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GMC: A more ‘compassionate’ regulator?

The GMC is taking new measures to soften its approach to vulnerable doctors, finds Joe Davis

GMC 3x2

GMC 3x2

The GMC is trying to give itself a makeover, in the hope of becoming more ‘compassionate’ and ‘sensitive’.

Pulse has learned that the regulator has appointed an independent expert to ‘pinpoint’ ways in which it can ensure that its fitness-to-practise (FTP) processes offer greater support to vulnerable doctors.

Professor Louis Appleby – professor of psychiatry at the University of Manchester and chair of England’s National Suicide Prevention Strategy Advisory Group – has been recruited by the GMC to look at ‘every stage’ of the FTP investigation process and assess how it could be more caring towards vulnerable doctors.

And the GMC’s chief executive, Niall Dickson, tells Pulse in an exclusive interview that he recognises the regulator has an ‘absolute moral obligation’ to protect doctors as well as patients, conceding that it is time for its FTP procedures to be more ‘sensitive’.

GP leaders have welcomed Professor Appleby’s appointment as a ‘step forward’, saying it reflects a change of approach from the regulator.

The appointment follows what has been an uncomfortable 12 months for the regulator, with a handful of studies suggesting the FTP procedures must be improved.

A GMC-commissioned review at the end of 2014 found 28 doctors had died while under investigation and concluded that doctors could become ‘marginalised’ during the FTP process and receive little support or compassion from the regulator.

Another review published last year said 13 doctors died while the GMC ‘failed to act’ after concerns were first raised about the high numbers of doctors dying by suicide while under investigation.

We want to be as compassionate as we possibly can be with all doctors

GMC chief executive Niall Dickson 

It said the GMC should have ‘immediately ceased’ its fitness-to-practise cases and ‘urgently reformed’ processes after concerns were first raised in 2012.

Another study last year went as far to say that complaints against doctors ‘may do more overall harm than good in terms of patient care’, as the majority of doctors who are reported to the GMC are found to have no significant case to answer.

 

Toxic impact

The shocking study of 8,000 doctors by researchers at Imperial College London highlighted the toxic impact the GMC’s complaints procedure has on the mental health of doctors – with one-sixth saying they had suffered severe or moderate depression following a complaint, and many others reporting anxiety and even suicidal ideation.

Perhaps, though, the most worrying finding from the study was the adverse effect on patient care. Some doctors admitted they changed the way they practise following a complaint, with one in four saying they had suggested invasive procedures against their professional judgment.

Since then, the GMC has formulated an action plan to implement recommendations from its own review, and says it has already changed the tone of its correspondence with doctors who are under investigation.

But it intends to go further. Mr Dickson tells Pulse: ‘We’ve already started mapping our process very carefully and look at each individual stage that we go through. And what we want Professor Appleby to do is to review that process and advise us on further things that we can do within our current legal powers.’

He says that while the GMC’s core duty to protect patients will remain, there is an important role to be played in providing support to doctors who are under investigation.

‘We absolutely want to be as compassionate as we possibly can be with all doctors, not just those who have mental health problems, but all doctors who are in our FTP procedures.’

GP leaders have welcomed the move. Former RCGP chair Professor Clare Gerada, who is medical director of the Practitioner Health Programme – a support service for sick doctors – told Pulse that the announcement of Professor Appleby’s review ‘shows a shift in the last two or three years at the GMC’.

She added: ‘I think it is good news for everybody – because the pendulum of regulation that is anti-doctor is beginning to swing back to a more healthy place, where doctors can be mentally ill – yet trying their best in very difficult times.’

Professor Appleby has already tweeted that he has heard from ‘several doctors’ since Pulse revealed his appointment and that feeling ‘guilty until proven innocent’ was a common theme.

The number of doctors undergoing FTP investigation has risen significantly, by 54% since 2010. But more than half of cases result in no action being taken against the doctor – leading to further calls for the system to be reformed.

New GMC figures show the number of complaints against doctors remains high, with 8,884 in 2014 and 9,093 the previous year.

But the proportion of investigations that lead to no action being taken is increasing, reaching 48% in 2014, compared with 44% in 2013.(3)

Empty complaints

Meanwhile, figures obtained by Pulse from the GMC, reveal that only one anonymous complaint against a doctor has led to a sanction over the past two years.

The figures, which are based on complaints made from 2013 to 2015, show that of 438 anonymous complaints, 97 led to an investigation being launched by the GMC – but only one of these actually led to a sanction being imposed. GP leaders say this raises serious concerns about the weight given to anonymous complaints.

BMA chair Dr Mark Porter told Pulse he was concerned about the implications of the figures.

He said: ‘Doctors strive to deliver the best possible care to patients and it is right that we have a robust system that ensures any problems that do occur are addressed. However, it is clear from these figures that, in the vast majority of cases, doctors are exonerated when complaints are made.

Dr Porter added: ‘Complaints procedures need to be efficient and fair. At present, doctors who are the subject of a GMC investigation can be left in limbo for months, or even years, before an outcome is reached. The stress that this causes to those affected can have life-changing effects.

‘While doctors always want to learn from clinical mistakes, it’s also important that the GMC learns from the way its systems operate. It is clear from these figures that anonymous complaints seem to be given undue weight in the complaints process.’

But Mr Dickson points out that the GMC is often legally obliged to act on every single complaint, even if in many cases no action is subsequently taken by the regulator.

He explains: ‘From the doctor’s point of view, that’s awful, because we’ve subjected [them] to all this anxiety over a period of time. From our point of view, we do it because the law says we have to do it, so what we have to do is try to find every way we can to reduce that amount of time.’

Mr Dickson adds that Professor Appleby will be tasked with recommending any legal changes that the GMC can lobby the Government to bring forward to ‘make the system better’.

The medical profession will be hoping he does a thorough job.

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Readers' comments (29)

  • The GMC-sadly like most Medical institutions has been taken over by political opportunists-the GMC has become the Medical Inquisition burning medical careers for expediency and politics. Forget about any sense of justice .Those on the present GMC would never risk their careers and pleasant lifestyles to fight for fairness for any of their colleagues-hell-they might have to go back and see patients!
    Lets hope the GPC doesn't go the same way!

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  • I have served as Medical Panellist FTP GMC from 2001-2010.I have been under wrong impression that a Whistle Blower had legal protection in UK first world country.I have been assaulted as I was unconscious and Ambulance took me to A&E Department in Hammersmith Hospital London as I had one right Kidney.FTP decided after seeing photographs of my injuries and reading Hospital discharge letter wrtten in english language explaining my multiple injuries,doctors & nurses provided me good medical care.Police was called as my medical conditition required to be reported to Police.
    GMC FTP had poor vision and could not read hospital discharge letter therefore decided that Dr S Qureshi might have sustained injuries and there in no injury neck and abdomen.I provide photographs of injury neck and abdomen to media along with injuries to other parts of my body.This is brief description.I request media and public to protect doctors as they are being discriminated in UK.

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  • I went through a FTP investigation about 5 years ago as the result of an anonymous complaint. It would have been very reassuring to see the above figures at the time. My defense body all along reassured me that it would be "difficult to see how they can take this further". Nonetheless everywhere I had worked during the previous year had to be written to. I had to wait and see if the anonymous person would come forward. Surprisingly I was advised not to help the GMC with the investigation in anyway at all whilst they were rooting around for more information from my workplaces. This seemed strange - at no time was I advised to provide any defense or explanation from the complaint!! Despite no further action being taken the final letter I received still made be feel guilty as it warned me not to do what I had been accused of even though I had not been found guilty! There was no hint of recognition in the letter of the stress that I endured and the appalling delay in reaching a conclusion. I don't feel anonymous complaints should be investigated at all. How can a GP possibly defend him/herself from an allegation of an offence during a consultation when he or she cannot even access the notes of that person or recollect any consultation where the offence could have been deemed to occur. I spend month trying to rack my brain to try and remember a consultation that could have led to the complaint. The only gratification I had from the process was the knowledge that the complainant would not be informed of the outcome - unless of course I was sanctioned.

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  • I hope the NMC are taking note. Some nurses who have reportedly committed suicide have taken their lives while under investigation.

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  • GMC's main aim to find doctor guilty :- in my case I proved the complainant ex staff was a fraudulent person / NHSE said it was disgruntled employees dribble but would GMC accept?
    Mark Porter BMA chair stop shedding crocodile tears. Institution you are chairing is most arrogant non co operative when it comes to helping doctors. I proved that since 1988. Again in 2013. So I stopped wasting my hard earned money on BMA. In 1988 I made BMA Chair to contact me to apologise for its handling of the case.

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  • again nothing is going to change unless the GMC feels threatened itself. there is a habit of institutions closing rank when they are threatened. what the GMC is worried about are reports which suggest they are culpable. if individual families or a group of individuals then take action against named accountable members of the the GMC and are successful then changes will have to occur. in the interim they will close ranks, appear to put in place superficial actions promoting change and hope to ride it through. don't be surprised if there is a change of leadership (revolving door) to defuse things.

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  • I have been under investigation by the GMC now for over 12 months, I am still awaiting conclusion, I was accused of taking patients medication (which I didn't), then they looked even harder to find that I once had ordered a large quantity of diazepam back in 2011, which i was politely told by the pharmacy that they could not supply, then intention was to get enough for my doctors bag, a little naive I know, then the only other thing i did wrong was to admit myself to a psychiatric unit, because I came awfully close to taking my own life, through an investigation by the area team, of which I was completely cleared, but it was referred to the GMC, as I may a risk to my patients, I now have a full investigation going on and an IOP due to the fact I stopped myself.
    I am really getting to the point where it is not worth it anymore, too young to retire, to old to change, now where to turn too? If the GMC keep it up I may be number 14

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  • People working in the GMC are above the law?

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