Proposed fitness-to-practise reforms ‘would put vulnerable doctors at risk’
Over 30 organisations have called on the Government to preserve the GMC’s ability to investigate doctors’ fitness to practise under the ‘health’ category of impairment.
In a letter addressed to health minister Karin Smyth, organisations including the RCGP and BMA pleaded with the Government to protect ‘the most vulnerable doctors’ during regulatory investigations, and avoid taking ‘a significant step backwards’.
The letter, led by the Medical Protection Society (MPS), said that while it is important that doctors are held to high professional standards with regulatory processes that protect patient safety, it is also essential that regulators are ‘efficient’ and ‘compassionate’ in how they conduct investigations into doctors.
There are currently six grounds upon which a doctor’s impairment can be investigated by the GMC, as laid out in the Medical Act of 1983:
- Misconduct
- Criminal conviction or caution
- Deficient professional performance
- Adverse physical or mental health
- Lack of knowledge of English language
- Determinations by other regulatory bodies to the effect that the registrant’s fitness to practise is impaired
If a doctor is investigated under ‘adverse physical or mental health’ certain measures can be put in place to protect them – such as holding parts/all of the hearing in private, or redacting published material that references their health.
As part of the 2024 consultation into regulating anaesthesia associates and physician associates, the previous government put forward proposals that would remove ‘health’ as a standalone ground for action.
Under those reforms, doctors who would have previously fallen into that category, would instead instead have to be investigated on the grounds of ‘inability to provide care to a sufficient standard’ and/or ‘misconduct’; language which the letter said could ‘stigmatise health conditions’ and deter doctors from ‘seeking help earlier on’.
The letter added: ‘Current provisions within the Medical Act, particularly the ability to investigate doctors under the health category of impairment, have been central to the progress that has been made.
‘In such cases, the GMC can use language which acknowledges the health concerns about the doctor without having to use pejorative terminology around misconduct and poor performance.
‘The regulator is also able to put in place particular measures to protect the doctor such as some, or all of the hearing, being held in private, and where the focus is on aiding recovery and return to practice in addition to patient safety. Put simply, it provides the GMC with tools to respond to illness in a more humane and proportionate way.’
Commenting on the letter, Charlie Massey, chief executive of the GMC, said: ‘We welcome the Government’s commitment to modernising our regulatory framework. Updating our outdated legislation is a vital step toward more responsive regulation, with simpler and less adversarial processes.
‘However, we urge officials to retain our ability to manage health issues as a ground for regulatory action, so we can continue to do so, both proportionately and compassionately.’
At the time the reforms were originally proposed in 2024, the GMC expressed concern about the removal of ‘health’ as a standalone category for action.
The regulator said that retaining health as a distinct route would ensure that it could conduct an impairment investigation in an ‘appropriate and compassionate’ manner, focussing on ‘current and ongoing risk to public protection, rather than on their past performance or behaviour.’
Dr Tom Kane, chair of the BMA’s Professional Regulation Committee: ‘The Government should be in no doubt about the potential impact of a GMC investigation on a doctor’s mental health. Too many cases have had ruinous effects up to the point of suicide.
‘It is in both doctors’ and the GMC’s interest to create a system that provides more compassion while it does its work.
‘We told the previous government that its proposals to remove the “health” category were a regressive step toward an even more uncaring system. Along with dozens of other institutions we’re urging the current Government to rethink and retain the ability to protect unwell doctors during the most trying times of their professional lives.’
Dr Steve Taylor, spokesperson for the Doctors Association UK – one of the letter’s signatories – also impressed the importance of preserving health as a distinct category.
He said: ‘It is vital that the GMC and Government acknowledge this letter and act to ensure that the ‘health’ route for fitness to practice is maintained.
‘There is a huge difference between being vulnerable and unwell, versus having been suspected of a fitness to practice issue for other reasons.
‘Being unwell will already have created significant stress on a doctor, as this letter clearly states, the statistics around the increase in stress related to an investigation could result in significant harm.
‘As doctors we know more than most, that health needs are to be safeguarded, with support to continue throughout any investigation.’
Last year, the MPS recommended that reforming the GMC should be an ‘urgent’ priority for the Government, with a focus on the ‘long overdue commitment’ to remove the GMC’s right of appeal over decisions made by fitness-to-practise panels.
In 2023, Pulse reported on the pressures that GPs under GMC investigations face, with over 40% having suicidal thoughts and nearly half considering quitting medicine as a result of the process.
