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GMC to train fitness-to-practise investigators to recognise ‘human factors’



The GMC is intending to train all staff involved in fitness-to-practise decisions and investigation to recognise the role of ‘human factors’.

The regulator said this would ‘give doctors assurance’ that their actions would be judged against the ‘backdrop’ of ‘any system failings’ going forward.

Following the high-profile Bawa-Garba case, the GMC has been criticised for failing to consider wider system failings when investigating doctor errors.

But the GMC said fitness-to-practise decision makers, case examiners and clinical experts will all now receive ‘human factors’ training – a tool widely used tool within industries including aviation, nuclear power and the military.

It said in future, responsible officers would be trained so that ‘the same approaches are also consistently applied locally’, ‘before’ issues are referred to the GMC.

The GMC said it will also draw on human factors experts to better understand system failures when investigating doctors going forward.

GMC chief executive Charlie Massey said the new approach would ensure ‘the role systems and workplaces play in events is fully and evently evaluated in assessing context following serious failings’.

He said: ‘That will guarantee consistency in how we investigate after things have gone wrong and give doctors the assurance that their actions will be seen clearly against the backdrop of any system failings.’

He added that it would also ‘help to embed a greater understanding across the health system of how environments contribute to patient safety incidents’.

The GMC will work in collaboration with the University of Oxford’s Patient Safety Academy, a department funded by Health Education England, for both the training and ongoing expert advice.

Project leader Professor Peter McCulloch, a professor of surgical science and practice, said integrating human factors into the fitness-to-practice process would involve both staff training and ‘modification of procedures and documentation’, to ‘ensure that the knowledge acquired is embedded into the investigative process’.

He said: ‘Our aim in this work is to ensure that context and systems issues are always fully taken into account when evaluating a doctor’s performance, allowing doctors to have confidence in the fairness of GMC procedures.

‘We believe that patient safety will be improved by a just culture for healthcare workers, and that this collaboration represents an important advance.’

The news comes as a BMA survey of 8,000 doctors found over half fear they will be blamed for making a medical error made because of systemic pressures in the NHS.

Medical Defence Union head of advisory services Dr Caroline Fryar said: ‘We are glad that the GMC is recognising and taking into account the fact that doctors are often put in a position where they are unable to control their environment and circumstances but must carry on and treat patients as best as they can.’

Earlier this year, the GMC successfully struck off Dr Hadiza Bawa-Garba in the High Court, overturning a decision from its own tribunal service, which found her fit to practise.

However, the medical profession reacted angrily to the decision, pointing out that there were a series of systematic failures that led to the death of six-year-old Jack Adcock in 2011.

In August, the Court of Appeal ruled that the GMC should reinstate Dr Bawa-Garba to the medical register.

Since the case made the headlines at the beginning of the year, a GMC review into gross negligence manslaughter charges against doctors has looked at why there are fewer cases involving healthcare organisations compared with individuals.

What does the ‘human factors’ approach entail?

Human Factors is a social science which examines the relationships between individuals, their interactions with others and how their working environment impacts on the way they behave and make decisions.

It’s used in a number of ways – proactively in order to identify and mitigate risks and so reduce medical errors, and after events to look at the reasons why decisions were taken and how the context in which someone was working may have affected the choices made and the results for doctors and patients.

‘The training that the Patient Safety Academy will deliver for the GMC will allow our staff to better understand interaction between humans tasks, technology and environment so that – when looking at whether a doctor’s fitness to practise is called into question – all of the context around their actions will be taken into account,’ a GMC spokesperson said.

Source: GMC