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Independents' Day

Niall Dickson: ‘We want doctors to feel protected’

The GMC’s chief executive tells Joe Davis how it plans to offer more support to vulnerable doctors

Niall Dickson - 3x2

Niall Dickson - 3x2

As Niall Dickson arrives to meet Pulse at the GMC’s London headquarters, he looks eager to get down to business, but slightly tense.

Given how uncomfortable the past 12 months has been for the regulator, this may be understandable.

The GMC published a review just over a year ago revealing 28 doctors had died while undergoing fitness-to-practise (FTP) investigations, and a number of other studies last year also highlighted the severe impact FTP procedures have on doctors and the way they treat patients.

However, the GMC’s chief executive tells Pulse the regulator wants to ‘reduce the stress’ its FTP processes can place on doctors, while making the transition to being a ‘compassionate’ regulator.

The GMC claims recommendations outlined in the 2014 suicides review have already been implemented, including improvements to the tone of its correspondence with doctors, and a move to establish a national doctors’ support service.

But Mr Dickson now says the GMC wants to go further, with the apppointment of mental health expert Professor Louis Appleby to carry out a review of FTP processes, examining ‘every stage’ to find ways to offer more support to vulnerable doctors. But it still faces a huge challenge to carry out its mandate to ‘protect the public’ while being ‘compassionate’ towards doctors. Will it be able to square this circle?

Do you think the GMC failed in its moral obligation to do more during the period in which 28 doctors died while under investigation?

It’s inevitably a very emotional and a very difficult issue, and absolutely terrible for the families of these doctors. Even our staff who are dealing with this find it incredibly difficult. But we did want to try to find out if there was more that we could do in terms of our contribution, remembering that most of these doctors enter our procedures already having had very serious mental health and addiction problems, and many have had suicidal ideation. But we recognise that our investigation process is stressful and will always be stressful.

But why do so many doctors have to die for the GMC to recognise it as an issue?

If you’re asking me whether these deaths could all be avoided by the GMC doing something, that would be ludicrous, and nobody who’s an expert in this area would even begin to suggest that.

But surely if doctors are dying while under investigation, the FTP process should have been suspended?

Stopping the process is stopping protecting the public. We have to take action and we don’t do so lightly – the assessments are done by two psychiatrists who recommend whether a doctor needs a form of restriction on their practice.

The question is, can we do it in such a way that we reduce the stress on those doctors? We’ve started looking at every step we take and we may be able

to do something within the confines of the current system, but a lot of it is dictated by an act of Parliament, and we won’t be able to change that without a law change.

What will the work entail?

We’ve already started mapping our process very carefully, looking at each stage that we go through. What we want Professor Appleby to do is to review that process and advise us on what we can do within our current legal powers, and also suggest any legal changes that we might seek from the Government in order to try to make the system better.

The GMC review called for a culture where doctors feel they are innocent until proven guilty. How can this be established?

I think this is largely around our written communications, although it’s also a question of ensuring staff are adequately trained and so forth. In a way, with these doctors there’s actually no ‘guilty’ at all.

We will certainly look, for example, at the role of our medical supervisors in terms of the support they provide and how they link up with local services to make sure the process is as joined up as we can make it, so the doctor feels supported. But I don’t want to mislead you. You can’t make this process easy. We have to investigate on the basis of trying to protect the public. That’s our first duty.

But you surely have a moral obligation to protect the doctors as well?

We have an absolute moral obligation to protect them, and we desperately want to do everything we can to try to make sure doctors who are undergoing our procedures feel as protected as we can make them. That won’t stop us making decisions about, for example, restricting a doctor’s practice, if we believe that is the right and necessary thing to do to protect the public. 

How do you think the GMC can become more compassionate and sensitive?

We absolutely want to be as compassionate as possible with all doctors, not just those who have mental health problems. For the vast majority, if for example their clinical performance isn’t good, it’s not because they woke up one morning and said ‘I want to be a bad doctor’. What we may do feels, and is, punitive. But our objective is not to punish – that is a side product, regrettably, of what we have to do.

The way in which we treat doctors – while it absolutely has to protect patients – must follow the legal procedures that are laid down. We need to try to do that in as compassionate and sensitive a way as we can. 

Complaints against doctors have been steadily rising over the past few years. Why do you think that is?

I think access to the GMC is much easier now. Going back 15 years, if you wanted to complain about a doctor to the GMC, you had to write it out and to get a notary to countersign in, whereas now you can simply go onto the internet. Also, people across all professions are more likely to complain than they ever were before. It’s a phenomenon we’re seeing internationally in medicine, but also in general – people are more challenging about decisions.

I think there is a question about making sure people with a complaint know where to go to get it dealt with at a local level. The stuff that comes to us really should be at the much more serious end. There is also a significant number of doctors who we open up investigations for because the law says we must. Then we subject that doctor and their family to a period of time when we’re putting them through an investigation, but at the end of it we say we’re not going to take any action. From the doctor’s point of view that’s awful, but from our point of view, we have to do it because the law says we have to do it. So we have to try to reduce the length of that period in any way we can.

According to GMC data, black and minority ethnic doctors are twice as likely to face sanctions by the GMC. Why do you think this is?

We know that those who are trained overseas can sometimes struggle with aspects of practice, and I think that raises real issues for undergraduate training in general, and indeed for the support that the whole system, including the GMC, can offer to doctors who come from another jurisdiction to practise here. So I think there is a recognition that cultural issues and other factors can lead to difficulties.

One area of concern for us is BME UK graduates, who again have slightly higher FTP rates. They do less well in terms in terms of postgraduate training and less well through their undergraduate years. It behoves us to keep this very much under review, to be absolutely clear and subject our staff to the right training to make sure that there is no unconscious bias on our part. We need to ensure, for example, that our FTP panels are as representative as we can possibly make them.

We’ve made significant advances to make sure the decisions that we do make are correct. I don’t pretend that we’ve absolutely cracked this. What I would say is that we’ve made some significant advances in our understanding, and we’re determined to look at every single stage of our procedure again to make sure it’s as fair as possible.

 

CV

Age

62

Education

University of Edinburgh (MA, DipEd); Moray House College (CertEd) 

Career

1982-83 Editor, Therapy Weekly

1983-88 Editor, Nursing Times

1988-90 Health correspondent, BBC

1995-2004 Social affairs editor, BBC

2004-2009 Chief executive, The King’s Fund

2010-present Chief executive, General Medical Council

Other interests

Playing golf

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Readers' comments (59)

  • As an "Expert in this area" I am concerned about this emphatic statement by the CEO of the MWC:

    "If you’re asking me whether these deaths could all be avoided by the GMC doing something, that would be ludicrous, and nobody who’s an expert in this area would even begin to suggest that."

    Do others share my view that this interview demonstrates a defensive and legalistic approach to humanity?

    Unsuitable or offensive? Report this comment

  • That's not what was being asked.

    What was being asked - was GMC inaction in any was CONTRIBUTING to so many deaths. Not entirely responsible, but a factor which could have been acted on sooner.

    After all, they've decided to act now - on what basis OTHER than the NUMBER of deaths/suicides.

    Logically there must have been a threshold of awfulness passed to stimulate the GMC into action. They chose do do nothing after 1 death, nothing after 2 deaths, but eventually were moved by some quantuty of deaths and pressure from the profession - Pulse in particular should be commended.

    "Q. But why do so many doctors have to die for the GMC to recognise it as an issue?"

    is rhetorical, the GMC failed to recognise it as an issue.

    The GMC failed. This man failed.

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  • It was a waste of time asking Niall Dickson any questions because under his watch doctors are dying. He has not brought about any change and perseveres with empty rhetoric. He should be investigated himself for not stopping a severely defective FTP process which is illegal, against human rights and has been severely criticised by the Civitas report and a number of other publications.


    The bottom line is that the Ftp process traumatises doctors causes severe disruption to clinical services as a result of ,retirement ,emigration ,staff shortages and defensive practice , the net result being that patient care is endangered rather than protected. Mr Dickson, you know this but won't admit that the stance you take is not about protecting patients - It is about pandering to complainants and more importantly justifying your own existence

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  • Niall dickinson " we want doctors to feel protected"

    What he is really saying according to his actions and those of his organistion and the climate of fear it has orchestrated is

    "WE WANT DOCTORS TO FEEL PERSECUTED"


    take note GMC this is the beginning of the end for you in your current form.......you cant hide any longer

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  • This comment has been moderated.

  • An anonymous comment because I am currently awaiting a GMC FTP hearing, and fear reprisals.
    There are simple ways to reduce the stress of a FTP investigation. I know this from personal experience:
    1. Communicate. Give the doctor under investigation a date when he/she will next receive an update on their investigation. 'In due course' is not sufficient, and cruel.
    2. Inform. Copy the doctor into all correspondence, so they know what is going on.
    3. Speed up. Investigations can be carried out much more quickly.
    4. Revalidate. How to make a doctor feel guilty until proved innocent: refuse to revalidate him, no matter what his appraisals look like and put his revalidation 'on hold' until the FTP process is complete. Revalidation should continue as normal. The GMC can always suspend your licence at any time if there are concerns.

    It's not rocket science, is it?

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  • You might WANT us to feel protected Niall, but we don't. We feel persecuted. Most of us WANT a way out. And, when there are no GPs left to regulate, perhaps then someone will wonder why.

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  • Stop for a moment and listen to what the GMC said to junior Doctors recently regarding a legal strike action, which the juniors have a legal right to do.
    We, the GMC, will watch and if a patient comes to harm the doctor will have to answer.
    That is a direct threat and bullying from the GMC.
    The fact that Junior doctors wish to protect themselves from exploitation and slave labour of 90 hour weeks does not matter to the GMC.
    I, like others, who has done the 80 hour weekends and the 168 hour weeks without sleep or protection from BMA or GMC, am glad the junior doctors refuse to do unsafe hours.
    BUT the GMC will have you for NOT working unsafe hours and they will have you if you make a mistake when you are tired.
    The GMC will have you one way or another. They are like a Black widow spider waiting.
    I have been investigated by them due to complaints from a mentally ill patient [ went on for years] and when nothing is found they do not even let you know. I was not told the outcome of my investigation ever. The letters just stopped.
    The GMC in its current form is an absolute abomination.
    I would advise any young person to seriously avoid doing medicine as a career with the likes of GMC and CQC about.
    They do not hound computer software/ electronic/mechanical Engineers.
    With 4 A* , be wise do something else, where your career will not end precipitously. AND you will be better paid.

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  • "We have an absolute moral obligation to protect them"

    The Medical Act 1983:-

    Section 38 - Power to order immediate suspension etc. after a finding of impairment of fitness to practise
    å
    and Section 41A - Interim Orders

    impose a legal duty of care upon the General Medical Council and the Proper Officers of that organisation, as I am sure Mr Dickson is fully aware, and also thereby statutory liability for the deaths of those registered persons.

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  • This is the face of a man who is in charge of an organisation which makes doctors kill themselves. We all know what kind of a man he is. But I cannot write it as my comments would be moderated.

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  • For goodness sake as they are already demanding new legal powers and supposidly their investigations using Louis Appleby has only just started 2 weeks ago.

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