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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)

  • Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me; your rod and your staff, they comfort me.

    The world is a cruel and nasty place and no matter how strong we are no matter how brave it will beat us down and keep us there unless we have something deep inside that pulls us out ,keeps us going and each of us have to find our own strength , our own rope our own will never stay down never give up

    Success has been defined and will continue to be defined as that person willing to get up one more time

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  • Una Coales. Retired NHS GP.

    Emotional resilience training into the medical curriculum so that junior doctors work a series of night shifts and do not speak up when the EWTD is breached, so that they drive home exhausted and risk car crashes on the motorway after long night shifts, so that they do not blow the whistle when hospitals attempt to cover up patient deaths, so that they put up with months or years under GMC investigation when they did no wrong?

    No, I think the solutions are transparency and accountability of the GMC for the consequences of protracted and inhumane processes that lead to corporate manslaughter; compensation for doctor victims; and the need for victims to speak out without fear of reprisal and snuffing.

    Doctors should not be taught to put up with inhumane working conditions, bullying and gagging when trying to improve patient outcomes and working conditions of colleagues and told to learn 'emotional resilience' when referred to the GMC to face representing themselves, doctors with no law degree in a legal FTP trial against the GMC's own barrister?

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  • Well said Una as always.To all those who may try to nullify your argument I will say what I have said on many times inmy career--'There is no experience like experience'
    Your last post highlights all the problems we face with the current arrangement and the solution is for us to become more resilient and understanding when having our careers wrecked !

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  • I was horrified to learn, during the process of when I was threatened with a vexatious complaint (which thankfully, hasnt materialised.....yet), that doctors emigrating cannot have a Certificate of Good Standing issued while a complaint is pending, so if facign even a 6 month triage investigation (not even a FTP process) I would not be able to take up an overseas post, and my compensation for loss of earnings? Nothing. Would my MDO help me sue the perpetrator if found to be purely vexiatious (and it genuinely was/is)? No. Innocent until proven guiity? Dont make me laugh. This, for a start, needs to change. CGS should be issued to all doctors until they have a sanction against them (Or send them to an IOP and determine risk), and until then, then they should not be penalised. It is barbaric what we have to put up with by this evil organisation. NO other profession would put up with this level of oppression.

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  • Una.what did Margaret report you for? If this was malicious shouldn't it be referred to .GMC?

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  • Thanks Una for bringing this up. I did contact you a few months ago to have a discussion, but I didn’t realise you have been dealing with all this. There are a lot of comments up till here and one can readily read the frustration between the lines. What is more interesting is no comments from the ‘other side’! One of the reasons could be ‘anything you say could be used against you in a court of law’, and that is ‘you have the right, actually not the right, you are bound to be silent!’
    My story is similar in some points and I might write it down further down, but I would like to just comment here, as someone who has been through the FTP process, for right or wrong, and has felt suicidal in many occasions, and still does every now and again, with flashbacks of harsh accusations and unfair judgements; how about those who have been through the process and been badly traumatised and left to rot?!
    There are several layers in Una’s comments and the following discussions. Looking at the matter in an ‘MRCGP exam-type’ manner(!), I could say the problems are at different levels of:
    Personal and professional relationship between colleagues, and between doctors and RCGP, and at a different level with the GMC.
    The next level is the way GMC treats doctors, with a mention of IMGs and the question whether they are treated differently.
    The next one is how we as a ‘non-union’ are dealing or can deal with this.
    Let’s look at the facts and figures: once a doctor is referred to the GMC, regardless of who has done it, the accusations start exponentiation; the poor chap becomes a monster and if all the start was a whistle blow, things turn around with colleagues’ concerns, several patient complaints, fraud investigation and all different sorts of bullying. You will even get emails from colleagues you haven’t even heard of, raising concerns about you. And all this happens, after 20 years of practice with no complaint, in a very short time of a few months. This will be viewed by the GMC as repetitive failure to meet the standards of a registered medical practitioner, although 6 months and 20 years are ‘significantly different’. In a way, it really doesn’t matter who starts the referral, Una, and I take it as the 54% referred by the college is a biased undervaluation of the depth of the calamity.
    The GMCs report on the failure rate of the IMGs in the RCGP exams is one thing, and the view of the sanctions and tribunals is the other. Surprisingly the number of IMGs who have shown ‘enough insight’ into their problems and might be able to rehabilitate back to work is ‘significantly’ lower than the corresponding white British group, as is the number of overall referrals to GMC. And of course, these are all due to ‘cultural differences’ and ‘language problems’, but still not accepted as an excuse in the FTPs.
    How are we dealing with this? Well, I guess nagging and moaning is part of the initial steps towards action; this shows there is a problem and we all recognise it. So the next step would be what to do about it. I for one, am doing nothing about it, as I don’t know what to do, I don’t have time, as I have to look for some cheap work to feed my family and pay my debts, and even if I did have time, I know I won’t be taken seriously unless I commit suicide.
    So, let’s carry on doctor…. And hope you are not one of those 1 in 4. With kindest regards and thanks for speaking up.

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  • Sorry I used to be a GP partner. I am no longer...

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  • Sessional locum 10.34 The majority of complaints have been by medics against medics and the majority of posts here back that up. Legitimate complaints by the public have caused the same distress by the GMC.......they need to be replaced along with the all too useless college...they have known the situation for years but kept quiet

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  • I recently went through a FTP initial investigation through a complaint from a patient. The wording on the initial letter is worrying. Thankfully, I knew I had done nothing wrong and I didn't even have to respond to the GMC before they completed their investigation. However, even that simple initial investigation took 6 months and was over my head during that time. I had to inform my employer who was thankfully very supportive and declare it to my appraiser. The GMC should be investigating doctors who have really serious complains against them - not ones that are clearly vexacious.

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  • i am confused - does the GMC itself not have a duty of care to these doctors (who are also patients). Isn't this the same as a prisoner dying in police custody or in prison? If that was to happen there would be a full investigation. Here we have at least 28 suicides - should the GMC not be fully investigated and appropriate accountability applied?

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