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At the heart of general practice since 1960

The GMC is making sick doctors worse. There has to be a better way

Professor Clare Gerada explains why current regulation processes should be updated

The recent Bourne report reinforces what I know from my clinical experience as medical director of the NHS Practitioner Health Programme (PHP); doctors who are undergoing investigation by the GMC are significantly more likely to suffer anxiety, depression and have thoughts of self-harm.

The report identifies increased defensive practices among those being investigated, which ironically doesn’t improve patients’ health or protect them from being complained about - in fact it probably increases the risk. Indeed, doctors who are able to continue working tell me they order more blood tests, make extra referrals and issue additional prescriptions as they enter this state of hyper-vigilance.

I run the Practitioner Health Programme in London, which is a confidential, NHS treatment service for doctors, dentists who are unable to access confidential care through mainstream NHS routes due to the nature of their role and/or health condition. We see many doctors who have been referred to the GMC for mental health problems, minor transgressions or even by a disgruntled or jealous colleague.

The current regulatory process assumes a doctor is guilty until proven otherwise. Additionally, there is no distinction made between ill doctors and those being referred for issues of conduct. It can take years for the process to be completed and in this time many become traumatised and often unable to work. The process takes a huge toll professionally, psychologically and sometimes financially - if doctors weren’t ill at the beginning of the process they can often become ill during the investigations.

Doctors live in terror of receiving a legalistic and accusatory-sounding letter from the GMC, so I welcome the new measures to soften the tone of letters sent to GPs under investigation. Doctors are unclear about what to expect from the process - how long will it take, what the likely outcomes are, whether or not it will affect their career. All doctors should be assumed at risk of self-harm when they receive a GMC letter - and it’s important that correspondence between them and the GMC (especially in the early days) reflects this.

There needs to be a distinction between those who do the investigating and those who decide upon the outcome

The GMC has now publicly acknowledged that there needs to be a distinction between those who do the investigating and those who decide upon the outcome. The Medical Practitioners Tribunal Service (MPTS), the panel that now makes decisions on the FTP cases, is to become a statutory committee of the GMC in order to enhance this separation.

But I am not sure whether this goes far enough - how can you be completely independent from an organisation that funds you and to whom your chair is accountable?

The GMC can appeal MPTS decisions - so far so democratic - but it’s not clear who will fund this. It’s also important to consider the impact the delays created by the new system will have on the doctor under investigation.

The GMC should start a review of practices and procedures that includes:

- a review of the time taken and the inherent delays in the process

- the separation of administrative and clinical incidents

- the separation of issues of conduct and ill health

- the training and competence of case assessors

- the development of a better balance between remediation.

I also asked the GMC to publish a clear explanation of which types of procedures are applied to each type of complaint and called for it to audit the impact of investigations on individual doctors and include how sanctions affect a doctor’s career.

Around one in 28 of us every year can expect to be referred to the GMC - this is equivalent to at least one a week in a large NHS Trust. We all know of a colleague, if not ourselves, who has been referred to the GMC so either firsthand or secondhand we all know it’s not going to be a good experience. Doctors feel that speaking out about the delays, uncertainty, inconsistency and stress caused by the investigation will have some sort of adverse comeback. The frustration described by doctors is often echoed by patients who raise concerns about how they feel about the process, which demonstrates that this is not productive for doctors or patients.

No one is arguing against regulation but we need a system that is fair, consistent, transparent and not unnecessarily long. Only a system that is sensitive and supportive can improve the health of doctors and their patients.

Professor Clare Gerada is the medical director of the NHS Practitioner Health Programme (PHP) and former chair of the RCGP.

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Readers' comments (38)

  • Well said Clare!

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  • The admin staff at GMC have simply no training. Whenever I receive an envelop from GMC, my heart stops beating, it turns out to be reminder of fees.
    Do doctors have any protection from abusive patients who walk into the doctor's room already set up for an unrealistic demand? The poor doctor will be implementing all consultation modules from GP training. It is time RCGP reviewed the old traditional teaching and consultation modules and GMC to quickly triage vindictive complaints against doctors.

    Doctors by all means will go for defensive practice. We do a lot to shorten patient's journey for any disease and diagnosis. But I can also very politely tell a patient that I will refer to a specialist and my job is done.

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  • More doctors will have to die for GMC to change.

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  • Sadly no one cares. Doctors will not stand together as they are divided by a natural division. Some have political aspirations and the others, they just want it all to go away and let them do what they want to do and are trained to do, heal.

    The GMC need to understand that the format of their letters needs to be seriously addressed. Even the good messages are covered in a cloud of gloom…"There was no evidence against you but, should there have been it would have been a most serious breach of our Good Medical Practice" When it might have said…."We are delighted to advise you that there was no evidence against you. We wish you a long and happy career in General Practice"

    I rest my case!

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  • The GMC will never change. Still awaiting a reply form a vexatious complaint by the relative of a patient (not even the patient who would never have complained!) and getting no where. All around me surprised this was not thrown out as petty and unreasonable. Practice defensively, write water tight notes, be risk averse and you will be fine. Refer more, prescribe more and look after number one, no one else cares if things go wrong, especially the GMC. They only care about the patients so we have to look after ourselves and hopefully each other....though more and more I see little of that happening. Emigrations is the best option. We are valued and looked after in the rest of world, just not in the UK.

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  • How can a person be in charge of policing Doctors with out any experience of having been a Doctor? How can anyone understand the problems with no experience?

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  • One in 28 referred each year. That says all you need to know about the present sad state of medicine in the UK!

    Well done Claire for taking this on, but you are right to say the present review does not go far enough. The reason that GMC processes are such a 'dogs' dinner' is because, like the rest of the NHS, they are grossly under-resourced, whilst the legal industry are exploiting the situation to their advantage.

    We need the following:

    1)Serious cases to be handled by the courts alone - you don't need another quango to stop criminals practising medicine.
    2)An end to double (or multiple) jeopardy where complaints are handed from one regulator to another until the desired outcome is achieved.
    3) Financial protection for doctors whole lives are ruined by vexatious complaints.
    4) An public enquiry into human rights abuses committed by the GMC.
    5) A time limit for making complaints and consequences for people who make complaints that are proven to be malicious.
    6) Targets to ensure all cases are resolved within 18 weeks.
    7) Assumption of 'no-blame' when things go wrong because of time and resource pressures. Liability for negligence should fall to the NHS alone unless a crime has been committed.
    8) Doctors should be immune from manslaughter charges through errors of omission.
    8) Acceptance that medical technology is still crude and imperfect. No test or procedure is free from error or potential harms.
    9) Guaranteed emotional and financial support for doctors who become ill through work - a bit like the military covenant.
    10) Local resolution and re-mediation for the majority of complaints. Expert teams to be set up to perform this work.

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  • 'Around one in 28 of us every year can expect to be referred to the GMC'

    those are not good odds. i hope those thinking of becoming doctors appreciate the risk - it just isn't worth it. there are other careers which pay more, are less risky, and you get to see your family.

    also as we have to work to 70 i.e. career of 46 years. you can expect to be referred to the GMC at some point !

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  • in effect within your medical career expect to be referred to the GMC. you could be referred maliciously or because you have upset your employer and your career will be over. It's basically Russian roulette.

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  • One in 28 per year chance of having your life ruined = 3.6%. We warfarinize people on lower odds!

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