Niall Dickson – 3×2
As Niall Dickson arrives to meet Pulse at the GMC’s London headquarters, he looks eager to get down to business, but slightly tense.
Given how uncomfortable the past 12 months has been for the regulator, this may be understandable.
The GMC published a review just over a year ago revealing 28 doctors had died while undergoing fitness-to-practise (FTP) investigations, and a number of other studies last year also highlighted the severe impact FTP procedures have on doctors and the way they treat patients.
However, the GMC’s chief executive tells Pulse the regulator wants to ‘reduce the stress’ its FTP processes can place on doctors, while making the transition to being a ‘compassionate’ regulator.
The GMC claims recommendations outlined in the 2014 suicides review have already been implemented, including improvements to the tone of its correspondence with doctors, and a move to establish a national doctors’ support service.
But Mr Dickson now says the GMC wants to go further, with the apppointment of mental health expert Professor Louis Appleby to carry out a review of FTP processes, examining ‘every stage’ to find ways to offer more support to vulnerable doctors. But it still faces a huge challenge to carry out its mandate to ‘protect the public’ while being ‘compassionate’ towards doctors. Will it be able to square this circle?
Do you think the GMC failed in its moral obligation to do more during the period in which 28 doctors died while under investigation?
It’s inevitably a very emotional and a very difficult issue, and absolutely terrible for the families of these doctors. Even our staff who are dealing with this find it incredibly difficult. But we did want to try to find out if there was more that we could do in terms of our contribution, remembering that most of these doctors enter our procedures already having had very serious mental health and addiction problems, and many have had suicidal ideation. But we recognise that our investigation process is stressful and will always be stressful.
But why do so many doctors have to die for the GMC to recognise it as an issue?
If you’re asking me whether these deaths could all be avoided by the GMC doing something, that would be ludicrous, and nobody who’s an expert in this area would even begin to suggest that.
But surely if doctors are dying while under investigation, the FTP process should have been suspended?
Stopping the process is stopping protecting the public. We have to take action and we don’t do so lightly – the assessments are done by two psychiatrists who recommend whether a doctor needs a form of restriction on their practice.
The question is, can we do it in such a way that we reduce the stress on those doctors? We’ve started looking at every step we take and we may be able
to do something within the confines of the current system, but a lot of it is dictated by an act of Parliament, and we won’t be able to change that without a law change.
What will the work entail?
We’ve already started mapping our process very carefully, looking at each stage that we go through. What we want Professor Appleby to do is to review that process and advise us on what we can do within our current legal powers, and also suggest any legal changes that we might seek from the Government in order to try to make the system better.
The GMC review called for a culture where doctors feel they are innocent until proven guilty. How can this be established?
I think this is largely around our written communications, although it’s also a question of ensuring staff are adequately trained and so forth. In a way, with these doctors there’s actually no ‘guilty’ at all.
We will certainly look, for example, at the role of our medical supervisors in terms of the support they provide and how they link up with local services to make sure the process is as joined up as we can make it, so the doctor feels supported. But I don’t want to mislead you. You can’t make this process easy. We have to investigate on the basis of trying to protect the public. That’s our first duty.
But you surely have a moral obligation to protect the doctors as well?
We have an absolute moral obligation to protect them, and we desperately want to do everything we can to try to make sure doctors who are undergoing our procedures feel as protected as we can make them. That won’t stop us making decisions about, for example, restricting a doctor’s practice, if we believe that is the right and necessary thing to do to protect the public.
How do you think the GMC can become more compassionate and sensitive?
We absolutely want to be as compassionate as possible with all doctors, not just those who have mental health problems. For the vast majority, if for example their clinical performance isn’t good, it’s not because they woke up one morning and said ‘I want to be a bad doctor’. What we may do feels, and is, punitive. But our objective is not to punish – that is a side product, regrettably, of what we have to do.
The way in which we treat doctors – while it absolutely has to protect patients – must follow the legal procedures that are laid down. We need to try to do that in as compassionate and sensitive a way as we can.
Complaints against doctors have been steadily rising over the past few years. Why do you think that is?
I think access to the GMC is much easier now. Going back 15 years, if you wanted to complain about a doctor to the GMC, you had to write it out and to get a notary to countersign in, whereas now you can simply go onto the internet. Also, people across all professions are more likely to complain than they ever were before. It’s a phenomenon we’re seeing internationally in medicine, but also in general – people are more challenging about decisions.
I think there is a question about making sure people with a complaint know where to go to get it dealt with at a local level. The stuff that comes to us really should be at the much more serious end. There is also a significant number of doctors who we open up investigations for because the law says we must. Then we subject that doctor and their family to a period of time when we’re putting them through an investigation, but at the end of it we say we’re not going to take any action. From the doctor’s point of view that’s awful, but from our point of view, we have to do it because the law says we have to do it. So we have to try to reduce the length of that period in any way we can.
According to GMC data, black and minority ethnic doctors are twice as likely to face sanctions by the GMC. Why do you think this is?
We know that those who are trained overseas can sometimes struggle with aspects of practice, and I think that raises real issues for undergraduate training in general, and indeed for the support that the whole system, including the GMC, can offer to doctors who come from another jurisdiction to practise here. So I think there is a recognition that cultural issues and other factors can lead to difficulties.
One area of concern for us is BME UK graduates, who again have slightly higher FTP rates. They do less well in terms in terms of postgraduate training and less well through their undergraduate years. It behoves us to keep this very much under review, to be absolutely clear and subject our staff to the right training to make sure that there is no unconscious bias on our part. We need to ensure, for example, that our FTP panels are as representative as we can possibly make them.
We’ve made significant advances to make sure the decisions that we do make are correct. I don’t pretend that we’ve absolutely cracked this. What I would say is that we’ve made some significant advances in our understanding, and we’re determined to look at every single stage of our procedure again to make sure it’s as fair as possible.
University of Edinburgh (MA, DipEd); Moray House College (CertEd)
1982-83 Editor, Therapy Weekly
1983-88 Editor, Nursing Times
1988-90 Health correspondent, BBC
1995-2004 Social affairs editor, BBC
2004-2009 Chief executive, The King’s Fund
2010-present Chief executive, General Medical Council