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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)

  • I am currently the subject of a GMC investigation, following an unsubstantiated allegation that I assaulted a patient. The police case has been dropped, but sparked other separate investigations by the local safeguarding team (also dropped), NHS England and the GMC. I have been told that the CQC have also been notified prior to our practice inspection.

    The entire process has been more stressful than I can describe, and the main reason is that - by all agencies - you are treated as guilty until proved innocent. You have no rights: not even the right to know the allegation that has been made against you, or who made it. 'Support' offered by NHS England has consisted of an Occupational Health Review to check that I do not have a mental illness, and investigations into my referral rates, prescribing habits, past appraisals and complaints. The recommendation that I should receive supportive counselling has been ignored.

    The BMA counselling service for doctors offered me 6 20 minute telephone consultations, but there was a 6 week wait.

    As far as the GMC have been concerned, the dreaded letter that fell on my doormat was politely but firmly worded. It informed me that a formal investigation would take place which would take six months to carry out. There are still five months to go. During that time, I have been offered no support and will be given no indication as to how the investigation is proceeding or when it will be concluded.

    In the meantime, the patient I am supposed to have assaulted is still on my list.

    My defence union has advised me that no action should be taken - not even discussing the situation with NHS England - until the NHS England investigation (end of January) and the GMC investigation (end of May) are concluded. In the meantime, I am supposed to be a good boy and sit down and behave myself. Even though I have done nothing wrong. I repeat, you are made to feel guilty until proved innocent: even posting this comment would be, strictly speaking, against legal advice as it could be 'misinterpreted as trying influence investigations into previous concerns'.

    I can only sympathise with anyone is subject to an investigation for a more serious allegation, such as sexual assault. Why can't those who are suspected of a serious crime or subject to a GMC investigation be accorded the same rights as any other member of the community? Innocent until proved guilty, constantly updated about progress of the investigation and offered supportive counselling as standard? That doesn't mean that those who are guilty of an offence or those who need to be reprimanded by the GMC should not be so, but to treat someone as if they are guilty before the evidence is gathered, and for it to take so long, is simply wrong.

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  • @1.48
    You have my heart felt sympathy.
    It would be interesting to compare and contrast your treatment with that of a patient who actually assaulted you.

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  • Una Coales. Retired NHS GP.

    @1:48 pm my heart goes out to you. Try efficacy, PHP, and a referral from your GP to local counselling services. Another source of support would be joining a private GP facebook group.

    There is an ED doctor in similar shoes who has been waiting months now for the outcome of an inital investigation after a GMC referral from a medical student he has never even met, who objected to a social media comment. He asked the GMC for an update and was told the hospital has responded and the information provided should not be considered as 'adverse information.' Wow, what terminology! Sounded like the GMC was actively looking for adverse info?

    It astonishes me that even a difference of opinion is deemed by some as worthy of a GMC referral! At this rate, there will be no doctors left. The in fighting and witch hunts will just take over.

    @1:39 a GP who gave up fighting the GMC after a 5 year investigation changed careers and is now a fitness trainer. Another GP plans to run a care home. Another changed professions and went in professional baking. Another doctor changed paths and studied law. Another became a property developer. Another became a ebay powerseller. Another started up a locum agency. The list is endless.

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  • Anon 1.48 It's ridiculous to be told you need to keep someone on your list..... if trust between you has irretrievably broken down alternate arrangements must be made Surely that person does not want to be on the list either.....what's going on!

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  • You are essentially GUILTY until proven innocent according to the GMC . Any patient can make a vexatious complaint against you , its simple through the GMC website . They actively encourage the public to 'COMPLAIN ABOUT A DOCTOR' on their main page. It seems as though once a doctor is subjected to an in investigation by this body you will be pursued with vicious and aggressive purpose until you are emotionally destroyed

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  • Una Coales. Retired NHS GP.

    As another Christmas approaches next week, may we remember our fallen comrades, our lost souls who needed help and support but many were forced to work 12-16 hour days and some 7 days a week, worked to death! People GPland is a JOB. It is not worth dying for a JOB!

    Nov 2013 38 yo GP Liz Pope overdosed on 22x fleicanamide dose in bath after car accident. Worked 12-16 hour days.

    October 2013 suicide fraud allegation 53 yo GP Dr Allim. NHSE were investigating her along with police. She stated in her suicide note she could not face enduring years of an enquiry.

    Feb 2013 suicide depression 53 yo GP Martin Bell

    Sept 2012 age 51 GP John King suicide

    June 2012 age 26 GP Elizabeth Foubister hanged. Thought text message was break up. Stressed from work.

    Feb 2012 GP Festus Ojagbemi aged 49 hanged. Feared double life exposure.

    Feb 2012 53 yo GP David John Weddell overdose at Hilton Hotel. Overworked. Worked 7 days a week.

    Dec 2006 47 yo locum GP David Scarfe faced a large tax bill and divorce, asphyxiated with plastic bag

    May 2006 46 yo GP Mark Gradwell jumped in front of train. Being investigated by PCT.

    Jan 2005 45 yo ICU dr slit throat Andrew Scott burned out

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  • Need to be careful about describing means of death even if this is in public domain already....some will be feeling fragile

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  • What I find to be particularly sinister, is the absence of coverage in the national media about this report. I don't believe that if 28 suicides ,and a total of 114 deaths, had occurred whilst people were being investigated in any other walk of life, there would not be an outcry in the press. It is hard not to conclude ,therefore, that doctors are regarded by many in authority, to be second class citizens.
    All doctors should be fully supported whilst under investigation, and should be presumed innocent until proved guilty, because that is the law of the land.
    Doctors who have been found innocent should be entitled to compensation, in particular , if the original complaint was vexatious, or there were no reasonable grounds to have concern about their clinical performance. Those who make these accusations should be held accountable, and that includes the GMC.
    It is simply not acceptable to stand by the defence of "concern about patient safety" in itself. There have actually to be reasonable concerns about patient safety!
    After 38 years of practice I speak as one whose only contact with the GMC is to pay them increasing amounts of money each year.

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  • Took Early Retirement

    Peter, you are spot on. Remember Deepcut Barracks? 3 "suicides" there and it still rumbles on. 28 doctors- no one gives a poo.

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  • Dr Maksimczyk, this actually wouldn't make life easier on those who are investigated. Although it might force some more caution in putting a few less doctors under investigation, it would force force the MPTS to find something wrong even if subtle, such as 'poor record keeping' or 'making improper comments on Facebook' etc.

    Besides, the argument here is not for any compensation, but is for more basic human rights. To be treated fairly and supportively, not insulting and punitive.

    I personally feel insulted when a panel implies I am lying while I have volunteered all the information, and have clearly shown how I have insight into my mistakes/misjudgements, but still prefer a patient's word against mine.

    But what is more is the advice from the MPS barrister who tells me to keep quiet and accept the verdict as this would be taken as my lack of insight. Basically, one needs to accept whatever is said in the FTP and should challenge anything because this would count against them. What is even more breath taking is the fact that the GMC barrister, who somehow knows I am not happy with the decision, keeps pushing me to speak out what I feel.

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