Is GMC investigation an ‘occupational hazard’ that doctors should accept?

Roger-Kirby

Doctors should expect to face a GMC investigation during their career as an ‘occupational hazard’ and build up resilience to deal with it, senior GMC executives have said.

Responding to MPs’ questioning in a House of Commons health committee hearing recently, the GMC’s new chair Professor Terrence Stephenson said that doctors seeing tens of thousands of patients during a 30-year career would get complaints and should be prepared for this while in medical training.

At the same meeting, chief executive Niall Dickson said that the plan for the future was for the GMC to have an ‘ongoing relationship’ with doctors regarding professionalism and driving up professional standards.

The comments come as GMC announced it is planning to introduce ’emotional resilience’ training and a national support service for doctors after an internal review found that 28 doctors committed suicide while under investigation by the regulator.

What are your views on these issues? Can one really teach doctors ’emotional resilience’ in the face of a GMC investigation? Please add your comments to this blog.

Comments (26) Add yours ↓
  1. Guy Webster

    This worries me.

    Patients should receive excellent care from excellent doctors. Unfortunately life isn’t perfect and ill health is one example. A doctor seeing tens of thousands of patients, some of them medically and emotionally complex, in a long career cannot be expected to succeed in both the medical outcome and the profesional relationship every time.

    Complaints will occur and a fair, rapid and honest mechanism to deal with them is right. Vexacious claims however by patients are also supported by taking a stance that the doctor is guilty and needs to prove his innocence. This flies in the face of UK law where the burden of proof is on the prosecution.

    Supporting doctors under investigation by the GMC is very welcome as it has thus far been lacking, according to many reports on the ill health and worse outcomes of those under investigation, and given the current media obsession with UK Heath Care/NHS/Standards the resulting exposure can be relentless, as some urologists have found.

    To state that GMC investigation is a given in a career is to make the negative and profoundly concerning allegation that either doctors are bad or that the process is unduly biased against the medical profession.

    It is difficult to retrain an adult ie doctor’s personality. Whilst emotional resilience can no doubt be influenced it cannot be retaught and this is approaching the situation from the wrong direction. We should raise the bar of medical care but also that of the ease of starting the GMC complaints procedure. The process of investigation can be changed, and should be in order to make it fair and better to both sides.

    It is not in the patient’s or society’s interest to have the medical profession trained to behave like, or worse still to be selected at interview, as for example an SAS officer is. Both may encounter very challenging environments and work to very high standards but they have rather different primary roles, with no disrespect intended.

    January 8, 2015 Reply
  2. Declan Cahill

    What an emotive subject. I have seen friends and colleagues subjected to the GMC process and it is brutal. The medical ethos of caring for the patient extends to the complaints process and they are very much put first. This is completely understandable until one sees some of the madness that is allowed to run on and on because it is not dismissed early enough by a robust and sensible body.
    Surgeons of course do have emotional training by default. Anyone who operates has complications. These are awful for the patient but also the surgeon. One has to learn to cope with the miserable self loathing and anxiety that stays with you 24 hours a day until the problem is solved and often much longer. One has to learn to compartmentalise this misery so you can look after this individual and keep on going for all your other patients. A school of hard knocks. Present to a degree for all doctors but more so for those that do it with a knife.
    We need a GMC complaints process. Patients must be protected from bad doctors. This needs to be separated from innate problems of a procedure such as an anticipated common complication or the rare disaster in the practice of an otherwise brilliant doctor.
    To do its job properly the GMC needs to start serving doctors as well as patients.

    January 9, 2015 Reply
  3. Simon Chowdhury

    Amazing that it has taken the GMC so long to recognise and instigate this. I always wondered what exactly we are paying our fees for and still do so. The GMC process is flawed, lacks transparency and the communication is poor. As Guy says the current stance is one of the doctor having to prove their innonence which is wrong. We all want the best care for our patients and a robust complaints process but I feel the balance is skewed at present. Complaints are stressful and time consuming. What support if any is given by NHS trusts and management? I feel this is another area that needs addressing as complaints are increasingly part of being a consultant. I welcome the new measures by the GMC but the fact that it has taken so long to introduce speaks volumes.

    January 10, 2015 Reply
  4. Matthew Bultitude

    Declan’s last sentence is very important [To do its job properly the GMC needs to start serving doctors as well as patients]. I too have seen colleagues undergo the investigation process only to be cleared months and most likely >1 year later. This is an incredibly long time for a doctors whole career to be ‘on the line’ and no wonder there are high rates of suicide and calls for better support. For all but the most serious complaints, the GMC need to streamline this process a maximum of 6 months. Support for the doctor also needs to come from hospital trusts as well who need to understand the intense pressure their employee is under.
    It would be interesting to hear the views of someone who has been unfortunate enough to undergo this process.

    January 11, 2015 Reply
  5. Roger Kirby

    28 suicides by doctors who were undergoing GMC investigation, that is a sobering statistic! Professor Stephenson states ‘I’m struck by how much the military invests in resilience training, and from talking to them I gather they don’t wait until they arrive in Helmand Province, they start in recruitment and training. And I think that is something we could think about exploring’. My own view is that doctors need more support when they are under investigation, rather than ‘resilience training’ as students. I recently wrote an article entitled Supporting the ‘second victim’ after a medical error for Trends, about the problems doctors experience after a medical error or a complication. We can all do more to help our colleagues in this situation, one problem is that they are often ashamed even to mention that they are being investigated.
    Unlike medics, soldiers get good support when they have a problem. They have welfare officers, the chain of command, they reduce the occupational workload, they have army welfare, a dedicated occupational health system, personal recovery units, etc. They also prepare for their deployments for a full 12 months ahead, and the families that are left behind are given an excellent support package.
    How much support are doctors provided with?

    January 11, 2015 Reply
  6. Sam Hampson

    As a urological surgeon who has been on the wrong end of a GMC ruling I should add comment. After a head injury I was declared unfit to practise and struck off the register. At no time did the GMC look at avenues whereby I could utilize the medical experience I’d learned. The principal concern was that someone with “cognitive impairment” should have no contact with the public, this defensive attitude ultimately impinges badly on clinical care and I can only endorse the comments, above, that the GMC should care for doctors.
    Sam Hampson

    January 12, 2015 Reply
    • Abeyna Jones

      Without knowing details about your head injury, I would have sincerely hoped that your case would have been reviewed by an Occupational Physician at some point in the process. There are extremely few reasons why anyone can’t work these days, and the fact you are able to write an extremely intelligent paragraph in this forum indicates as a minimum, that you have retained and can demonstrate several important functional capabilities relevant to medical practice.

      I don’t think any amount of emotional resilience training can prepare a doctor for GMC investigations. We spend our entire career trying to avoid what they are claiming is the inevitable, and we will all cope in different ways depending on the support structure we have in our personal and professional lives.

      What they could do is eliminate or lessen the stigma associated with undergoing investigation, depending on its nature, provide multi-disciplinary support options from the get-go, and avoid vilifying any doctor until proven guilty.

      January 14, 2015 Reply
  7. Julian Shah

    There is a lack of understanding of the complaints process whether local, legal or national. We all have a fear of the legal process. It can be shrouded in mystery and takes a tortuous path to reach the end. A better understanding of why patients complain, what to do when things go wrong and how to deal with them would make a difference to the emotional response which is natural and has affected most if not all of us at some time or another. It is probably true to say that a fuller understanding of risks and complications probably reduces both. Thus more education about these issues for all health professionals is necessary along with better support when things do go awry.

    January 12, 2015 Reply
  8. Jonny Coxon

    Some wise comments here already.

    I think we all agree that we need a powerful and efficient body in place to deal with genuine cases of negligence, where clear bad practice can be demonstrated. it has to be accepted that that will be more clear in some cases than others.

    But we also unquestionably need that body to understand the huge emotional turmoil its investigations can impose on doctors who may have practised to the best of their ability, often meeting all the criteria of the Bolam test and falling some way short of negligence, but where outcomes have sadly not met with the understandable expectations of patients or their families.

    We all know the overwhelming majority of decisions and actions we undertake in our practice are done with the best intentions for the patients, often at the expense of our own increasingly strained workload. It is essential that we are given ample opportunity to explain those intentions, both to others and to remind ourselves.

    I think the support provided by the proposed national service is a step in the right direction, and I hope it will be combined with faster and more efficient processes for all GMC investigations, of all degrees of severity. If this can be secured along with a step-up in dissemination of lessons to be learnt when things have not gone to plan, in the numerous ways that this can arise, the GMC can be shown to increasingly represent the welfare of the profession as well as its patients.

    January 12, 2015 Reply
    • Declan Cahill

      From a practical service improvement point of view it would seem pretty easy for the GMC to audit their workload and staff it appropriately. That so many doctors are left in limbo for so long may be the case for many reasons but I hope it is not a shortage of processing manpower. If so it should be addressed. Whether a doctor has come up short and especially if not, surely it is best to address these issues promptly.

      January 12, 2015 Reply
  9. Noor

    This below is a very insightful article by Dr Maria Jalmbrant

    http://www.bmj.com/content/349/bmj.g5744/rr/771934

    The GMC consultation on regulation suggests the regulator has ambitions to be a punitive body based on “maintaining public confidence”, whilst the proposed regulatory changes may harm doctors and patient care.

    Walshe and Archer call for support for proposed changes in medical regulation. The GMC recently produced a public consultation on sanctions guidance [1]. This document is a concern, as the questions simplify issues substantially and remove any ambiguity relating to the “correct” way to respond. Using simplistic case studies, the GMC invites people to make judgements about fairness on the specific cases and not the real effects of the proposals. Whilst there are no fixed rules, there are ethical recommendations that may have been violated.

    The GMC justifies further intrusive oversight on the basis that “public confidence” in the profession needs to be protected. This is at odds with a recent MORI pole showing public opinion of doctors has been high and stable for 25 years [2]. So who determines “public confidence”?

    Changes envisaged by the GMC seek to extend the regulator’s power and influence to an alarming degree. Clause 65 of current ‘Good Medical Practice’ states doctors must: “make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession” [3]. As the meaning of “your conduct” is not restricted, in effect it applies to any conduct in both a doctor’s private as well as working life. Does clause 65 overstep a doctor’s Article 8 rights [4] of the Human Rights Act to respect their private life?

    The GMC seeks to investigate and/or impose sanctions without accounting for the personal consequences for doctors. I would argue the GMC in its regulatory role acts as an arm of the state, yet wants to act without regard to the impact of their investigations and sanctions on individuals. This when there are serious questions about suicides amongst doctors subjected to GMC proceedings. Furthermore the GMC is aware of data showing significant increases in depression, anxiety and suicidal ideation amongst doctors subjected to actions by them and other bodies. Surely the GMC and doctors on their panels have a duty of care to individuals they are investigating, particularly from vulnerable groups (e.g. those with mental illness).

    Article 6 of the Human Rights Act specifies that for all civil proceedings citizens should have the right to a fair trial so any court/tribunal must be independent and impartial4. Yet members of GMC fitness to practice (FTP) panels apply to be members and so must see value in their involvement with them. All panels have a legal assessor appointed by the GMC. Furthermore panels must have regard to the GMC’s indicative sanctions guidance so are not free regarding the actions they take. Finally it might be argued that imposing sanctions reflects the GMC acting “effectively” and justifying its existence. These arrangements are likely to introduce both imputed and actual bias making GMC proceedings at odds with natural justice. Given the GMC makes decisions that fundamentally impact on individual’s rights, the regulator must surely have a duty to act judicially.

    Fundamental to a free trial is that defendants can present their case and challenge any case made against them. However the GMC appears to interpret challenging them as evidence that a doctor lacks insight. The new GMC consultation document clearly indicates that by defending a claim made against them, doctors run the risk of incurring higher sanctions. The risk with the GMC’s proposed approach is similar to those seen with plea-bargaining in the United States. Blume and Helm raised concerns about this system [5]. Innocent defendants may plead guilty because they fear Draconian consequences should they lose their case in court. There are examples of defendants pleading guilty to murders they have not committed to secure release, the “Alford plea”. As Alford said, “I just pleaded guilty because they said if I didn’t, they would gas me for it.” Doctors may be tempted to do the same and accept sanctions rather than face hearings in which they have no confidence, furthermore the timescale of the regulators glacial processes means sanctions may seem preferable to having one’s life put on hold for months. This is not natural justice.

    What if doctors recognise a problem in their practice and take action to put things right so there is no longer a risk to patients? For example a surgeon who stops particular procedures or seeks further training. The consultation document suggests this is not sufficient. The GMC wishes to punish doctors in these circumstances despite any threat to the public no longer being present. How does this protect patients? The GMC is aligning itself with organisations that deal with criminal behaviour where punishment is often said to have the purpose of retribution, incapacitation, deterrence and rehabilitation. Although “rehabilitation” seems missing from the regulators ambitions. Why sanction doctors who have shown “insight”, changed their practice, and expressed regret for their previous errors? Even if there is no longer a risk, the GMC now seeks to act as prosecutor, judge and jury in order to punish doctors. This is a fundamental departure from the current system.

    Against this backdrop there must surely be significant evidence showing investigations and sanctions imposed by the GMC protect patients. As far as I am aware there is none. We hear a great deal about the culture of fear, lack of transparency and blame that exists in the NHS [6]. This starts at the top with the regulator. The consequences of the existential threat doctors feel is rarely considered. How does this affect how doctors practise medicine and the treatment received by patients [7,8]? There is evidence suggesting the answer is that doctors practice very defensively. This includes avoiding difficult procedures and complex patients, over prescribing and over referral. This is not in patients’ interest. Any intervention unless carefully assessed carries risks of unintended consequences. Those by the GMC are no different and it is entirely plausible that the regulatory structure run by the GMC causes harm to more patients than it protects.

    There is a different way to regulate doctors based on trust, transparency and professionalism. Medical regulation needs a radical rethink in the United Kingdom not an untested larger dose of the same oppressive oversight.

    References
    1. GMC consultation: Reviewing how we deal with concerns about doctors – A public consultation on changes to our sanctions guidance and on the role of apologies and warnings https://gmc.econsultation.net/econsult/consultation_Dtl.aspx?consult_Id=… (accessed 28th September 2014)

    2. MORI poll on public confidence in professions December 2013 http://www.ipsos-mori.com/researchpublications/researcharchive/15/Trust-… (accessed 1st October 2014)

    3. GMC good medical practice http://www.gmcuk.org/guidance/good_medical_practice.asp (accessed 28th September 2014)

    4. Human Rights Act 1998 http://www.legislation.gov.uk/ukpga/1998/42/schedule/1 (accessed 28th September 2014)

    5. Blume, John H. and Helm, Rebecca K., “The Unexonerated: Factually Innocent Defendants Who Plead Guilty” (2014). Cornell Law Faculty Working Papers. Paper 113.
 http://scholarship.law.cornell.edu/clsops_papers/113
    6. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry February 2013. Chaired by Robert Francis QC. http://www.midstaffspublicinquiry.com/report (accessed 1st October 2014)

    7. Studdert DM, Mello MM, Sage VM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 2005;293:2609-17.

    8. Nash L, Walton M, Daly M, et al. GPs’ concerns about medico legal issues: How it affects their practice. Australian Fam Physician; 2009; 38: 66-70

    Competing interests: No competing interests

    January 12, 2015 Reply
    • Peter Herbert

      Excellent and comprehensive statement. Thank you.

      January 14, 2015 Reply
  10. Mike Kirby

    Rather than building up resilience, perhaps the approach should be to make the whole process faster and much less stressful!!

    January 14, 2015 Reply
  11. Tim Terry

    With 28 doctors commiting suicide whilst under investigation by GMC one has to ask who investigates the regulator as clearly they are not currently fit for purpose. Whilst doctors do need support (I prefer the term mentoring to emotional resilience) what is also required is an urgent need to change the way the GMC operates against allegations made about doctors. At the very least their turnaround times are appalling as is the standard used to decide hearings. Beyond all reasonable guilt should be the standard when the penalty is removal from the medical register. Whatever happened to mediation with key stake holders before the legal process begins? One also might question who benefits in the current process and whether this might be made more effective.

    January 15, 2015 Reply
  12. Tom Rosenbaum

    This is an excellent blog as it promotes reflection and debate in our profession. The goal posts are clearly moving, patients are much more informed, expectations are changing and the managers have been thrown at us. It took us ages to recognise that be can no longer stand by in isolation and ignore it. We must get involved and participate in our social and political affairs. This blog is a step in that direction. I hope that it helps us to learn, to be less selfish, to take the long view and to unite to defend the role and values of the medical profession in our society. That will make us stronger which is essential to make our voice heard at all levels, including the GMC.

    January 15, 2015 Reply
  13. David Redman

    It is too easy to be reported and the complainant suffers no ill should it be dismissed. Having been reported I feel great animosity towards the complainant and only wish that I could countersue. My complaint was dismissed but those nice people at the GMC said that it remains on the record anyway .The amount of work and worry engendered is awful. I did not know that you could teach resilience.

    January 15, 2015 Reply
  14. Mike Bailey

    I was fortunate that in 40 years of NHS practice, I did not have to face a GMC inquiry. I did, however, have to respond to the GMC regarding doctors at the hospital where I was medical director for 6 years.

    I do not think the GMC has any concept of how stressful this can be for a doctor. With the exception of very rare individuals, none of us go to work with the intention of harming patients. I have come across individuals who are bullies, and this may warrant the attention of the GMC, as of course does fraud, inappropriate relations with patients and one or two other misdemeanours.

    One particular example of GMC heavy handedness and its unforeseen consequences:

    An SpR was consenting a patient whose partner was a GP. The Spr took a textbook example of consent, highlighting the risks of the procedure, which in this case included death. The partner, who had initially demanded that he should sign the consent and that his wife should not be troubled by having to worry about the process, complained to the GMC. Instead of throwing the case out (and teaching the GP about consent) they investigated the SpR. This took nearly two years, during which time the SpR should have been applying for consultant posts but was effectively stopped from doing so by the box on the application form ‘are you the subject of a GMC inquiry’

    I feel the GMC process needs to be better targeted, more expeditious and that those being investigated need better support,

    January 16, 2015 Reply
  15. John C

    A colleague of mine is facing an investigation in the first year of a Consultant post. A patient didn’t agree with the outcome of a consultation and rather than go back to the GP for clarification or get a second opinion, they wrote off to the GMC complaining about the Consultant’s attitude. I am sure the complaint will be thrown out eventually but my colleague has been severely affected in many ways. I am helping them through but there has been little or no support from the hospital. The process needs speeding up and part of our subscription needs to go towards an independent telephone helpline for real support during the process.

    January 17, 2015 Reply
  16. Mike Kirby

    BMJ Open published yesterday details the size of the problem!!!!

    The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey
    Tom Bourne, Laure Wynants, Mike Peters, Chantal Van Audenhove,
    Dirk Timmerman, Ben Van Calster, Maria Jalmbrant
    BMJ Open 2015;4:e006687. doi:10.1136/bmjopen-2014-006687

    ABSTRACT
    Objectives: The primary aim was to investigate the impact of complaints on doctors’ psychological welfare and health. The secondary aim was to assess whether doctors report exposure to a complaints process is associated with defensive medical practise.
    Design: This was a cross-sectional anonymous survey study. Participants were stratified into recent/current, past, no complaints. Each group completed tailored versions of the survey.
    Participants: 95 636 doctors were invited to participate. A total of 10 930 (11.4%) responded, 7926 (8.3%) completed the full survey and were included in the complete analysis.
    Main outcome measures: Anxiety and depression were assessed using the standardised Generalised Anxiety Disorder scale and Physical Health Questionnaire. Defensive practise was evaluated using a new measure. Single-item questions measured stressrelated illnesses, complaints-related experience, attitudes towards complaints and views on improving complaints processes.
    Results: 16.9% of doctors with current/recent complaints reported moderate/severe depression (relative risk (RR) 1.77 (95% CI 1.48 to 2.13) compared to doctors with no complaints (9.5%)). Fifteen per cent reported moderate/severe anxiety (RR=2.08 (95% CI 1.61 to 2.68) compared to doctors with no complaints (7.3%)). Distress increased with complaint severity, with highest levels after General Medical Council (GMC) referral (26.3% depression, 22.3% anxiety). Doctors with current/recent complaints were 2.08 (95% CI 1.61 to 2.68) times more likely to report thoughts of selfharm
    or suicidal ideation. Most doctors reported defensive practise: 82–89% hedging and 46–50% avoidance. Twenty per cent felt victimised after whistleblowing, 38% felt bullied, 27% spent over 1 month off work. Over 80% felt processes would improve with transparency, managerial competence, capacity to claim lost earnings and action against vexatious complainants.
    Conclusions: Doctors with recent/current complaints have significant risks of moderate/severe depression, anxiety and suicidal ideation. Morbidity was greatest in cases involving the GMC. Most doctors reported practising defensively, including avoidance of procedures and high-risk patients. Many felt victimised as whistleblowers or reported bullying. Suggestions to
    improve complaints processes included transparency and managerial competence.

    January 17, 2015 Reply
  17. Roger Kirby

    Very recently there has been a call for more support for vulnerable doctors and a speeding up of the GMC’s fitness-to-practise procedures. The impact of complaints procedures on the welfare, health and clinical practise of doctors, published in the BMJ Open, reported that 80% of doctors who had experienced a complaint in the past changed their clinical practice as a direct result.
    The report, which included feedback from 7,926 doctors, revealed that such defensive practice following a complaint being made led to some doctors ‘acting against their professional judgement’, and deploying methods such as ‘hedging’ – overprescribing and referring more patients for specialist opinion.
    It found that of the 3,889 who had a past complaint, 79.9% changed the way they practised medicine, 82.6% displayed hedging behaviour 42.9% displayed ‘avoiding behaviour’ while 23.2% ‘suggested invasive procedures against professional judgement’.
    Even the 1,780 doctors who had not suffered a complaint – but whose colleagues had – said they changed the way they practised medicine as a result of the complaint (72.7%), with 81.7% displaying hedging behaviour, 46.1%displaying avoiding behaviour and 20.2% saying they had recommended invasive procedures against their professional judgement.
    The researchers said that this trend could adversely affect patients, concluding: ‘These behaviours are not in the interest of patients and may cause harm, while they may also potentially increase the cost of healthcare provision.
    ‘Our data also show the vast majority of doctors who took part in the study reported engaging in defensive practise. This included carrying out more tests than necessary, overreferral, overprescribing, avoiding procedures, not accepting high-risk patients and abandoning procedures early.’
    The researchers also found that doctors subject to a complaint in general are at significant risk of becoming severely depressed and suicidal, with 15.6% of doctors who had received a recent formal complaint reporting they were ‘moderately to severely depressed’, compared with 12% who had received an informal complaint and 9.5% of those who received no complaint.
    In addition, 9% of doctors who received a formal complaint had thoughts of self-harm, while 13.5% suffered from moderate to severe anxiety – both significantly higher than doctors who had received no complaints. Doctors who had undergone a fitness-to-practise hearing were significantly more likely to suffer all forms of psychological distress.
    There are surely important lessons be be learned here?

    January 18, 2015 Reply
  18. John Mcknight

    Interesting article. It is concerning the depths the GMC process has taken people. More worrying is the many who look set to follow. Patients need to be protected but presumed guilt is not a good starting place.

    February 5, 2015 Reply
  19. Roger Kirby

    The GMC has just published its own very worrying report into suicide among doctors under its “fitness to practice” review. Between 2005 and 2013, 28 doctors died as a result of suicide:, nine during 2013 alone. Of these 28, twenty were men, two thirds were younger than 50 and, tragically, two were trainees. In nearly half the investigation procedures had taken more than a year at the time of the deaths. Although suicide risk had been highlighted in some cases, in most instances there was a specific record that there was no known risk.
    This GMC report highlights a wide range of concerns. These include the style and nature of the fitness to practice procedure, the nature and effects of the GMC communications to doctors under investigation and the prolonged length of time involved.Other problems identified included the need greater recognition of factors that may contribute to complaints or referrals such as marital breakdown, legal issues, workload and burnout. Failure to utilise local review processes before referral to the GMC as well as inadequate support of doctors who are under GMC investigation were also identified as problematic.
    One does wonder whether the current bid to increase the powers of the GMC is in order, at least until it puts its own house in order?

    February 28, 2015 Reply
  20. Roger Kirby

    Maria Jalmbrant cogently points out in a letter to the BMJ (BMJ 2015;350:h14390) that “the study of 7926 doctors who had undergone GMC investigation indicates that they would like a strict time limit on the complaints process, appropriate resourcing of investigations and clearer more transparent communication. Many doctors felt that they were assumed guilty until proved otherwise and called for this to be reviewed.
    Provision of a support service for doctors is a laudable concept. However the real issue is that there is simply no justification for doctors to be made sick, indeed suicidal, by poor processes, whether by the GMC or hospital trusts. The glib statement that such processes are “inevitably stressful” understates the impact on doctors and may lead to patient care being compromised through defensive practice and a distressed and demoralised workforce”.
    I wholeheartedly agree!

    March 22, 2015 Reply
  21. Roger Kirby

    Rather under the radar, parliament has recently approved changes to the law to give the UK General Medical Council the right to appeal to the High Court if it considers that doctors have been treated too leniently by regulatory panels. A new order made under section 60 of the Health Act just days before parliament was dissolved, gives the GMC right of appeal and makes changes to speed up its current snails-paced disposal of its cases. The GMC pledged to press the new government to progress the reform of the regulatory framework. Niall Dickson admitted that “The law that governs the regulation of healthcare professionals is outdated and change is overdue’. It is to be very much hoped that any changes introduced will allow the organisation to act with more celerity and efficiency, and to be more responsive in supporting improvements in medical practice.

    April 4, 2015 Reply
  22. Roger Kirby

    The University of Plymouth researchers conducted a review of GMC guidance, criteria documents, and 187 randomly selected case files. The researchers said that they found no evidence of “bias or discriminatory practices” and that the GMC’s decisions were “appropriate.”

    They wrote, “Whilst some parts of the guidance and criteria documentation do reference specific doctor characteristics—notably the doctor’s stage of career, their health and their cultural background—these references are either in the context of discussing factors which could genuinely impact upon a doctor’s fitness to practise or on ensuring that doctors are not disadvantaged within the fitness to practise system.”

    But the researchers did say that there was a need for “greater clarity and transparency” in fitness to practise procedures. They said that, although in some cases a decision seemed appropriate for the circumstances of the case, “the rationale for it was incomplete or unclear.” They said, “Improving the consistency of decision writing and recording, particularly by increasing direct references to the guidance and criteria applicable, would enhance the defensibility of the procedures and the accountability of decisions made within it.”

    References
    Regan de Bere S, Bryce M, Archer J, Lynn N, Nunn S, Roberts M. Review of decision-making in the General Medical Council’s fitness to practise procedures. Dec 2014. http://www.gmc-uk.org/21_01_15_CAMERA_Final_Report_FTP_Review.pdf_60065721.pdf.

    April 4, 2015 Reply
  23. Roger Kiry

    General Medical Council’s response to the Queen’s Speech
    Niall Dickson, Chief Executive of the General Medical Council, said:
    ‘We are deeply disappointed that the government has not taken this opportunity to improve patient safety by modernising the regulation of healthcare professionals.
    ‘The UK Government, the devolved administrations and indeed all the main political parties have stated their commitment to reforming our legislation to enable effective, independent regulation. The Mid-Staffordshire inquiry highlighted the vital importance of effective regulation focussed on promoting safe, compassionate patient care rather than, as too often in the past, intervening only after patients have been harmed.
    ‘In spite of all we have done to reform our services, the truth is that patients, professionals and the health service as a whole will now be left with a system everyone accepts is outdated and not fit for purpose.
    ‘I hope the government will make these reforms a priority and introduce legislation as soon as possible. If taken forward, the draft Bill by the Law Commissions of the UK would allow us to respond more quickly and effectively to protect patients and maintain the standards of good medical practice. By streamlining and reducing the burden of regulation, the Bill would also help to drive down costs and help all health professionals to focus on providing the best care for patients.
    ‘We are committed to introducing a series of further major reforms to protect patients more effectively, but our current legislation makes this impossible. We do understand that the government wants to concentrate on the huge pressures on services and on front line professionals but we very much hope these important and long overdue reforms will be taken forward as soon as possible’.

    May 28, 2015 Reply

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