The GMC should have ’immediately ceased’ their fitness-to-practise cases and ’urgently reformed’ processes after concerns were first raised about the high numbers of doctors taking their own life while under investigation, a new review has concluded.
The review, Suicide whilst under the GMC’s fitness-to-practise investigation: Were they preventable?, published in the Journal of Forensic and Legal Medicine, suggests that there were 13 deaths by suicide while the GMC was conducting a review of its fitness-to-practise procedures.
As such, GMC review last year of 28 doctors who died by suicide while under fitness-to-practise (FTP) investigation between 2005 and 2013 was ‘reactive’, when it could have been proactive.
The new review – written by Dr David Casey, a GP and a tutor in medical law, ethics and professionalism at the University of Central Lancashire, and Dr Kartina Choong, a senior lecturer in law and ethics at University of Central Lancashire – also criticises coroners for not raising FTP investigations as a possible suicide risk earlier.
The GMC’s review, led by Sarndrah Hosfall, the chief executive for the National Patient Safety Organisation, outlined a number of core recommendations that it needed to implement in order to improve its fitness-to-practise processes – in a bid to offer more support vulnerable doctors under investigation.
The review found:
- Some doctors were receiving multiple letters from the GMC, with one doctor receiving up to five letters over a four-day period;
- Many doctors felt the GMC’s tone was ’accusatory’, with a failure to show compassion;
- Doctors felt they did not receive any support, and there was ‘minimal’ communication with them;
- And there were unacceptable delays in investigating some concerns, in some cases leading to a higher risk of suicide.
But the new study claims that the concerns were first raised in 2012 by an FOI request by a psychiatrist, and that there should have been immediate action before the review was published in 2014.
In 2012, four doctors took their own life, with a further nine deaths by suicide the following year.
The study concluded: ’It is submitted that the interval between concerns about suicide being raised and the release of the report were unacceptable.’
It concluded that an ’immediate cessation in the active investigation of doctors by the GMC could have taken place with an emergency reform of the processes and assessment of the risk posed to these doctors could have been made’.
The authors added: ’The extrapolated effect of an immediate failure to act leaves no doubt that these further cases of suicide – 13 deaths – could have been managed differently. Thus although the GMC did commission an independent review in 2013, the report was ultimately reactive, not proactive.’
The study also suggests that the coroners service also failed to act in time – and argues that it did not detect the pattern of doctors that had died by suicide while under investigation by the regulator, adding that it should have alerted the GMC of the emerging trend.
However, it added that this did not absolve the GMC, which itself should have identified the high numbers of doctors taking their own life while under FTP investigations.
It concluded: ’That FTP investigation has never, prior to , been isolated and identiﬁed as a distinct risk factor for physician suicide meant that practically nothing has been done to avert such deaths.
’As argued above, culpability for the omissions lies mainly with two parties: the coroners and the GMC itself.’
GMC chief executive Niall Dickson told Pulse: ‘This is a complex area and we entirely accept our responsibilities to everyone involved in our investigations. Of course we have to protect patients, but we also want to help doctors who are unwell and find themselves in this predicament – that is why we commissioned the independent review.
‘The truth is some doctors in our procedures have very serious health problems and are referred to us having already had ideas of taking their own lives. Often they are also having to deal with many other serious personal and professional issues. We do not need to be involved where the doctor is ill and it is being managed appropriately, but we do have a duty to act where patients could be at risk.’
He added that the GMC is working with the BMA and medical defence organisations to change its correspondence with doctors under investigation.
Last week, an inquest heard that a newly-qualified GP voted ‘Trainee GP of the Year’ hanged himself after fearing he would be struck off by the GMC for failing an alcohol test.