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GMC to reduce full investigations into ‘one-off’ clinical incidents

Exclusive The GMC is looking to reduce probes into ‘one-off’ clinical incidents in a move that it hopes will reduce the number of full fitness-to-practice (FtP) investigations by the hundreds.

The GMC is piloting changes to its FtP process including closing cases early where a clinical incident was a one-off mistake, the doctor has identified and reflected on it, made changes to prevent it happening again, and apologised if necessary.

It hopes these measures, which are being piloted over the next six months, could remove the need for a full investigation in around 230 cases a year, and said early trials already showed it was cutting investigation times by half.

The GMC said the changes were the latest act in its ‘major campaign of reform’ of FtP, and recognised the fact that a faster and fairer system was ‘better for everybody involved’.

Under the pilots, experienced investigators can identify where a case could be closed if one or two pieces of evidence are collected, rather than conducting the entire investigation process, the GMC told Pulse.

An early pilot on around 350 investigations into conduct and behaviour cases, all of which would normally have had a full investigation lasting up to six months, had managed to close 75% of cases early – halving the time on average.

Speaking in an exclusive briefing, GMC chief executive Niall Dickson said: ‘If you as a doctor have done something to me as a patient, it’s a one-off thing, it may be a terrible thing that has disastrous consequences for me. But… If it’s a mistake and there’s nothing reckless or deliberate, and lessons are learnt from it, there shouldn’t be a risk to the profession going forward.’

Later pilots will also include instances where a doctor has been reported for a series of mistakes, but with a single patient. For example a missed diagnosis on three separate appointments, where there may be other issues involved.

GMC will also look at reducing baseless or vexatious complaints, or incidents where a doctor has been referred to the GMC by an organisation or individual that the doctor has previously raised concerns about, by requiring referrals by medical organisations or professionals to sign a formal declaration that they are making it in ‘good faith’.

Mr Dickson said: This is part of a major campaign of reform, which we’ve been engaging in for a number of years.

‘We want to make the system quicker, because a slow system is not good for the doctor, it’s not good for the complainant, it’s not good for us – it costs us more money, costs doctors more money.’

‘So a faster system which retains fairness has to be better for everybody involved. That is a really important aspect of this: that justice delayed is justice denied, so finding ways that we can speed the process up is really important.’

The campaign to improve the FtP process follows a GMC review into doctors’ suicides while under investigation, which recommended emotional resistance training, and advice this year by Professor Louis Appleby – England’s National Suicide Prevention Strategy lead – proposing changes to reduce the impact on vulnerable doctors.

GP leaders said last year that the spectre of investigation had led to doctors ‘practising in fear’ of a complaint.

Commenting on the new measures, GPC deputy chair Dr Richard Vautrey said anything that would reduce the time taken for investigations ‘was to be welcomed’.

He said: ‘Anything that reduces the time of the investigation process, thereby reducing the stress on the individual concerned, is to be welcomed I think. If they can look at doing that wherever possible, that will benefit both patients and the complainants as well.’

He added that cases of vexatious complaints against whistleblowers were unusual in general practice, but said it was ‘certainly possible’ where a GP had raised concerns about a partnership or, even CCG, and it was important to have processes in order to look at this.

Is Fitness to Practice fit for purpose?

The new pilots propose a significant structural reform, when previous changes have focussed on GPs’ resilience. The GMC pledged last year to introduce ‘resilience training’ similar to that offered to soldiers in Afghanistan in order to be prepared for the ‘occupational hazard’ of a GMC investigation.

The GMC accepted proposals in April this year in a bid to make its fitness-to-practise process more ‘sensitive to the needs of vulnerable doctors’ following Professor Louis Appleby’s review.

The review, launched in December last year, proposed doctors with mental health or addiction issues should be spared full investigation and ensuring all doctors have access to mental health support – like the BMA’s Doctors-for-Doctors which is backed by the GMC.

And this came after Pulse has published a series of articles about the pressure that GMC procedures put on vulnerable doctors, including a report that found that 28 doctors had died by suicide while under investigation and that 13 additional doctors died while the regulator contemplated action.

Another study showed that complaints against doctors ‘may do more overall harm than good’, and a paper this month called for an end to ‘confrontational’ NHS complaints processes – in all investigations.