The ‘unpredictable circumstances’ of the Covid-19 pandemic will be taken into account when investigating doctors’ fitness to practise, the GMC has said as it unveils new guidance on assessing allegations.
It comes as a medical defence union has warned it has seen an ‘influx’ of cases since the GMC restarted its investigations in July, following a period in which the regulator said it would only make FtP requests during the pandemic if there is ‘an immediate patient safety concern’.
The regulator’s guidance said assessors should consider factors such as availability of PPE, staff shortages due to Covid-19 illness or self-isolation requirements, and new ways of working in unfamiliar teams.
The disproportionate impact of disease and mortality rates for individuals from black and minority ethnic groups should also be considered, as should the ‘changing and sometimes conflicting guidance and protocols’.
The guidance said it was ‘unlikely’ FtP cases would be pursued further if the allegation was about a doctor undertaking a remote consultation, or if non Covid-19 related treatment was delayed due to reduced access to services.
Similarly, if a doctor used PPE against guidelines but it was ‘an agreed response to the circumstances at the time’ – such as reusing PPE or using less of it due to shortages – this would also be ‘unlikely to raise a question of impaired fitness to practise’.
However it said an allegation that would ‘likely’ lead to a FtP case being pursued would be if a doctor refused to wear PPE and treated a patient ‘when the dangers of this were known, where they knew that PPE was available and accessible, and no reasonable justification has been identified’.
The GMC guidance said if a doctor at higher risk of infection refused to treat a patient due to lack of PPE – and had tried to make alternative arrangements – this would be unlikely to lead to further investigation.
Meanwhile the regulator noted it was aware doctors faced ‘sustained and extreme periods of fatigue, and in some cases significant distress and emotional trauma’ during the pandemic.
When assessing allegations during the pandemic, the GMC said it would look at how doctors provide safe care ‘in line with the best evidence available at the time’ and how they ‘challenge and report poor practice which negatively impact on their practice’.
Announcing the guidance, GMC chief executive Charlie Massey said: ‘The unpredictable circumstances of the Covid-19 pandemic have forced doctors of all levels to change their practice and work more flexibly.
‘Our new guidance considers the environment, created by the pandemic, in which doctors were working, along with any relevant information about resource, guidelines or protocols in place at the time.’
He added: ‘During this challenging time, doctors of course still have a duty to provide the best and safest care they can in the circumstances. When we consider concerns raised about doctors, we always review the circumstances and context of the case to decide whether they pose a future risk to patients and whether their fitness to practise is impaired.’
The Medical Defence Union welcomed the new guidance and said it was ‘vital’ the GMC only begins full investigations where ‘absolutely necessary’.
Dr Caroline Fryar, head of advisory services at the MDU, said: ‘The publication of the guidance is well timed because, since the GMC restarted its investigations in July, we have seen an influx of cases. Almost 25% of GMC cases this year to date have come to us in the last month.’
She added: ‘Whilst the GMC’s recognition of the impact of the pandemic is reassuring, some of the complaints facing our members also have the potential to become clinical negligence claims which is why it is vital that the government acts to ensure all NHS healthcare professionals are exempt from Covid-19 related litigation, and the additional distress and anxiety it inevitably causes.’
Chris Kenny, chief executive of MDDUS, said: ‘We warmly welcome this pragmatic and timely new guidance from the GMC.
‘Now we need the Government to step forward and ensure similar principles are applied in COVID-19 related criminal proceedings against doctors, and by other regulators and NHS employers.
‘We were pleased to work with the GMC as they developed this guidance and it is gratifying to see it deliver on some of the important areas we believe need action by government.
‘This guidance should ensure that patients are protected, while doctors who have been working on the frontline under unprecedented pressures are not left exposed.’
The new GMC guidance comes as Pulse revealed three complaints have been made against GPs to the GMC, including an allegation of a doctor’s failure to wear appropriate PPE.
Meanwhile, Public Health England recently downgraded PPE requirements for the upcoming flu vaccination programme so that GPs do not need to change items between every patient.