‘We’re here to protect the public’
The new GMC chair Professor Terence Stephenson explains to Joe Davis how he sees the role of the regulator and why GPs need ‘resilience training’
Professor Terence Stephenson has started as GMC chair at a turbulent time for the regulator.
An independent review recently found 28 doctors had died by suicide while undergoing investigation by the GMC.
Another study of almost 8,000 doctors, published earlier this year, painted a shocking picture of the damaging effect that complaints procedures – including the GMC’s – have on the mental health of doctors.
This report1 found doctors who have had complaints made against them were significantly more likely to suffer anxiety, depression, and thoughts of self-harm, and to practise too defensively and overinvestigate patients.
In his first major press interview since his appointment in January, Professor Stephenson explains to Pulse why he told MPs that GPs needed training like soldiers heading for Afghanistan, and that his number one goal is to establish unequivocally that the GMC is a ‘patient safety organisation’.
GPs tell us they see the GMC as unsupportive and a source of stress. How do you respond?
I’ve been investigated twice by the GMC myself so I recognise it’s very stressful. Investigation by a regulator is inevitably stressful for any professional. The onus on us is to minimise that as much as possible, but we need to keep in mind that our primary duty is to protect the public and that these are quasi-legal processes. We can try to change the tone of them but they will always be stressful.
A recent review recommended a national support service for doctors, after finding 28 had died by suicide while under GMC investigation. How will you implement this?
The BMA has piloted a Doctor Support Service for two years. Anyone being investigated by the GMC could speak to a doctor confidentially for emotional support – and could be accompanied to a hearing. It seems to have been a success and we want now to make that service permanent.
One of the review’s other recommendations, which we also support although it’s not in our gift to provide, is the Practitioner Health Programme [a confidential advisory service for doctors] in London, run by former RCGP chair Professor Clare Gerada.
So you’d advocate a service modelled on the Practitioner Health Programme being rolled out nationwide?
We absolutely support that principle across all four nations in the UK but we don’t provide health services or pay for health services for doctors.
The review also called for a culture of ‘innocent until proven guilty’ after a complaint. How can this be achieved?
The old adage ‘there’s no smoke without fire’ is a bit of a false notion. The nature of British justice is that you´ll know in a court of law you´re either found guilty or not guilty. As an organisation we assume all doctors facing a complaint to be innocent until proven guilty, not the other way round.
Many doctors feel depressed, anxious and even suicidal while under investigation. What is the GMC doing to lessen this effect?
We can improve the tone of our processes. When I was last on GMC Council, I was involved in a review of all our letters to try to make their tone less intimidating. Now we are going to repeat that exercise.
That said, these are legal documents. We have to take advice from lawyers in terms of how far we can go in that respect.
Do you accept that the investigation period needs to be cut to make it less stressful on the doctor?
We certainly need to help doctors by making our processes more streamlined, quicker, and more efficient. We’re governed by the Medical Act 1983 but have just got through an amendment that allows us to reform those processes and apply some sanctions for delays. We’re responsible for some of these, but the doctors, their employer, lawyers and the police can now all be subject to sanctions if they unduly hold up the process.
However, we need to try to do this in a way that does not lead the public to think the GMC is a body that closes ranks and protects doctors. We are here to protect the public.
Earlier in the year, you told MPs that doctors should have ‘emotional resilience’ training like soldiers in Afghanistan. Do you stand by that comment?
Yes I do. Practising as a doctor is already incredibly stressful and it’s getting more so. When I spoke to the House of Commons health committee, I’d been talking to some army personnel from training soldiers for Afghanistan. They made the point that they would not begin that training just as they’re about to deploy.
I’m not sure that’s something that medicine, or indeed other high-pressure professions, have really thought that much about. But there are lessons we could learn from other organisations and other disciplines.
What would the emotional resilience training involve?
I’m not an expert on resilience training. The first thing I would do would be to go and talk to some experts who do it.
We should be trying to prepare our young doctors for the rigours of practice and there are experts around who could help us with that.
So would you say doctors need to toughen up, then?
No, I wouldn’t use that phrase. Resilience doesn’t mean you shouldn’t be an empathetic, caring doctor. It does mean you need some protective mechanisms.
Doctors see things that many other members of the public will never see in a lifetime. Just as when soldiers go to Afghanistan, you don’t want the first time they’re looking at somebody who has no legs to be when they’re under fire, in the heat of the moment. You try to prepare them for that in advance.
We need to prepare tomorrow’s doctors as trainees for the situations they’re going to face after they qualify.
BME doctors are more likely to face sanctions. Why do you think that is?
It’s possible that statistic reflects the behaviours of people who’ve trained and worked in another country, as much as the colour of their skin.
Overseas doctors have provided invaluable service to the NHS since 1948. They’ve often shored it up. They’ve often staffed unpopular inner-city practices and unpopular specialties and we are hugely dependent on overseas doctors.
But if I were to train in this country and in my language and then go to practise in another country, in another culture and language, I think it’s quite likely I would find that more difficult.
What’s your number one goal as GMC chair?
To get across clearly that the GMC is a patient safety organisation.
Do you accept the FTP process needs to be speeded up?
We aim to finish 90% of our investigations within six months and we’re close to achieving that. Many cases that drag on for two or three years entail a police investigation, and the GMC can’t really start until the police finish their work.
Do you think it’s fair that the GMC funds private health insurance for its staff?
I don’t see it as a moral issue. The GMC isn’t the NHS. It’s an organisation that employs staff to do a job, and my personal view is to leave it to the human resources staff and the senior management team to choose the salaries, the recruitment packages and incentives to get the best people.
Do you think CQC inspections are too punitive on the profession?
I have no role in the regulation of practices or hospitals. I’d leave it to the CQC to do the best it can.
How often do you practise?
I practise in blocks. So when I practise, I do weeks at a time at the University College London Hospitals.
1 Bourne T, Wynants L, Peters M et al. The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey. BMJ Open 2015:5;e006687