In 2015 the GMC appointed Professor Louis Appleby from the University of Manchester as an independent expert to advise the GMC on how to reduce the impact and stress of a fitness to practise investigation and on making improvements to its investigations process.
Prof. Appleby was approached by the GMC after it commissioned an independent review into cases where the doctors had died from suicide while subject to investigation over an eight year period.
The aim of the review was to establish whether the impact of a GMC investigation could be reduced to minimise stress, particularly for doctors who are already under considerable stress and who may be vulnerable.
Professor Appleby worked closely with the policy teams to review every stage of the investigation process and identify what changes (both small and fundamental) could be made. The GMC has developed and have now implemented those proposals.
Some of the key changes are:
1. Reducing the impact of the process by ensuring the GMC only investigate when necessary
- They have introduced a process called provisional enquiries, where they make early stage enquiries in order to decide whether they need to investigate a complaint or close it with no action
2. Reducing the impact of the process by ensuring that they only investigate cases that are solely or primarily about a doctor’s health
- Updated guidance for employers and providers to help them make decisions about concerns relating to a doctor’s health helping them understand when a concern should be managed locally rather than referred to the GMC
3. Strengthen medical input to decision-making in cases about a doctor’s health
- The GMC have trained psychiatrists and doctors who help staff spot signs that a doctor under investigation is unwell and how to handle cases involving vulnerable doctors sensitively
4. Reduce stress of all investigations through changes to the process, communication and duration
- If a doctor, who is being investigated, is very unwell, the GMC is now able to pause the process so they can receive medical treatment and possibly undergo a health assessment
- Created a specialist team to manage cases relating to doctors’ health who are trained to deliver specialised and tailored communication. They also provide advice to investigating staff about sensitive communication
- Reviewed and updated the materials they send to doctors to strike a balance between clarity and sensitivity
- Appointed a single point of contact for doctors during the course of the investigation to reduce any confusion
- Reviewing the way all GMC staff correspond with doctors who are under investigation
- The GMC are pushing for legislative change for more flexibility to act proportionately and efficiently to speed up the investigation process
- The caseload of the investigation officers has been reduced in order to allow them to dedicate more time to their cases
5. Working to pursue consensual conclusions as a preferred outcome to try and avoid referring doctors to a tribunal
6. Working more closely with employers on the number and appropriateness of referrals
- Regularly meet with doctors on the ground to help better understand the issues and pressures they face
- Pushing cases to be handled locally with their employers when appropriate without the need for a GMC referral
7. Expanded the support for doctors during the fitness to practise process including tribunal hearings
- Promoting confidential and emotional support available through the Doctor Support Service which the British Medical Association (BMA) provide
- BMA has trained the GMC investigation and tribunal teams
- The Medical Practitioners Tribunal Service (MPTS) has set up the Doctor Contact Service
8. Continuing to promote the need for mental health services for doctors nationally
9. Ensure supervision of doctors with restrictions and publications and disclosure after the fitness to practise case has concluded are proportionate
- Introduced time limits on how long sanctions, undertakings and warning given to doctors following an investigation are published on the medical register
If you have been referred to the GMC you should seek specialist legal advice without delay. Contact our team of expert lawyers on 01616 966 229.
By Jessica Macaulay, paralegal in the regulatory department