Just over 40% of GPs being investigated by the GMC reported suicidal thoughts, and nearly half considered quitting medicine as a result of the process, according to a medical defence organisation.
The Medical Protection Society (MPS) surveyed 197 doctors, including 34 GPs, who had been investigated by the GMC in the last five years, and found that 78% of them believed it had a detrimental impact on their mental health.
This was higher (85%) among the GP group, where all but one of the respondents said the process caused them stress and anxiety.
The MPS has called for ‘radical reform’ to the GMC’s investigation process, including on the number of doctors investigated, the length of the process, and the communications between the regulator and doctors.
Over two thirds of GPs surveyed said the length of the investigation impacted their mental health most, while 62% felt the tone of communications from the GMC had a big impact.
And 41% of GP respondents said they experienced suicidal thoughts during the investigation, which is 10 percentage points higher than the average for all of the doctors surveyed.
Last year, a GMC report revealed that five doctors died by suicide while under investigation between 2018 and 2020.
Dr Rob Hendry, medical director of MPS, said there was ‘no reason’ why the GMC ‘cannot operate and communicate with doctors with more compassion’.
He called for changes to the GMC’s initial letter so that it highlights the regulator’s policy for dealing with ‘malicious complaints’, and also to the letter which closes the investigation with no further action, as currently many doctors feel it implied ‘we’ll get you next time’.
But the MPS’s main ask was for the Government and the GMC to ‘ensure fewer doctors are dragged through this extremely stressful process unnecessarily’.
Dr Hendry said: ‘For the Government this means progressing GMC reform with urgency to give the regulator more discretion to not take forward investigations where allegations clearly do not require action.
‘Reform should also reduce the number of doctors who are pursued by the GMC on the vague and ill-defined basis that action will “protect public confidence in the profession”, when investigations should surely be focused on doctors who potentially pose a risk to patient safety.’
In 2021 the Department of Health and Social Care (DHSC) consulted on reforms to the Medical Act 1983, which is the legislation governing the GMC.
The aim of the proposed changes was to ‘deliver a fitness-to-practise process that is less adversarial and with more cases resolved without the need for a fitness to practise panel hearing’.
Proposed changes included ‘allowing more cases to be concluded earlier’ and removing the GMC’s right to appeal FTP panel decisions.
However, the consultation response was published in February and did not give a clear timeline for cementing these policy positions.
A spokesperson for DHSC said it is ‘committed to modernising the regulatory framework for doctors as a top priority’ and that the current consultation on draft regulation for anaesthesia associates and physician associates by the GMC will form the basis of the reformed legislation for regulation of doctors.
GMC chief executive Charlie Massey said the ‘40-year-old legislation’ that governs the regulator ‘constrains us from making further much-needed reforms’.
Responding to the MPS’s survey, Mr Massey also said: ‘We are required by law to consider any concerns about a doctor’s fitness to practise and we know receiving a complaint can be a cause of great distress and anxiety for doctors.
‘We have made a number of improvements to take a more compassionate and proportionate approach, and to reduce the impact of our processes on all involved in an investigation.’
He highlighted that initial contact with doctors is now always by phone, and that the GMC’s outreach team works with employers to help promote managing concerns locally where appropriate.
As well as mental health impacts, the survey showed that 47% of GP respondents considered quitting medicine due to the investigation, which is ‘particularly concerning’, according to RCGP chair Professor Kamila Hawthorne.
She added: ‘The GMC fulfils an important purpose in keeping patients safe, but it is vital that fitness to practise investigations of individual doctors are proportionate, that they are initiated from a place of openness and fairness, and that the potential impact of these investigations on clinician’s mental health is considered and mitigated.’
BMA council chair Professor Philip Banfield said the union continues to call for ‘a root and branch independent evaluation of the entire GMC referral pathway’ to ensure it is ‘fair and proportionate’ in its treatment of doctors.
He added: ‘Doctors’ confidence in the GMC has been persistently eroded, feeling as though it is more interested in pursuing and punishing them than it is about finding out what really happened and learning from events.
‘These concerning findings underline the sense of “guilty until proven innocent” that doctors under investigation experience, and the feeling of hopelessness this can cause.’
Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin (BAPIO), said the MPS’s survey results were ‘not surprising for us at all’, and that the GMC’s initial investigation letter is the ‘beginning of a sort of mental torture’ for doctors.
He said BAPIO agrees with the MPS’s recommendations, but that they should go further, including fixing the ‘faulty’ screening process and giving human factors training to the barristers of the Medical Practitioners Tribunal Service (MPTS).
Dr Mehta said: ‘We know that BAME doctors – whether they’re local graduates or international medical graduates – have a much higher chance of being forwarded for disciplinary action at the MPTS.’
Last year, the GMC faced backlash for the controversial ‘laptop’ ruling in which the MPTS suspended Dr Arora for a month for ‘dishonesty’ after she told an IT department she had been ‘promised’ a laptop.
And figures from the MPS last year revealed that more than a quarter of overseas GPs lack legal representation at fitness to practise hearings, and are more likely to face ‘harsher sanctions’ as a result.
The MPS recommendations
- The tone of GMC communications should be reviewed on an ongoing basis.
- The GMC should explain in the initial communication that it is required by law to review all complaints and allegations that a doctor’s fitness to practise may be impaired.
- When the GMC closes a case with no action, they should provide guidance and reassurance to doctors regarding what circumstances a doctor would be expected to declare the investigation when completing an employment form.
- The GMC should explore options to discourage complaints that clearly do not require regulatory action, including better communication to the public and profession on the threshold for a complaint.
- In its initial communication with doctors, the GMC should include information, or a link to its policy, for dealing with vexatious complaints.
- The GMC should acknowledge any stress caused to doctors as a result of an investigation which is subsequently found to be based on a vexatious or spurious complaint, and where appropriate offer an apology for the stress caused.
- The DHSC and GMC should consider the role of mediation for some cases, as part of the long overdue amendments to the Medical Act.
- The GMC should continue to take steps to ensure initial notifications do not land on a Friday when the doctor has more limited access to professional and wellbeing support.
- The GMC should notify a doctor of the outcome of an investigation a few days before their employer is notified.
- The GMC should keep doctors fully informed when there are delays.
- The GMC should ensure investigators dealing with complaints at an early stage are suitably experienced in order to be able to close those cases not requiring further action swiftly.
- The DHSC should prioritise legislation to amend the Medical Act which would enable the GMC to process complaints more quickly.
- The GMC should ensure all communication and material for doctors facing a fitness to practise investigation includes details of how they can access mental wellbeing support that is available 24/7, not just Monday-Friday 9-5pm.