The GMC's Fitness to Practise Changes: 6 Questions

Peter Russell


May 18, 2018

The General Medical Council (GMC) has announced that changes to its fitness to practise process have prevented around 400 cases against doctors from going to a full investigation.

The regulator said a major change involved obtaining key information shortly after receiving a complaint to help decide whether an investigation is needed – a process, known as provisional enquiries. It has also increased support available to doctors.

If a doctor who is being investigated is very unwell, the GMC can now pause the process while they receive medical treatment. The GMC confirmed to Medscape UK that investigations against seven unwell doctors have been paused since this process was launched in late 2017. The changes followed a report by Prof Louis Appleby, University of Manchester, on how to reduce the impact and stress of investigations on doctors.

Dr John Smyth

We asked Dr John Smyth, a former GP, who oversees investigation decision makers known as Case Examiners at the GMC, to explain the new investigation process.


Medscape UK: Can you outline the main changes that have been made to the GMC's fitness to practise processes?

Dr Smyth: We have made a series of changes following the advice from psychiatrist Prof Louis Appleby.

The main changes include the use of provisional enquiries. This involves investigation staff making provisional enquiries shortly after a complaint is received about a doctor. Obtaining key information such as medical records at an early stage allows us to decide whether a full investigation is required.

This process enabled [us] to prevent around 400 doctors being investigated last year.

We have reviewed the way the whole GMC communicates with doctors who are under investigation to make sure we are as coordinated as possible, and we have reviewed the tone of our correspondence so that it is as sensitive as possible. We have also introduced a single point of contact to any doctor under investigation who will be their contact throughout the whole process. We have made a range of changes to how we handle cases where a doctor is unwell, which I describe further below.

Medscape UK: You were complained about while working as a doctor – how did this affect you?

Dr Smyth: Over the years as a GP I have received a couple of complaints from patients, and it was disappointing to think that patients felt I had let them down.  After I had reflected on the concerns and discussed with my medical defence organisation, I was able to provide a detailed response and each complaint was resolved. 

I haven't personally received a GMC complaint but I know of colleagues and friends who have. Being complained about is unnerving and it is easy to picture the worst-case scenario.  I sought advice from a defence organisation, when required. This will help you to think logically and to provide a thorough response to any concerns. 

Unfortunately, most doctors will receive complaints, whether they are made locally or to the GMC, at some point during their career.

Medscape UK: How will these new procedures reduce the stress and impact on doctors who come under investigation?

Dr Smyth: We know a GMC complaint or any complaint about a doctor is going to be upsetting and stressful. However, we are confident that the improvements we have made will help to ease the pressure on doctors investigated, particularly vulnerable doctors. The main ways are through the points made in question one but also other changes such as ensuring doctors subject to an investigation have a single point of contact for the process, who they can trust and seek advice from.

Also, we have improved the support available for doctors. We encourage doctors to use the free confidential support from the Doctor Support Service, which the GMC commission the BMA [British Medical Association] to run. It offers emotional support for doctors from other doctors.

The Medical Practitioners Tribunal Service has also introduced a service whereby doctors appearing before a tribunal have support while at the hearing centre.

Medscape UK: How will doctors be supported in cases where doctors are experiencing mental health problems, depression, and suicidal thoughts?

Dr Smyth: We are now able to pause investigations for 6 months if a doctor is unwell and struggling to engage with us. This is to allow the doctor to seek required medical treatment without GMC contact.

A small amount of doctors fall into this category. However, since introducing change we have paused seven investigations since late 2017.

Additionally, we have a number of employees who are medically qualified, including psychiatrists.

Investigation staff are able to get medical advice if they are concerned about a doctor's wellbeing.

Doctors being investigated purely for health concerns will be dealt with by a skilled team who only deal with health complaints and are focussed on assisting doctors through the process.

Furthermore, these changes are not the end of the work we have been doing. We will be creating a Medical Advisory Board, who will meet twice a year and advise on the GMC's approach to vulnerable doctors.

We are currently piloting the use of provisional enquiries in cases where the only concern raised is about a doctor's health.

If a doctor is unwell but his/her health is being well managed and it is not affecting their work or patient safety then the GMC does not need to be involved. A health concern that is well controlled is usually something that can be dealt with locally. We have revised our guidance for employers to clarify the concerns that require GMC involvement. Reducing the amount of investigations solely about a doctor's health will prevent additional stress on doctors.

Staff with direct contact with doctors have all been trained by medical professionals to spot possible warning signs that a doctor might be unwell and vulnerable. They've been taught how to respond to such concerns in a compassionate way and how to seek help if required.

Medscape UK: To what extent do you think these changes will help restore confidence among doctors in the regulator's procedures, particularly regarding the length of time they take?

Dr Smyth: I am very conscious from my experience as a GP that the perception of the GMC is very different to the reality. Being complained about and contacted by the GMC is not going to be welcomed by doctors, we understand that. However, doctors can be reassured that their wellbeing is a huge priority for us. Our staff are compassionate and supportive and understand that an investigation can be very stressful for a doctor.

We have reviewed our whole investigation process with Prof Louis Appleby, one of the UK's leading mental health experts who leads the Centre for Mental Health and Safety, the largest research unit in this field internationally. His independent advice has been incredibly valuable; we have accepted all of his recommendations. We hope our efforts help provide reassurance to doctors.

Medscape UK: Is there a danger that reducing the number of investigations might undermine patients' confidence in the system?

Dr Smyth: The reduction in investigations is a way of speeding up the process, certainly not a way of turning a blind eye on serious concerns about a doctor. All concerns referred to the GMC are still looked at in detail.

However, we now have a process (provisional enquiries) to help obtain required information more quickly.

Closing complaints more quickly that could be dealt with locally or don't warrant an investigation is also in the interest of patients as investigations can also be a stressful experience for the complainant as well as the doctor.

Patients should be reassured that where we can we are now able to resolve complaints more quickly. 

Image Credit: GMC


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