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Independents' Day

GMC to reduce full investigations into 'one-off' clinical incidents

Exclusive The GMC is looking to reduce probes into 'one-off' clinical incidents in a move that it hopes will reduce the number of full fitness-to-practice (FtP) investigations by the hundreds.

The GMC is piloting changes to its FtP process including closing cases early where a clinical incident was a one-off mistake, the doctor has identified and reflected on it, made changes to prevent it happening again, and apologised if necessary.

It hopes these measures, which are being piloted over the next six months, could remove the need for a full investigation in around 230 cases a year, and said early trials already showed it was cutting investigation times by half.

The GMC said the changes were the latest act in its ‘major campaign of reform’ of FtP, and recognised the fact that a faster and fairer system was ‘better for everybody involved’.

Under the pilots, experienced investigators can identify where a case could be closed if one or two pieces of evidence are collected, rather than conducting the entire investigation process, the GMC told Pulse.

An early pilot on around 350 investigations into conduct and behaviour cases, all of which would normally have had a full investigation lasting up to six months, had managed to close 75% of cases early – halving the time on average.

Speaking in an exclusive briefing, GMC chief executive Niall Dickson said: ‘If you as a doctor have done something to me as a patient, it’s a one-off thing, it may be a terrible thing that has disastrous consequences for me. But… If it’s a mistake and there’s nothing reckless or deliberate, and lessons are learnt from it, there shouldn’t be a risk to the profession going forward.’

Later pilots will also include instances where a doctor has been reported for a series of mistakes, but with a single patient. For example a missed diagnosis on three separate appointments, where there may be other issues involved.

GMC will also look at reducing baseless or vexatious complaints, or incidents where a doctor has been referred to the GMC by an organisation or individual that the doctor has previously raised concerns about, by requiring referrals by medical organisations or professionals to sign a formal declaration that they are making it in 'good faith'.

Mr Dickson said: This is part of a major campaign of reform, which we’ve been engaging in for a number of years.

‘We want to make the system quicker, because a slow system is not good for the doctor, it’s not good for the complainant, it’s not good for us – it costs us more money, costs doctors more money.’

‘So a faster system which retains fairness has to be better for everybody involved. That is a really important aspect of this: that justice delayed is justice denied, so finding ways that we can speed the process up is really important.’

The campaign to improve the FtP process follows a GMC review into doctors’ suicides while under investigation, which recommended emotional resistance training, and advice this year by Professor Louis Appleby - England’s National Suicide Prevention Strategy lead - proposing changes to reduce the impact on vulnerable doctors.

GP leaders said last year that the spectre of investigation had led to doctors ‘practising in fear’ of a complaint.

Commenting on the new measures, GPC deputy chair Dr Richard Vautrey said anything that would reduce the time taken for investigations ‘was to be welcomed’.

He said: 'Anything that reduces the time of the investigation process, thereby reducing the stress on the individual concerned, is to be welcomed I think. If they can look at doing that wherever possible, that will benefit both patients and the complainants as well.’

He added that cases of vexatious complaints against whistleblowers were unusual in general practice, but said it was 'certainly possible' where a GP had raised concerns about a partnership or, even CCG, and it was important to have processes in order to look at this.

Is Fitness to Practice fit for purpose?

The new pilots propose a significant structural reform, when previous changes have focussed on GPs’ resilience. The GMC pledged last year to introduce 'resilience training’ similar to that offered to soldiers in Afghanistan in order to be prepared for the 'occupational hazard’ of a GMC investigation.

The GMC accepted proposals in April this year in a bid to make its fitness-to-practise process more ‘sensitive to the needs of vulnerable doctors' following Professor Louis Appleby’s review.

The review, launched in December last year, proposed doctors with mental health or addiction issues should be spared full investigation and ensuring all doctors have access to mental health support - like the BMA’s Doctors-for-Doctors which is backed by the GMC.

And this came after Pulse has published a series of articles about the pressure that GMC procedures put on vulnerable doctors, including a report that found that 28 doctors had died by suicide while under investigation and that 13 additional doctors died while the regulator contemplated action.

Another study showed that complaints against doctors ‘may do more overall harm than good', and a paper this month called for an end to ‘confrontational’ NHS complaints processes – in all investigations.

Readers' comments (7)

  • Who holds this Politburo to account? 41 doctors have died during their investigation process - most of whom more than likely had no case to answer - and the GMC response is to infer that these people were not resilient enough?!

    Over-diagnosis and over-investigation is a real burden on NHS resources and we need the GMC to actually 'do what it says on the tin' and work with doctors rather than against them.

    But I see they have appointed Hunt's poodle Charlie Massey as new sword-bearer in chief..says it all really

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  • What a lot of nonsense. Spin the carrot in front of the profession....
    Basic questions remain unanswered.
    What about reduction of "investigator" bias? Gender bias? Increased transparency? Process of redress? Personal accountability? etc.

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  • Sadly no one holds the regulators to account.The PSA who are to monitor them have no say in things and cannot take any action. Question is are we really in a democracy?? Politicians who wage in illegal wars are made peace envoys...and even very minor complaints against doctors are chased till the doctor just loses the will to carry on!!

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  • Right, that is how you fix it! It is not living up to the high standards we expect you to expect of yourself in fixing the doctors deaths caused by this organisation.

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  • What is GMC going to do about damage already done to many doctors who have already been harmed by the reckless GMC prior to Prof Appleby's recommendations ? The ones who have died cannot complain but what about many doctors punished on flimsy reasons or given disproportionate punishments.

    They should find if any doctors they punished had any pre existing mental health issues.GMC should provide financial assistance, accommodation and food during their trials. While panel members get around £ 4000 per week with free accommodation and lavish meals the doctors who fund them are made to feel like petty criminals during these trials.Even banana republics treat their precious resource ie doctors better than this.

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  • Niall Dickson said: ‘If you as a doctor have done something to me as a patient, it’s a one-off thing, it may be a terrible thing that has disastrous consequences for me. But… If it’s a mistake and there’s nothing reckless or deliberate, and lessons are learnt from it, there shouldn’t be a risk to the profession going forward.’ - beyond pathetic- how come he comes out with this now just as he leaves after his disastrous term as chief executive. Has he no shame at all?

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  • The GMC is well overdue for reform. It is vindictive, obsessed with finding fault with doctors and pursing doctors in the mistaken belief it must be seen to be doing so because Joe Public is baying for blood.

    Look at some of the recent cases where it's "independent" quasi-judicial arm the Medical Practitioners Tribunal Service has been flexing its muscle. They make very sad reading.

    A doctor who had been found guilty of fraud, sentenced and had requested voluntary erasure was still dragged before the Court.

    For what purpose, exactly? DId this exercise in self aggrandizement cost nothing? The result was the same - she was erased but it sent a powerful message (to the GMC's ego) that she was a naughty doc and deserved to be punished again and again and again and then some more.

    In another case a judge had made a ruling about a doctor's behavior but the GMC didn't agree so a case was brought against the doctor who was erased.

    Even after you have been found guilty, sentenced and done your time you are dragged back before the Holy Inquisition. You may have complied will all the stipulations that still isn't good enough.

    The GMC's lawyer is still invited at MPTS hearings to oppose the lifting of sanctions/ restoration to the register etc.

    They might (if you are lucky) "not oppose" or "be neutral".

    God forbid that the doctor who has made a one off mistake, shown remorse and insight, apologized, reflected, tried to amend their practice, kept up to date, worn sackcloth and ashes, self flagellated and done whatever else they were asked to do should then be forgiven and allowed to get on with their life.

    We are desperately short of doctors who are leaving in their droves but hey ho the GMC is there to remind them that we are all guilty, they just haven't proved it yet. But don't worry they are watching and ready to pounce.

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