In their recent article in Pulse, Drs Lees and Williams highlighted the impact of GMC investigations on doctors, following research by Bourne et al published in BMJ Open last week. This is an important issue, and one which we are already addressing, but we accept it is an area where more can be done.
Bourne et al looked at the responses from nearly 8000 doctors who had been investigated by various organisations, the vast majority by local NHS bodies. Unsurprisingly it found that levels of stress were higher among the 374 doctors who had been referred to the GMC.
Being referred to a national regulator is bound to be stressful – it is hard to see how that can be avoided and it is right that doctors should be accountable for their actions. But we should do what we can to minimise the trauma – that is one reason why we are exploring consensual disposal and why we are doing everything we can to speed up our processes.
That is also why, over the last few years, we have been doing everything we can to show that the system is fair, to speed up the process at every stage and provide support for both doctors and patients who find themselves involved in our investigations.
Drs Lees and Williams are right to point out that a lot of the concerns raised with the GMC are closed without a doctor ever facing action. Many of the complaints we receive could and should be resolved at a local level, with the GMC handling just the most serious concerns. We have made changes to how we deal with less serious complaints, so that we can focus on those issues that might require us to take action on a doctor’s registration.
But contrary to what was suggested, we do not ‘welcome’ the huge rise in complaints to the GMC – not least because there is nothing we can do about most of them. What we do welcome is a more transparent system and one where doctors and patients work in partnership.
Likewise we are keen to do everything we can to encourage a culture in healthcare institutions that encourages and supports those who raise concerns. The fact that we have to take action in a few cases where doctors have seriously or persistently flouted our guidance is not incompatible with this stance.
Some of the concerns referred to us are very serious and we must act first to protect patients. That can include asking an independent panel of the Medical Practitioners Tribunal Service (MPTS) to impose conditions on a doctor’s practice, or suspend their licence, while we investigate.
This is not, as is suggested by Drs Lees and Williams, about punishing doctors before evidence has been found proven. It is a fundamental part of our role to protect patients. These panels have a duty to assess whether there is a prima facie case which, if proved, would put patients at risk. The decisions made by those panels have no bearing on the investigation or on the final outcome, which is not determined by the same panel.
So the claim that we want to punish and punish more is quite wrong. We have always accepted that the effect of the fitness-to-practise process created by Parliament can be punitive, the point we have sought to make is that the purpose is not to punish. It is to protect patients and the reputation of the profession.
The authors depict us as punitive and vindictive yet, as they point out, we dismiss most complaints because they do not reach our threshold. Sometimes we have to investigate to reach that conclusion but we are keen that as much as possible is managed and resolved locally.
And our consultation on sanctions guidance has provoked the largest number of replies we can remember and while we will have to wait for the detailed analysis, the overwhelming response has been positive.
We are reaching out to the profession and engaging with front line doctors as never before, and we have revolutionised the way we engage with employers through regular face-to-face meetings. Our Employer Liaison Service (ELS) has created strong links with employers and now supports Responsible Officers in managing concerns locally, helping to make sure that doctors are referred to us only when it is necessary. We are also making better use of our data to see what more we can do to support doctors at risk of receiving a complaint.
The fitness-to-practise work we do will always be controversial. The stakes are high and the circumstances are often disputed – it is unusual for both complainant and doctor to be satisfied. But it is important work and the actions we and the MPTS, do protect patients and do help to maintain the justifiable trust patients have in the profession. We have done a lot to improve a system under a lot of pressure, but we accept there is a lot more to do.
Niall Dickson is Chief Executive of the General Medical Council