Time to reform the regulator
Urgent fitness-to-practise improvements are needed at the GMC to ensure doctors get a fair hearing, says Dr Udvitha Nandasoma.
In 2021, the GMC received more than 9,000 fitness-to-practise inquiries from the public, employers and other sources.
While the vast majority (7,401) were closed at the initial triage stage, that still means more than 1,000 registrants found themselves under scrutiny by the regulator.
When you consider that there were over 350,000 on the register in 2021, the number of investigations is small.
But the fear of becoming involved in an investigation is palpable and the impact on affected doctors is significant.
Unfortunately, the investigation process is often protracted and distressing and there is also a real anxiety about whether the outcome will be fair. This is borne out by recent events.
The GMC has been criticised for its handling of the case against one of the MDU’s GP members. A GMC-commissioned independent learning review of the case reported recently.
This is the latest in a number of reviews into fitness-to-practise investigations. All point to the need for reform of the current system – something the GMC itself wants to see.
Key recommendations
Prof Iqbal Singh and Martin Forde KC concluded in the recent review that the case should not have been taken forward and that ‘the GMC missed multiple opportunities to stand back and assess whether the allegations were serious enough to be referred to a tribunal’.
The report’s recommendations – accepted in full by the GMC – include:
The need to collaborate with other organisations to produce a local resolution approach first to avoid unnecessary referrals;
Embedding a culture of professional curiosity among staff;
Considering how to ensure decision-making is fair and unbiased.
Significantly, the authors recognised that ‘referral to the GMC is hugely stressful and traumatic for any doctors, irrespective of the outcome.
‘They often feel trapped, humiliated and ill-treated. Going through such an experience affects not only their physical and mental well-being but also their wider families.’
First-hand experience
This chimes with the MDU’s first-hand experience of supporting doctors with GMC investigations, whether they are GPs or consultant specialists.
Our members look to us to listen, provide a robust defence and help with services like our peer support network, which links them to others who have been in their shoes.
However, our advisers and lawyers often find it painful to witness the emotional toll that the gruelling fitness-to-practise process takes on members, their families and colleagues.
We welcome the GMC’s apology to the doctor in this case and we will continue to do everything possible to stand up for members in this difficult situation.
Concerns about the fitness-to- practise process are not new. A growing number of reviews have looked into the GMC’s procedures over recent years and pointed to the need for more compassionate and flexible regulation.
These include the Hamilton review into gross negligence manslaughter and culpable homicide (June 2019) and the Horsfall report (December 2014) into doctors who commit suicide while under investigation.
Reforming the system
In responding to the latest review, the GMC’s chief executive Charlie Massey said the regulator ‘shared the aspiration of the review’s co-chairs that modern regulation should contribute to a better health system which is compassionate, fair and supportive’.
We would add ‘completed as quickly as possible’ to that list. Regardless of the support afforded to any doctor, an ongoing GMC investigation inevitably adds ongoing stress and anxiety that, at present, can sometimes go on for years.
We do, however, recognise that the GMC’s hands are tied when it comes to some aspects of reform of the system for regulating healthcare professionals.
Frustratingly, while the then Government was set to introduce the legislation needed to modernise regulation this year, it has been delayed.
Recommendation 18 of the review says: ‘The UK government should bring forward legislative reform for the regulation of healthcare professionals at the earliest opportunity.
‘This would enable our recommendations of compassionate, supportive, fair and proportionate regulation, by allowing the GMC to dispose of appropriate fitness-to-practise cases consensually.’
If the Government is looking for a policy that can demonstrate its commitment to doctors’ well-being and help workforce retention, then fast-tracking GMC reform in 2023 would be an excellent choice, as most of the groundwork has already been done.
As we have repeatedly said, all doctors deserve a regulatory system that is proportionate, timely and fair, while underpinning safe care. The current system falls far short of this standard.
What to do if the GMC comes calling
Involve your medical defence organisation as soon as you are aware of a GMC complaint
The evidence shows doctors have a better outcome with legal representation. Between 2016 and 2020, MDU solicitors representing members at tribunals achieved no finding of impairment in 42% of cases compared to the GMC average of 21.5%
Speak to your medical defence body before responding to a complaint or adverse incident, then write a statement of what happened while events are fresh in your mind
Get support from colleagues, your family or your GP, while respecting patient confidentiality
Take time to reflect on what you have learnt and what you would do differently. Evidence of insight and professionalism is an important element of resolving any fitness-to-practise concern
Dr Udvitha Nandasoma (right) is head of advisory services at the Medical Defence Union