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Overseas GPs lack representation at fitness-to-practise hearings and face ‘harsher sanctions’

Overseas GPs lack representation at F2P hearings and face ‘harsher sanctions’

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.


Fay Wilson 16 May, 2022 10:30 am

The failure to inform incoming doctors of the need for MDO protection is an indictment of induction processes. It shows how those recruiting doctors from outside the UK do not have a mind set of looking after them but just getting work out of them. For sure nobody should practise in the UK without personal professional cover via an MDO. Even if you believe you will never ever put a foot wrong you could have a health problem or an unjustified complaint. It can cost thousands to pay for your own legal support. Please all trainers, employers and induction organisers, cover this topic.

Anthony Everington 16 May, 2022 10:40 am

This is incredibly unjust. In our national system under similar sort of jeopardy, a court will appoint a lawyer. It cannot be right for the GMC to have their own Barristers and QCs and accept the doctor does not. At a conference last year, discussing this issue a participant referred to some of these Barristers/QCs as “trophy hunters”. The only way you stop this behaviour and ensure fairness and ultimately justice is to have equality of representation by all participants and it is for the judge (GMC) to ensure that this happens. Sam Everington (GP and Qualified Barrister)

Darren Cornish 16 May, 2022 10:52 am

I can say that I was properly informed when coming from the Netherlands, numerous times, that I would need my own representation outside of the state indemnity. Both when applying to the GMC register, there is information on indemnity and was informed by the health board and practice to have my own indemnity in place. I could not start work without it here in Wales. With this article we cannot see whether or not the issues raised were due clinical negligence resulting in sanctions. Yes, 28% is higher than 21% and that 7% needs to be addressed. The induction I had in Wales was very clear. Also doctors can follow working in the UK courses offered by the GMC as well which I believe has a high uptake. Not sure if there is a correlation between these courses and lower concerns. I think the issue between foreign trained GP’s and local GP’s is mainly the issue of locally grown doctors know the pitfalls and hence know when and how to record information and recognize potentially litigious situations? Perhaps in countries where medicine is more hierarchical and paternalistic with patients, there is a higher risk of complaints? Either way it requires more investigation to understand where and why going wrong.

David Church 16 May, 2022 2:04 pm

Ah. I thought MDO membership was Compulsory. It certainly was up until at least 2015, when we last checked, and many Partnership Agreements make it Mandatory.
Indeed, it seems it WAS compulsory, but no longer is. GMPI does not cover this, which is essential. But still, I am surprised at the high numbers of GPs who do not have membership outside of GMPI! GMPI is present only to serve the interests of the local health service managers, not either Doctors or patients.

Patrufini Duffy 16 May, 2022 4:24 pm

Doesn’t surprise anyone, smells off. This is 40 years old. They weren’t taught to nanny patients, and do what they say, when they came here with boundless knowledge, experience of complex disease to be faced with IBS and a panic attack complainer. Most GPs would be happy to mentor them, and teach them rule 1 of UK medicine: to give “them” what they want, and smile at the trivia and non-medicine you’re confronted with, or then be confronted, as no one is coming to protect you.

Decorum Est 16 May, 2022 5:56 pm

Sam Everington (GP and Qualified Barrister) is right. The GMC (judge/court) has a duty to ensure fairness and ultimately justice by insisting on having equality of representation by all participants. Just another demonstration of how the GMC is a ‘kangaroo court system’.

Hank Beerstecher 18 May, 2022 10:20 am

My experience (n=1) I underwent 16 investigations of NHS England (5) NCAS (2) GMC (5) CQC (4). The first set of investigations in 2007 started after I declined to sign up to the choose and book enhanced service. The second set started in 2011 after I refused to cooperate with NHS England in a press cover up, I had a call from the responsible officer telling me my life would be made difficult. The investigations eventually culminated in suspension for two months for not treating CQC that produced a false report on the practice as colleagues.
Unbeknown to me the MPS had spent £70,000 on legal costs defending me over this 11 year period and immediately suspended my membership on the GMC suspension. My re-application was refused, I offered to exclude representation from the package, MDU MDDUS also refused to cover me.
Without crown indemnity I would have been unable to work in the UK thanks to the refusal of cover by the defense unions.
A condition of re-entering the performance list, after being restored on the GMC register, was to undergo a psychological course of three days that gave me the insight that I had been victimised in an 11 year bullying campaign, the GMC refused to investigate my allegations repeatedly over the years, the GMC only processes what is delivered at the door and foreign medical graduates are an easy target for bullies within the NHS structure, so they appear more often as the only thing required is a referral. GMC does not examine or question referrals. My experience with the GMC is akin to that with the NCAS and CQC there are elements in the organistions that enjoy bullying and there is no oversight for this, I ended up having to audio tape all encounters with these organisations and the publication of the evidence was not appreciated by the GMC panel.