GMC: Making Fitness to Practise fit for practice
The General Medical Council (GMC) has implemented changes to their Fitness to Practise processes in an effort to reduce the impact and stress of their investigations on doctors. The proposals come at a time when self-reported mental health cases are at their highest in the healthcare sector.
In 2015 the GMC commissioned a review by psychiatrist Professor Louis Appleby into how the fitness to practise process could be changed to reduce stress on doctors. This followed a 2014 report on doctors who committed suicide whilst under GMC investigation which recommended that:
“the fitness to practise process be reviewed from a doctor’s viewpoint to identify aspects of the process that have a direct effect on their wellbeing.“
The result of this review is a series of proposals covering each step in the process from initial complaint to referral to a tribunal.
The proposals include:
Reducing the overall number of full investigations by conducting provisional enquiries into complaints. The aim is to complete these enquiries within 63 days.
The Judge found that to be an unacceptable change of evidence given the clear and unequivocal witness evidence of the claimant and her husband that those matters had never been mentioned or raised by the defendant ‘at all’. Indeed, that dramatic change of evidence as well as video surveillance evidence led the defendant to seek a finding that the claimant was fundamentally dishonest. In the event, the Judge found the claimant and her husband to be unreliable, but not dishonest witnesses.
Reducing stress in all investigations through changes to process, communication, and duration. Doctors will now be provided with one sole point of contact at the GMC, whose staff have also received training in order to improve the support and communication they provide.
Pursuing consensual conclusion as the preferred outcome. Where the GMC and doctors agree to restrictions necessary to protect patient safety, a tribunal referral can be avoided.
Expanding support for doctors during the fitness to practise process. In conjunction with the BMA, the GMC are promoting the Doctor Support Service for those under investigation.
Promoting the need for a national mental health service for doctors. A service already exists for GPs, but the GMC is advocating a service be made available to all doctors.
The GMC has already implemented a number of the proposals. Others would require legislative amendment.
A major focus is on minimising the potential negative effects on doctors’ mental health. This is timely given Clyde & Co.’s recent analysis which demonstrates that self-reported work-related mental health cases are at record levels. The data from this study ranked the health and social work sector as having the highest prevalence of self-reported mental health problems.
The GMC is currently reviewing a number of its policies and procedures in other areas. They are also reviewing their sanctions guidance with a view to improving both the content and layout. In April 2018 they launched a major project to better understand why some doctors are referred to them for fitness to practise issues more than others. This follows an appreciation that there is an over representation of black and minority ethnic (BME) doctors being referred.
The GMC has also announced a review by Dame Clare Marx, reporting in 2019, into gross negligent manslaughter and culpable homicide in healthcare following the high-profile case of Dr Bawa-Garba. This is in addition to their participation in the Williams review set up by the UK Government.
The implementation of Professor Appleby’s proposals may seem cosmetic at first glance, but they represent a rebalancing of the investigative process to provide more support to doctors. Though speeding up investigations will require amendment to the General Medical Council (Fitness to Practise) Rules 2004, the other changes have already been rolled out. It can be hoped that they will help engender a system which both protects patients and supports doctors.
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