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GPs go forth

Too many doctors are investigated by the GMC, claims review lead

EXCLUSIVE The expert leading the GMC’s new review has questioned the number of fitness to practise investigations conducted by the regulator each year, saying there are ‘too many’ for the number of doctors in the UK.

Citing figures that show  82% of GMC investigations lead to no sanctions, Professor Louis Appleby told Pulse that there was room for a more ’consensual’ process to assess the validity of complaints against the medical profession.

The exclusive interview gives the first indication of the direction of Professor Appleby’s review into the FTP process this year.

Following mounting criticism of the stress the GMC puts on doctors - and following a review last year that found 28 doctors had died while under investigation - Professor Louis Appleby said that the 2,500 doctors having to go through the fitness-to-practise (FTP) process was ‘a lot’ and that he would be questioning this in his work this year.

Pulse revealed last month that renowned mental health expert Professor Appleby has been appointed by the GMC to review its FTP procedures to ensure that it is more ‘compassionate and sensitive’ to the needs of vulnerable doctors.

The GMC said that Professor Appleby had been recruited to look at ‘every stage’ of the regulator’s FTP investigation process and he would also suggest legal changes that could be made to reduce the pressure on doctors.

A review last year concluded 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. But the GMC insists it is required by law to investigate.

Professor Appleby echoed this in his interview with Pulse, saying that some investigations might not be ‘necessary because every investigation carries a degree of stress for the person that is being investigated’. 

He said: ’I haven’t identified a number of investigations that shouldn’t have taken place – I am looking at the pure numbers. Of the 2,500 investigations concluded in 2014… 82% don’t lead to a sanction. That to me sounds like people are going through investigations increasing their risk and distress with no outcome imposed on them.

’It makes me think that there are too many and that a consensual process and outcome should be the aim for as many processes as possible.’ 

Professor Appleby went on to question whether the inevitable stress a GMC investigation poses on a doctor is necessary. 

He added: ’It is bound to be stressful for doctors to face investigation but there are about 2,500 investigations every year and that seems to me to be a lot given that there are 150,000 doctors in the country. So one question is bound to be whether all those investigations are necessary because every investigation carries a degree of stress for the person that is being investigated.’ 

Niall Dickson, chief executive of the GMC, said: ‘We agree with Professor Appleby. That is why we introduced meetings with doctors after a successful pilot to increase consensual disposal – and an independent review showed this is a much better process. It is also why we have been calling for legislative reform to take consensual disposal much further and it is why we have consistently said the process we currently have to follow is too legalistic and confrontational. 

‘What is more, within the current law, that is why we have been so keen to reduce our investigation times and the number of cases referred for a hearing. In a recent pilot we resolved 70% of cases in a much faster time by making preliminary enquiries which avoided a full investigation. Speeding up cases and making the process less stressful for doctors continues to be a top priority. 

‘We will work with Louis Appleby to look at anything further we can do to support doctors who are vulnerable and with him we plan to develop a set of proposals to be shared for discussion in April.’

Professor Appleby said that he hopes to conclude his review by April and pass the results to the GMC.

Are too many doctors being investigated?

GMC nameplate square

GMC nameplate square

The number of doctors undergoing FTP investigation has risen significantly, by 54% since 2010. But over 80% of cases result in no action being taken against the doctor – leading to calls for the system to be reformed.

A recent Pulse investigation revealed that just one only one anonymous GMC complaint has led to a sanction imposed on a doctor in the past two years.  

The BMA called for a review of the complaints system, with chair of council Dr Mark Porter telling Pulse: ’It is clear from these figures that anonymous complaints seem to be given undue weight in the complaints process.’

See more: GMC: A more ‘compassionate’ regulator?


Readers' comments (28)

  • We are only allowed to refer if the lump is larger than 5cm (earlier if rapid growth).I wonder if the effect of such policies were taken into account.

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  • And if my experience is anything to go by, for following "duty of candour", "freedom to speak up" and putting patients first, I was threatened several times, in letters from my former employers, NHS Forth Valley, of not abiding with GMC guidance.

    The point I am making is that as medical professionals we have come to live in fear of the GMC. I would say this is neither gooid for our health or for patient safety.

    Dr Peter J Gordon
    Who was the only psychiatrist in NHS Scotland to advocate for a timely approach to the diagnosis of dementia

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  • At last!

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  • He doesn't go far enough. When you have so many deaths and when so many of these 'investigations' go nowhere, there surely has to be grounds for a criminal investigation?

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  • Vinci Ho

    Thank you , Professor.
    Based on this opinion , please answer my question about how a whistle-blower ,serving the duty of candour , can be protected from the risk of counter-allegation or counter-complaint leading to a FTP proceeding , effectively killing his/her voice . Obviously , the worst scenario could be the whistle-blower committed suicide.....
    If the whistle-blower decided to remain anonymous , the investigation , ironically,would be unlikely to lead to sanction according to this extraordinary statistics.
    Then , on the other hand, where are the features of these investigations to ascertain presumption of innocence in line of the spirit of Common Law? Of course , one can argue GMC is nothing near to law enforcement or judicial system. Then again, how can it declare the first duty to 'protect the public'?

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  • The GMC is used by the government, and others, as a weapon of intimidation and control. Some up high want to control our profession as they know what we can do if and when we unite. Time to show them our strength. Oh, I think its happening as we speak.

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  • If the duty of the GMC is to protect the public, then it needs to be funded centrally - and not by the medical profession.

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  • among all the terrible things happening, excessive workloads, constant criticism, imposed Contracts, Pay and pension cuts, 24/7 working, the most frightening by far is the GMC. Your career can disappear over a mistake made by pressure of work, lack of sleep and genuine error [ we are human, but we are not allowed to be] or not even made but a spurious complaint.
    I would advise any young person with the brains to be a doctor, please do something else. This game of litigation, medical defence and GMC is now very very dangerous. Go do computers, you will be wanted and paid and have family time and wonder of wonders = NO GMC

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  • In the 15th century Torquemada softened the procedures of the Spanish by moderating the use of torture, limiting its use to suspects denounced by two or more "persons of good nature." In the 21st century a doctor can be put to the sword by the GMC on the word of one anonymous complainant. Many would prefer the brutal but swift dispatch of the thumbscrews, castration and iron maiden to the modern day equivalents of humiliation, vilification and emasculation over a 2 year inquisition

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