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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)

  • It is true that most Doctors fear ther GMC. The perceived aggressive style from the GMC is counterproductive. It specifically discourages GPs from any interaction with the GMC either as whistleblowers or if help is needed. Any POLICEing activities should be done sensitively. The public want supervision not retribution.

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  • The GMC prodcedure I went through was abusive, intrusive, overly drawn-out and incompetent. Whilst accepting it was right for the GMC to investigate the process pushed me over the edge. The response of the GMC was to add the allegation of unfit to practice due to health as well, and to insist on two independent psychiatric reviews. Neither of the psychiatrists even asked about suicidal ideation let alone anything more significant.

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  • You are told to go and get your own support (and there is not a lot out there) and then left to it....its very easy to see how suicide risk could arise and go undetected with the tragic consequences that have occurred.
    The exercise of the GMC investigative function is deeply troubling - you should be innocent until proved guilty but their whole approach tends to be the other way round.

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  • Maybe if the constant monitoring and evidence based practice trend continues to increase in complexity, then GP's will have more compassion for sick and disabled people who have to undergo endless ATOS examinations and constantly fill in forms with accompanying evidence that is very hard to obtain.

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  • Are their any Suicide figures for Doctors undergoing NCAS Assessment. They usually are pressurised into taking part in the assessment under the joint threat of GMC Referral and Breach of Contract.It would be interesting to know how many take part Truly Voluntarily

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  • Sudheer Surapaneni

    GMC procedures show most of the targeted are the International graduates. They get referred by the NHS employers for smallest of the reasons, which they would not do in case of the White/British graduates.NHS racism comes to the fore when the doctor in question suffers indirect discrimination at the work place, and he is further discriminated by the process of GMC referral. And the doctor finds himself suffering double whammy of loss of work,career and legal help, as the Defence organ isations refuse to help because of the costs involved.http://www.bmj.com/content/346/bmj.f4088

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  • Maybe if the constant monitoring and evidence based practice trend continues to increase in complexity, then GP's will have more compassion for sick and disabled people who have to undergo endless ATOS examinations and constantly fill in forms with accompanying evidence that is very hard to obtain.
    ----

    How utterly disgraceful to use this topic to swing things around to your agenda. You should be ashamed of yourself.

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  • Dear "Anonymous", there is nothing shameful about my comment and I have no agenda. I am a retired GP so am not affected by developments in the profession or DWP. My policy has always been to examine both sides of any situation and look for similarities rather than differences. What ruffles your feathers in others is often what is unexamined/unacknowledged in yourself so maybe you need to put the spotlight on your own issues and bias rather than projecting them onto others where one way or another, now or in the future, they will only reflect back at you and bite you on the ass.

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  • Sudheer Surapaneni

    The Independent expert psychiatrists do not examine you as a patient, but you they are asked to give a medical report. In the process, you do not have patient-rights, s you are not their patient.
    The expert assessors and witnesses brought by the GMC are protected by the GMC.They can do any number of basic/serious mistakes but they will not be investigated for their fitness. If you complain, you will be branded 'wexatious'.

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  • This comment has been removed by the moderator.

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  • 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:-
    http://www.youtube.com/watch?v=ehKfnezwqoM
    http://www.youtube.com/watch?v=pEKD5htWRyA

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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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  • An enquiry is to be welcomed; but an internal enquiry is unlikely to inspire confidence in the findings, particularly if the enquiry reports the GMC to be entirely blameless.

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  • If someone acts out of freewill and commits suicide why blame the GMC?

    Troll comment but on that basis we would happily sell alcohol to 13y olds and not set speed limits on motorways. The GMC are a factor in this and have to be held accountable.

    'Patient safety has to come before anything else.'

    Agreed but doctors are also patients and not immortal as some sections of the public and press seem to believe. The GMC has a duty of care to all parties involved in complaints and should act responsibly. It is inappropriate to behave threateningly to doctors when a mediation approach would have much better outcomes all round.

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  • Sudheer Surapaneni

    Criminalising health professionals' mistakes and dealing them through regulators' bodies is a way for the all the others to escape the real issues which are at the heart of the problems. Convicting doctors on 'manslaughter' charges does not look fair when the managers at the Mid Staffordshire dscandal walked away with big handouts.

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  • Is this another important debate about to be hijacked by trolling?

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  • Psychotherapists need to come under a GMC-style Fitness to Practise regime.

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  • Why all the whinging?If you don't like the system then leave.No one is forcing you to stay.

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  • 'If you don't like the system then leave.No one is forcing you to stay.'
    A bit defeatist don't you think? Medical advances happen by slow incremental improvement over the years. That includes medical ethics too.

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  • When you have invested so much in a career and have a mortgage and children it is very difficult to leave. Remember it is not just a career but a way of life.

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  • Agree @3.29 pm - no confidence in internal review. We need a confidential enquiry as per the petition.

    Re patient safety, for any non-medical readers, the GMC is where whistleblowers - or those who simply raise concerns - dread to find themselves. Most doctors will advise each other, 'keep your head down'. This benefits no-one -patients, doctors or doctors-as-patients but it is a reality.

    I raised concerns about patient care that led to the staff turning against me, as did seniors in the organisation. They simply wrote false reports about me that is so easy to do. You cannot prove you did not say or do something. I was branded unprofessional and suspended. The investigation was a sham made credible by including a few accurate facts. The inappropriate patient care was whitewashed over: it never happened. The cost to me is a lifetime of fear, let alone the career and financial implications yet I did the right thing.

    I was not subject to GMC proceedings but the equivalent within my organisation and by people who are part of the GMC machinery (the GMC is not an isolated cell).

    Remember that many of those involved are not doctors and are completely unregulated, the same as hospital managers. The title 'prof' may not be of medicine. I was subject to bullying on a grand scale - intimidation, a whispering campaign, veiled threats, lies and verbal aggression such as I have only seen in films when confessions are extracted. At one point I was even told I was 'lucky'. I was shunned and isolated by staff and colleagues, some of whom have never been back in touch while others meet but not in public.

    The Police advised me to keep my curtains closed and to take care at night. Sadly I was too scared to sue for harassment and the reason they win is, of course, because we want to remain doctors, despite all this, and we need to work. We say to ourselves that it is wrong to give in to bullying.

    Let us not think that this is a new phenomenon. Many readers will know it is little different from years ago. Sociopaths are employed in all walks of life and sadly are good at climbing the greasy pole from where they effect more damage (why? - to bolster their own position and because they get their kicks from it). Don't underestimate the power they have to create a smokescreen in which the majority of decent people will simply believe what they're told.

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  • Approximately 300 of their staff were involved so far in my case since 2006 sometimes sending two or three letters per day, constantly assuming other functions within the hierarchy and making décisions that they were not alloowed to make according to their job-descriptions.

    Evidence gets distorted or withheld right from the start of the "investigation" up to the endless chain of IOPs and FTP-Panels. Lawyers are hindered to speak up and transcripts are "edited".

    It does not help having been set "free" by the first panel. They simply go on and on. For years. That is how they make their living.

    Mr. Dickson is wrong to assume that only "vulnerable doctors" would be at risk and need special attention during the "investigation". This is not a problem of "choosing the right wording" in order not to frighten these vulnerable colleagues. The point simply is to obey to the law, to their own policies and guidelines and display some sort of decency and honesty occasionally. I guess that the GMC is the most inefficient and also the most verocious corporation east of the Ural.

    Mr. Dickson really gets it very wrong to suggest that it would be "vulnerable doctors" who are at risk.

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  • Turkeys paying for christmas-doctors paying for GMC crucifixtions.

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  • The problem is the GMC presides over a toxic mix of fear and blame for which it is in part culpable. It is in desperate need of reform to something less destructive where lessons can truly be learned without fear of reprise and we are encouraged to develop a safer more constructive culture.

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  • The solution is dissolution

    The Corporate Manslaughter and Corporate Homicide Act 2007.

    An organisation found guilty of such an offence receives the 'death penalty'. An eye for an eye...

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  • 6.06 Quite right. When I graduated, I could never quite work out why we were paying so much money for the privilege of being able to get struck off! The idea that we are self-regulated is clearly nonsense when you look at the composition of the GMC a political creation which is used to beat the rank and file into submission. The government are taking doctors for a ride on this one. If they want a punitive regulatory system it should be paid for by the beneficiaries of that system, i.e. the taxpayer not the poor sods at the sharp end of it. The best option would be to refuse to pay the subs en-mass. If you want to put a fire you starve it of oxygen...

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  • See my letter

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  • I agree with Dr.Surapaneni's observation that the victims are mostly of foreign origin ethnic minority doctors.

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  • The GMC had done a lot of unlawful acts, deceptions, fraudulent acts and the evidences are in the transcripts of the proceedings. Normally, a decent organisation would be willing to reinvestigate that. But the GMC would not. The reason many doctors committed suicide under the GMC investigations - is because they knew they will never be able to come out unscathed - once the GMC took on case against them - however flimsy the ground may be. A doctor may be reported to the GMC for demanding for remuneration for extra work, or for contractual reasons from his employer who may then report to the GMC making false allegation. In my case, the GMC actively pursued a false complaint in spite of knowing that there was supportive evidence in the case notes. So, it denied me those notes by stating lies that those could not be found. This is only a tip of the ice berg of the GMC's deceptive acts.
    Similar experiences had been reported by other doctors in the D4J web site.

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  • 5.32 - I am so sorry. I can't imagine what you have been through. I am not currently in any proceedings but I am suffering from having raised a concern and currently cannot work due to various procedural issues. I keep thinking this hell will end if I give up medicine but I don't know if it would just haunt me with regret.

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  • I note all the buzz words and phrases in the article.
    facts are- this happened. GPs tragically ended their lives due to or in past due to GMC contact

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  • Sudheer Surapaneni

    Thanks Stephen Mcminn for not using the anonymous identity. Most doctors have extremefear about putting their name in even acknowledging the establishment abuses. It shows the level of bullying and harassment prevalent in our profession. The petition got only 1197 signatures in over two months because of the same reasons. We are divided, apathetic, terrified and most importantly suspicious.

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  • Agreed with above - it happened.
    I hope that there will indeed be an open and transparent review with ALL findings made available to the medical fraternity. I also would expect that in keeping with present activity people and committees who were involved will be named, if serious enough then suspension of thei role should be standard until the investigation ahs been carried out completely . It would be unlikley that such investigation would find them entirely correct in any actions /communcations taken and this would result in them being tarnished no matter how innocent.
    Common sense is required and the GMC needs to be made answerable - crerdible organiosations who could do this would be 1) a group of politicians 2) The Daily Mail.

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  • Having been and still going through the GMC process I can only state it is to be categoricary avoided at all costs. Hence the anonymous post due to the way the process is currently viewed as a whole by the profession Having faced them for mental health issues they decided initially with psychiatry advice I was OK so then they moved on to fitness to practice a sort of "double jepardy" type issue I felt. So far the process has been running for > 2 years and when at work I almost permanently have one eye on the "consience monkey" on my shoulder. If there are benefit sfrom the process I'm a happier person because I've confronted "burn out," wiser to the inner workings of the system and above all extremely fortunate to have an extensive private/personal support network. I did offer my inner thoughts to be printed but it was declined.

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  • The GMC has started running but it can't hide any more.
    Corporate Manslaughter is a serious offence.
    A Private Prosecution will give the Beast a taste of it's own medicine.
    This has been coming for some time:
    The wheel of Justice may turn slow... but turn it does!
    Woe to the perpetrators in it's path!
    What are the odds on whose head is going to fall first?

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  • When huge amounts of money are at stake, like £90 million per year collected by compulsion from doctors, the GMC will use all the devices it can to show the public and the doctors by using media effectively. Daily mail headlines,Channel4 documentaries create as much fear and loathing among the public of the 'alien' / 'dangerous' /'pervert' doctor who need GMC to weed out. We have the criminal courts for to deal with them. Atleast they get proper legal defence there. At GMC hearings half of the doctors do not have representation.legal aid does not cover. no legal funds or charities do the work. Legal fees amount to 60k to 100k for a four week FTP hearing. Remember, the FTP hearing happens after so many Interim hearings, where 'wild ' or 'vague' allegations are used to suspend your registration without making a finding. Each IOP legal cost will be 2.5k . This in top of your loss of employment, career destruction, loss of public standing, Tabloid demonization, peers turning against you and all the rest. Is this what the public really like to do to doctors? NO. GMC and the media want us to believe this is all nec essary for 'patient safety' What about managers and medical managers who are involved in all sorts of scandals ? Well they are immune.

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  • I am staggered that as many as 96 doctors have died whilst waiting for fitness to practice hearings.This is a real tragedy in the true sense.If the GMC is responsible ,in any way, for even one of these deaths then they should be held to account.Can you imagine the media uproar if doctors ,by their actions,we're responsible for so many deaths?
    Doctors ,when they are Ill ,deserve to be treated as patients in exactly the same way as anyone else.
    This is a story which would have major coverage in the media if it involved any other group in society.

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  • Public believe the media-fed details about GMC's role and it's necessity. The GMC utilises doctors money to prosecute doctors in the above manner. Our leaders refuse to take any action.

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  • From my personal experience, I do not believe the "GMC launches internal review" is true. The GMC would hush up the truths. There is no reason not to investigate the GMC as per " e petitions direct.gov.uk/petitions/54034. I urge all to please sign.

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  • The problem is that for anyone unfortunate enough to find themselves targeted by the GMC it's a real David vs Goliath fight. They are too well resourced and have too much influence for there to be any scope for justice or proper scrutiny as more often than not it is one persons word against another. When you think of how many slightly odd people who come through your rooms, the odds of a malicious allegation against you are disturbingly high and yet there is a worrying lack of due process in what is after all a quasi judicial process that goes on behind closed doors in the name of 'patient safety'. The GMC have blood on their hands now and have created a monster which is not going away any time soon.

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  • The painful irony is that we already have law courts and well established legal principles which could easily deal with most of the GMCs work. Why we need an enormous institution to sacrifice doctors on the alter of patient safety is anybodies guess.

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  • 96 deaths in 10 years!! That is 96 too many. If these doctors were curmudgeons swindling the system, they would scarper or resign rather than snuff themselves out. If they had mental health issues or financial issues that pushed them over the edge they needed help and not persecution. The coleagues who bring shame on the profession by real crimes get away sometimes, or do not end their lives, and throw their families into turmoil forever, by stepping into that dark, lonely night on their own. We should hand our heads in shame that it has come to this. We would be the laughi8ng stock of the world and the general public, if they knew that we pay 90 million in subs every year to an organisation, that instead of ensuring all doctors are good , persecutes many this way.

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