Big increase in GP fitness-to-practise cases closed at triage, GMC data reveals
Exclusive: There has been an increase in GP fitness-to-practise cases being closed at triage without further action, new GMC data has revealed.
Exclusive freedom of information (FOI) data obtained by Pulse from the regulator shows the proportion of decisions being closed at the initial triage stage rose from 72.8% in 2020 to 81.4% in 2024 – 8.6 percentage points.
The data also shows that while the number of allegations has remained similar over that time period, there has been a broadening in the types of allegations GPs face.
GPs faced 6,401 individual allegations in total in 2024, including those that went no further than triage – while in 2020 the figure was 6,167.
The increase in overall allegations comes as a major new Pulse white paper on complaints in general practice revealed that four in five GPs practise ‘defensive medicine’ amid a growing threat of complaints.
Of these, many of the categories of allegations were newly introduced in 2024 following changes to Good Medical Practice, according to the GMC.
Over 1,000 of the allegations in the new categories related to patients in 2024, including 544 categorised as ‘Treating patients with respect’, which was the third-most common allegation.
Other patient-related allegations included ‘Respecting patient rights’ (271 total allegations); ‘Sharing info with patients’ (136); ‘Supporting patients with decisions’ (44); ‘Comms with patient family/friend’ (35).
Across the five years, allegations related to a GP’s ‘Knowledge and experience’ were the most common, making up 31% of all allegations. This was followed by ‘Acting with honesty and integrity’ (12%) and ‘Partnerships with patients’ (11%).
The GMC told Pulse it had strengthened its approach to early decision-making so that non-serious concerns could be closed more quickly. It said many concerns raised would be better addressed through local complaints, governance or employment processes.
Professor Azeem Majeed, a GP and head of the Department of Primary Care and Public Health at Imperial College London, said: ‘The increase in GP fitness-to-practise cases being closed at the initial triage stage may be because the GMC has become more effective at identifying which concerns raise a genuine question about a doctor’s fitness to practise and which are more appropriately dealt with through local complaints procedures.
‘There may also be increased awareness among patients of the GMC as a route for raising concerns, resulting in a larger volume of referrals that do not ultimately meet the threshold for a formal fitness-to-practise investigation.’
On the new categories of allegations, he said: ‘These categories may also reflect the pressures currently affecting general practice such as high demands for care, workforce shortages and limited consultation times. These pressures can affect patients’ experiences of access, communication and continuity of care, even when the clinical care itself is appropriate.
‘As a result, concerns raised by patients may increasingly focus on communication, involvement in decisions, and whether they feel listened to and respected.’
Meanwhile, figures for 2024 show a continued outsized representation of ethnic minority groups among complaints.
GPs identifying as Asian or Asian British made up 26% of the GP register but 28.1% of fitness-to-practise triages and 28.9% of erasures or suspensions. Meanwhile, Black or Black British GPs made up 6.3% of registrants but 13.1% of erasures or suspensions.
The GMC told Pulse that many concerns raised with them are better addressed through local complaints, governance or employment processes. In 2019, the GMC introduced provisional enquiries, allowing investigators to gather key information at an early stage of a case. This means cases that once may have progressed to an investigation are closed at triage stage where appropriate.
It said changes in the source of complaints may also have played a role and it had previously noted that a rise in complaints from members of the public has been a factor in the reduction in investigations, because public complaints are significantly more likely to close at triage than referrals from employers, police, coroners or other organisations.
On the variation in allegation types, the regulator said it is worth noting that changes in Good Medical Practice in 2024 resulted in different allegation types being used in its processes, and therefore it is not possible to compare the data between the two time periods.
It added that in recent years, it has strengthened its approach to early decision-making so that concerns which do not raise a serious question about a doctor’s fitness to practise can be identified and closed more quickly. This helps ensure its investigations remain focused on cases where there may be a risk to patients or public confidence.
Responding to the data, RCGP president Professor Victoria Tzortziou Brown stressed the importance of complaints being ‘handled fairly, consistently and proportionately for both patients and doctors’.
‘Where concerns do not meet the threshold for further action, it is right that these are identified as early as possible, helping to avoid unnecessary distress for GPs and unnecessary investigation, while allowing regulators to focus their resources on cases where there are genuine patient safety concerns,’ she said.
‘Patients must always be able to raise concerns about the care they receive, and GP practices should be supported to learn and improve where appropriate. But complaints and regulatory processes must also recognise the realities of delivering care in an overstretched NHS, where GPs and their teams are working under intense pressure and are often bearing the brunt of patients’ frustration about difficulties accessing services across the wider health system.’
In January, a GMC report showed 2.9% of employers had excess referrals in relation to a doctor’s ethnicity or place of qualification from 2020-2024 – which was a deduction from 5.6% during 2016-2020.
Read the full Cogora white paper on patient complaints
