More than a quarter of overseas GPs lack legal representation at fitness-to-practise hearings, and are more likely to face ‘harsher sanctions’ as a result, an indemnity organisation has revealed.
GMC data obtained via a Freedom of Information (FOI) request by the Medical Protection Society (MPS) showed that 28% of UK GPs who graduated overseas were not represented when facing a Medical Practitioners Tribunal Service (MPTS) hearing between 2018 and 2021.
This compares with 21% for those GPs who qualified in the UK.
The figures also showed the ‘dramatic difference’ representation makes to tribunal outcomes, the MPS said.
Among 98 overseas GPs who faced an MPTS hearing, those ‘without legal representation were more likely to receive a harsher sanction’, it added.
The findings included:
- Of those who were unrepresented, 93% were either suspended or erased from the medical register with only 4% receiving a ‘no impairment’ judgement.
- However, only around half (52%) of those who were represented were suspended or erased from the register while 28% received a ‘no impairment’ judgement.
- One in ten (11%) of those with representation were given a more lenient ‘warning’ – indicating their behaviour or performance is below the standards expected and should not be repeated – but no GPs without legal representation had this outcome.
MPS says inductions for doctors who graduated overseas must ‘dramatically improve’ so they are aware that the state indemnity schemes only cover NHS clinical negligence claims and not GMC fitness to practise hearings.
It urged the GMC to encourage more overseas doctors to join a medical defence organisation (MDO) when they arrive in the UK ‘so they do not risk facing a fitness-to-practise hearing alone’.
MPS president Professor Dame Jane Dacre said: ‘We have been talking with doctors who qualified overseas to gauge their understanding of the healthcare system and indemnity arrangements when they arrived in the UK.
‘Only 52% said they joined an MDO when they arrived and started work. The GMC figures serve as a powerful reminder of how important it is for these doctors to ensure they have support with GMC investigations as soon as they start work.’
She added that ‘many coming to work in the NHS may assume that the state indemnity schemes provide blanket protection’, with NHS guidelines ‘bewildering for any doctor’ and ‘even more difficult’ for those who trained overseas.
However, state schemes cover only NHS clinical negligence claims and ‘support with GMC investigations, complaints, inquests and disciplinary proceedings is also vital’, she said.
Professor Dacre added: ‘GMC investigations often take several months – and sometimes years – to conclude and the hearings can last weeks. For some, fitness to practise proceedings have career ending implications.
‘I cannot imagine facing this process alone, without someone fighting my corner. Sadly though, 28% of GPs who graduated overseas do and the majority go on to face tougher sanctions at their hearing when compared to those with legal representation.’
British Association of Physicians of Indian Origin (BAPIO) GP forum chair and GP trainer Dr Kamal Sidhu told Pulse: ‘These findings are truly shocking and very disappointing. Opportunity for those under investigation to receive adequate representation is the basis of any fair and just system.
‘If these highly trained professionals whom the system desperately needs are being lost as a result of lack of representation, it is a gross miscarriage of justice and a disservice not only to these doctors but also to the very patients whom the regulators exist to protect.’
BAPIO has also heard from members that ‘quality of representation sometimes may also vary based on ethnicity and country of qualification’ and ‘recently learnt that anonymisation of cases results in reduced disparities in performance proceedings’, he added.
‘It is very clear that this cohort of doctors does not receive fair treatment,’ Dr Sidhu said.
A GMC spokesperson said: ‘Our own published peer-reviewed research shows that any doctor who doesn’t attend their hearing or have legal representation is more likely to receive more serious outcomes at hearings. That same research shows that tribunal outcomes are unrelated to whether doctors qualified in the UK or not – non-attendance or lack of legal representation puts any doctor at a disadvantage.
‘But we know that doctors coming to work in the UK face a range of challenges and do not always get the support that they deserve and we have been working extensively with NHS England since 2019 to develop an induction programme for international medical graduates.’
They added that the GMC has ‘long term’ targets to ‘eliminate disproportionate complaints from employers about ethnic minority doctors by 2026 and to eradicate disadvantage and discrimination in medical education and training by 2031’.
Fitness to practise and racial bias
The GMC admitted earlier this year that it needs to do more to reduce racial inequalities, after achieving only marginal improvements against its targets.
Last year, the GMC chief executive said the regulator was to become a ‘force for good’ in tackling the ‘shameful’ disadvantage ethnic minority GPs face in their careers.
It also said it would consider proposals to establish ‘measures and targets’ to mitigate bias against ethnic minority doctors in FTP referrals as well as address the ‘attainment gap’ faced by BAME medical students and trainees.
Meanwhile, the regulator last month proposed a number of amendments to its Good Medical Practice guide, including a commitment to consider which ‘context’ a doctor was working in if a complaint arises.