needs a criminal investigation to establish whether or not the GMC behaviour contributed to those suicides.

    But I know nothing will happen. As always, doctors will moan but do nothing and let another nail be driven into their coffin while all they do is wring their hands.
    You desperately need a union that comes out fighting instead of playing the gentleman.

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  • 3 and 1/2 years for me and still going!

    Axillary vein thrombosis and now cardiac monitoring in the meantime, maybe its just bad luck?

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  • 11.36 The whole issue of prescribing for friends and family needs testing in court because it is not illegal, it will help us manage simple conditions and sensible prescribing is very unlikely to be be harmful.

    Obviously no-one should be prescribing themselves/family benzodiazepines and strong opiates but the current rules seem to be based on dogma and prejudice rather than evidence.

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