The recent Bourne report reinforces what I know from my clinical experience as medical director of the NHS Practitioner Health Programme (PHP); doctors who are undergoing investigation by the GMC are significantly more likely to suffer anxiety, depression and have thoughts of self-harm.
The report identifies increased defensive practices among those being investigated, which ironically doesn’t improve patients’ health or protect them from being complained about – in fact it probably increases the risk. Indeed, doctors who are able to continue working tell me they order more blood tests, make extra referrals and issue additional prescriptions as they enter this state of hyper-vigilance.
I run the Practitioner Health Programme in London, which is a confidential, NHS treatment service for doctors, dentists who are unable to access confidential care through mainstream NHS routes due to the nature of their role and/or health condition. We see many doctors who have been referred to the GMC for mental health problems, minor transgressions or even by a disgruntled or jealous colleague.
The current regulatory process assumes a doctor is guilty until proven otherwise. Additionally, there is no distinction made between ill doctors and those being referred for issues of conduct. It can take years for the process to be completed and in this time many become traumatised and often unable to work. The process takes a huge toll professionally, psychologically and sometimes financially – if doctors weren’t ill at the beginning of the process they can often become ill during the investigations.
Doctors live in terror of receiving a legalistic and accusatory-sounding letter from the GMC, so I welcome the new measures to soften the tone of letters sent to GPs under investigation. Doctors are unclear about what to expect from the process – how long will it take, what the likely outcomes are, whether or not it will affect their career. All doctors should be assumed at risk of self-harm when they receive a GMC letter – and it’s important that correspondence between them and the GMC (especially in the early days) reflects this.
There needs to be a distinction between those who do the investigating and those who decide upon the outcome
The GMC has now publicly acknowledged that there needs to be a distinction between those who do the investigating and those who decide upon the outcome. The Medical Practitioners Tribunal Service (MPTS), the panel that now makes decisions on the FTP cases, is to become a statutory committee of the GMC in order to enhance this separation.
But I am not sure whether this goes far enough – how can you be completely independent from an organisation that funds you and to whom your chair is accountable?
The GMC can appeal MPTS decisions – so far so democratic – but it’s not clear who will fund this. It’s also important to consider the impact the delays created by the new system will have on the doctor under investigation.
The GMC should start a review of practices and procedures that includes:
– a review of the time taken and the inherent delays in the process
– the separation of administrative and clinical incidents
– the separation of issues of conduct and ill health
– the training and competence of case assessors
– the development of a better balance between remediation.
I also asked the GMC to publish a clear explanation of which types of procedures are applied to each type of complaint and called for it to audit the impact of investigations on individual doctors and include how sanctions affect a doctor’s career.
Around one in 28 of us every year can expect to be referred to the GMC – this is equivalent to at least one a week in a large NHS Trust. We all know of a colleague, if not ourselves, who has been referred to the GMC so either firsthand or secondhand we all know it’s not going to be a good experience. Doctors feel that speaking out about the delays, uncertainty, inconsistency and stress caused by the investigation will have some sort of adverse comeback. The frustration described by doctors is often echoed by patients who raise concerns about how they feel about the process, which demonstrates that this is not productive for doctors or patients.
No one is arguing against regulation but we need a system that is fair, consistent, transparent and not unnecessarily long. Only a system that is sensitive and supportive can improve the health of doctors and their patients.
Professor Clare Gerada is the medical director of the NHS Practitioner Health Programme (PHP) and former chair of the RCGP.