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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)

  • Una, I think we all feel your pain and the above seems to explain a great deal of your anger. Sadly any system can be used by people as a means to their own ends or for political gain, or to get rid of people they don't like. It can also be misinterpreted by people who feel that they have a right to determine how other people behave ( sometimes with the best of intentions). When emotions run high, calm analysis can be lacking. It is a credit to the system that, as far as I know, these complaints were not in the public domain.
    The current system is unacceptably harsh on both genuine whistleblowers and doctors under investigation and we are all being sacrificed " for the good of the public".

    It raised two points though.
    First, having so publicly accused Maureen Baker, she must have a public opportunity to reply. Not to do so might be interpreted as an acceptance that what you say is true. ( expect moderation by Pulse!)
    Second, the fact that so many complaints did not get past triage and that the two that did were dismissed actually suggests that The GMC are ( far too slowly) doing a good job.

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  • Una Coales. Retired NHS GP.

    @7:07 am thank you for reading. I wrote so that doctors out there who are currently under GMC investigation and have also been denied medicolegal support from their defence organisation, may understand the process and know they are not alone in this.

    [Comment moderated]

    Anyway, it is water under the bridge. I have resigned membership of the RCGP. Instead of supporting IMGs, I feel they have only made their professional lives harder. Without IMGs, the NHS will fail. Without the NHS, doctors may go private and join the Independent doctors federation which I chaired the GP section for a year and found them to be more supportive of GPs of all ethnicities.

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  • Una Coales. Retired NHS GP.

    For GPs out there doing both NHS and private, I would highly recommend you join the £250 a year Independent doctors federation. During my one year as GP chair, I set up free basic life support courses, (now they have added free child protection courses), black tie Christmas dinner for GPs and spouses, and we had revolving dinner tables with consultants, free educational lectures and last on the list to set up was a subsidised weekend retreat for R&R destressing which I never got around to completing. The IDF now has an appraisor specifically for portfolio GPs who have done unconventional routes, ie military, occu health, etc. so even they can pass revalidation without multiple appraisals with different orgs. They lobby on behalf of consultants and GPs and have even taken on insurance companies and engaged the competition commissioner. The camaraderie between consultants and GPs in this org is amazing to see. And one ex St Thomas' hospital consultant reached out and offered to help a NHS GP transition into PP as he had done! This is how it should be. Colleagues supporting each other and not using the GMC as a weapon.

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  • Una Coales. Retired NHS GP.

    PS when I was GP chair of the IDF, their accounts showed a healthy balance of £100k and no multimillion pound debts to repay...In my opinion, this makes a difference in priorities. IDF puts doctor members first.

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  • I thank you Una, I think your comments have been very enlightening.

    It also shows the type of 'characters' we have who sit on these various panels. To somehow see this as an example of the GMC at work is nonsensical, especially in the second case where the MPS refused to act. It was a political decision by the MPS which should be known more widely.

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  • Took Early Retirement

    Most importantly: where can one read the report? I'd like to before deciding whether to report the GMC to the Police for corporate manslaughter. Prima facie: from the list of things they say they will now do, there seems a good case for it.

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  • Here is the report: http://bit.ly/13jz0AV

  • Took Early Retirement

    2 further things:

    1. Why the delay? This report was due out in Sept. You have heard of "burying bad news"? Consider me paranoid if you wish, but it is a well-known trick (in some areas) to publish this sort of thing as close to Christmas as possible.

    2. If only half of Una's allegations are true, it is still a terrible indictment of the system we have. As it happens, I'm much inclined to believe Una over the RCGP and GMC.

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  • This comment has been removed by the moderator.

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  • With all due respect to Dr Coles, this isn't about you. It is a damning report which shows how 28 of our colleagues WHO WERE ILL took the desperate decision to end their lives in the most devastating way possible. Doctors with alcohol/ drug / mental illness must be dealt with by a separate GMC route with a view to pastoral care rather than punishment. There but for the grace of God go any of us.

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  • @ 8.36
    I respectfully disagree..... It is about all those doctors who, under GMC investigation, have felt so desperate that they have considered ending their lives.
    Those who committed suicide cannot speak for themselves. Una survived and I applaud her for speaking out, perhaps in behalf of some of those who did not.
    It would be interesting to know how many if these doctors had mental health/drug/alcohol problems before the GMC investigation and in how many the investigation induced it?
    There is a parallel with whistleblowing here. The stress of the situation caused mental health difficulties and the person concerned is therefore dismissed as being unwell. Which comes first?

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  • Why hasn't this investigation been referred to the police?

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  • Una Coales. Retired NHS GP.

    I commend Margaret McCartney for challenging systems. http://www.bmj.com/content/349/bmj.g5959

    Yes, the dead cannot speak up but survivors can.

    Perhaps before choosing a medical indemnity org, a good question would be to ask what % of doctors who pay your fees, do you use your discretion to refuse to provide medicolegal support? Do you refuse more BME/IMGs?

    I think the stresses became much worse the second time around, BECAUSE I did not have medicolegal support even though I was STILL paying the medical protection society, my medicolegal defence org. They did a brilliant job the first time around but deserted me the second time around and STILL took my money! Their argument was it was not a patient complaint. So be forewarned, any GMC referral from a colleague or institution may be deemed as discretionary to refuse legal assistance.

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  • Secure environments GP

    I wish to read the full report.

    Enlightening comments so far. Very sad situation for many doctors. Let’s support them all better in future. A radical re-think and change of processes is essential now. The pendulum has swung too far the other way for too long.

    Remember a lot don't take their own lives. But their personal and family lives are destroyed. Financial hardship. Can you imagine the trauma to a family (with kids), with a doctor as the main breadwinner losing their house whilst under investigation? Then they may actually be cleared. I think we should all try understand matters better rather the fear the unknown. I cannot fully appreciate how this may feel. I suspect local resolution of issues is by far the best way.

    Locum doctors and GP partners in particular are put on a roller-coaster of what must feel like total annihilation. We should be hearing the narrative stories of more doctors who've lived to tell the tale.

    Defence organisation should defend their fee-paying doctors at least to the full total of their contribution over the years. Ie £6K x years paid to that defence organisation. No discretion for this please. Even criminals get legal defence and a fair trial, compensation if due.

    As I’ve said many time before, failing to attend to the needs of one group of patients (doctors) does nothing to benefit the wider population. Doctors living in fear doesn’t help either. Time for change.

    Can doctors please be brave enough to name themselves when making comments, why anonymous?, have the courage of your convictions and uphold your right to (carefully constructed) free speech...

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  • Here is the full report: http://bit.ly/13jz0AV

  • I am ( and will remain) anonymous because I am not as brave as Una.
    The personal backlash and bullying that you can be subjected to for speaking out, even when you are proved to be completely correct, is so awful that no sane person would risk it.

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  • Una Coales. Retired NHS GP.

    I agree David. For as long as doctors hide behind anonymity, they may feed into the 'system'. By speaking out and identifying oneself, we end the socialist system of perpetuating fear by 'silence and snuff.'

    A late law professor once told me to go public in 2008 as he feared I may not be the only one referred to the GMC by my own college.

    I would love to hear from others who have been referred to the GMC and why post on Pulse. I only have a collection of anecdotes from IMG colleagues who have been referred for one reason or another, ranging from being in a chain of GPs who missed a cancer diagnosis (delayed) to refusing a pay cut as a salaried GP.

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  • Secure environments GP

    Una is very brave.

    I also meant more like Dr Gerada openly discussing these challenging matters, those who've heard and seen the effects on colleagues (and their families).

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  • Una Coales. Retired NHS GP.

    @9:06 am that in itself may be an indictment of the GMC process. Why should those who have been referred wrongly or those who have become suicidal while under GMC investigation fear repercussions for speaking the truth? When doctor victims are too fearful to speak, how do we change the system?

    Thank you John Glasspool for reading. When innocent doctors are put in a situation where they have no control over the outcome or length of a GMC ix, they may take that frustration and anger out on themselves.

    I commend the GMC for introducing this new system of triaging complaints with no evidence so that malicious complaints may be closed without putting a doctor through hell for several months. It is one way forward.

    Another would be legislature that insists any doctor paying a medical defence org must be offered medicolegal assistance with GMC complaints. There should NOT be a discretionary clause. Hospital doctors are protected by crown indemnity but GPs not.

    And any doctor who contacts the GMC case officer at risk of self harm or mental illness due to the protracted length of inital investigation, should have their case pulled and placed in a priority urgent pile for the case examiner. Chicken or the egg. Many sane doctors become depressed because of the GMC process.

    And at FTP, all doctors should be given a lawyer, even if the GMC has to pay for one themselves!

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  • Oddly, I would identify myself if a complaint had been made against me which had proved to be unfounded.
    The fact is that I was a whistleblower, proved completely correct, but suffered terribly.
    I have phoned the (ex) PCT, GMC and MPS to try to become involved in supporting those in need, both raising concerns about patient safety and suffering complaints, or to develop local policies but have not had any response. I would be happy to work with anyone who wants to move this forward.

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  • I would like to read the report into these suicides.

    Is there a link?

    I agree with a previous comment that "There is a parallel with whistleblowing here. The stress of the situation caused mental health difficulties and the person concerned is therefore dismissed as being unwell. Which comes first?"

    My experience in raising concerns and thus trying to put patients first was very difficult indeed. I am still facing the consequences for raising concerns.

    I understand Scotland is considering an approach involving "Duty of Candour". I do hope all healthcare professionals, if they raise genuine concerns, will not face what I have. It has been tough. My experience has left me fearful.

    However by speaking out I feel that I have made some difference. I would do it again as I feel raising concerns was the right thing to do.

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  • Here is the report: http://bit.ly/13jz0AV

  • Anonymous | GP Partner | 19 December 2014 8:36am

    I think Una's example is exactly what we need to know about.
    this is where real bullying is and the tragedy of the suicides can get lost without real examples

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