Recent changes to the GMC’s fitness to practise process
28 Sep 2016
Fitness to practise procedures in the GMC are starting to look different, which is good news for doctors who have found themselves in the middle of these long, trying investigations.
The changes come after a heavy period of review and consultation. An independent review into cases of doctors committing suicide when under investigation by the GMC was chaired by Prof. Louis Appleby, Professor of Psychiatry of the University of Manchester and another review, led by Sir Anthony Hooper, examined the way that the GMC engages with whistleblowers. Alongside these reviews was a workshop that ran with the aim of reducing the impact that GMC fitness to practise investigations have on doctors.
As a result of these initiatives, the GMC’s investigative processes are undergoing a much needed makeover. The changes come with a number of objectives:
- To reduce the overall number of investigations.
- To reduce the stress caused by any investigation.
- To make a consensual conclusion the preferred outcome.
- To give better protection to doctors who raise concerns about patient safety.
- To promote better support for doctors, especially mental health services.
Reducing the number of investigations
A significant change is that the GMC will not open a full investigation where there is an allegation that a doctor has made a mistake that involves substandard clinical care. Instead of starting a full investigation, the GMC will collect relevant information. If their information shows that the mistake was a one-time thing – a ‘single clinical incident’ – and the doctor accepts that they made an error and shows that they have taken measures to prevent the incident occurring again, the GMC will close the case. In this way, a full investigation can be avoided.
This change to the GMC’s procedures will be piloted in a few areas of the UK for the next six months. It is hoped that it will lead to a reduction in doctors’ stress and that it will free up GMC resources due to a reduced need for full-blown fitness to practise investigations.
At present, doctors can be forced to wait for a long time to find out what may or may not happen to them as a result of an investigation, as the strain on GMC resources prevents quicker resolutions. Last year’s figures suggested that an average investigation lasted for eight months (254 days). Changes that free up resources for necessary investigations are definitely welcome for all involved.
Better protection for whistleblowers
Any body that refers a doctor for a GMC investigation will have to state whether that individual has previously raised concerns about patient safety and declare that their complaint is being made in good faith. This is a key part of the GMC’s mission to afford whistleblowers better protection.
If this change is successful, it will reduce the risk of any whistleblowing doctors becoming the subject of a later referral or investigation. In the past, doctors have been reluctant to raise concerns about patient safety due to the political environments that many find themselves in and the fear of disadvantaging their professional reputation, careers and standing with the GMC.
Further changes to the investigations
Various stakeholders attended a workshop in May on behalf of doctors and numerous healthcare organisations with the aim of improving the current fitness to practise process. As a result, more changes have been suggested to work alongside the pilots already mentioned.
A report, published in December 2014 by Professor Appleby of the University of Manchester, found that 24 doctors were known to have committed suicide during a fitness to practise investigation since 2006. Because of this tragic fact, the primary aim of the workshop was to look for ways to reduce the stress that doctors feel when under investigation, ideally by making the process simpler.
One key area of focus was communication. Alongside the proposed reduction in investigations off the back of single clinical incidents, a recommendation from the workshop was that there needs to be clear explanations of the new enquiries system and what distinguishes an investigative enquiry from a full-blown investigation. Otherwise, confusion as to the severity of the enquiry/investigation could lead to the stress that the new system is designed to avoid.
Also recommended were better guidelines on a local level to allow Trusts and other employers to deal with cases more efficiently. This would be accompanied by better information on when a local case needs to be transferred for a more thorough, regulatory investigation.
Another point was that doctors need to be given more frequent updates during a fitness to practise investigation. The workshop also suggested starting various stages of the investigation earlier, proposing pre-hearing conferences away from the GMC or even over the telephone as ways to smooth the process further.
Where a doctor’s health is the core issue in a case, it was recommended that case coordinators be assigned to be a primary point of contact for the doctor under investigation, providing clarity that didn’t exist before. With regards to these cases in particular, it was agreed that full-scale investigations should be avoided if at all possible. It was also agreed that the option to bring in more extensive medical input would be helpful in these instances.
Again, the end goal of concluding cases with a consensual agreement was brought up as the preferred outcome of any investigation.
Also discussed were improvements to the confidentiality of the process, particularly which stages of an investigation should be kept confidential. In light of other changes discussed, it was acknowledged that tightening confidentiality would be tricky, especially in situations where outside help is being sought for the benefit of the doctor. It was agreed that there must, at least, be clear explanations of what it is necessary to keep confidential.
When will we start to see these changes?
At the time of writing, some of these changes are already being piloted, and we will see more in 2017. Some of the proposals will require changes to the current legislature, which will increase the amount of time it will take for them to come into force. In all these cases, the intention is to provide better support for doctors during a potentially stressful and anxious time.
What do the changes mean for doctors?
If the pilot schemes that are being implemented are shown to be successful, fitness to practise investigations will be reduced in number and those that go ahead will be much less stressful. However, this doesn’t change the fact that it is still advisable to seek legal advice as soon as possible, once a doctor knows they are the subject of a GMC investigation.
Doctors can always rely on our extensive experience when it comes to regulatory investigations. Our expert solicitors can support you at every stage, including drafting a response to the GMC, representing you at interim orders hearings and at a fitness to practise hearing, should it be necessary. We will provide a robust defence and provide persuasive mitigation if it is beneficial to do so.
A number of pages have been linked to throughout this news article that will provide you with up to date information on the subjects mentioned here. If you know that you are the subject of an upcoming investigation, contact the MedicAssistanceScheme using the form on the right.