Doctors have good grounds for fearing scrutiny by the GMC because it has powers to take action on your registration. In cases where there has been a serious breach of standards the regulator can stop you from practising either temporarily or permanently.
Fortunately, a GMC investigation is still relatively unusual for most doctors, and being suspended or stopped from practising happens only in a minority of cases.
In 2014, the GMC received 8,884 complaints about doctors. However, only 2,750 of those complaints reached the threshold for a full investigation. Bearing in mind there are over 260,000 registered doctors, this means approximately one out of every 100 doctors underwent a fitness to practise (FTP) investigation in 2014.
But the risk of an investigation has risen in recent years with the GMC reporting that complaints increased by 54% over the five years from 2010–14. However, there is no evidence that this is the result of poorer care and it seems much more likely to be the product of changing expectations.
Here are five steps to take if you receive a letter from the GMC informing you of an investigation:
1. Contact your medical defence organisation as soon as possible
If you are a member of a medical defence organisation (MDO), contact them immediately to request advice and support.
The MDU advises that you do not provide any comments to the GMC about the concern raised until you have discussed the case with us.
It is helpful to write some notes about the case for the benefit of your MDO adviser as soon as you can, while events are fresh in your mind. Your adviser will assess your case, advise you on the best way to respond to the GMC and arrange legal representation if you need it.
Always be open and honest with your medico-legal adviser so that they can help you get the best outcome. Let them know if there are any other issues that you think might be relevant, such as health problems.
2. Co-operate fully with the GMC process and the requirements of your employer
You will need to inform your employer (if you are not a GP partner), as well as NHS England or your health board. Performers’ list regulations require GPs to do so in writing, within seven days. It is also a good idea to contact your medical director.
In addition, the GMC requires you to complete and return a work details form within seven days.
3. Don’t let the complaint affect patient care
Surprisingly, many patients wish to continue seeing the doctor they have complained about. It is understandable that if a patient refers you to the GMC, it can make you feel uncomfortable about seeing and caring for that particular patient in future.
You may feel that you wish to end your professional relationship with the patient who complained, however, the GMC makes it clear in Good Medical Practice that ‘you must not allow a patient’s complaint to adversely affect the care or treatment you provide or arrange’.
If possible, you should continue to see and care for the patient as before, although you can end your professional relationship with the patient ‘when the breakdown of trust between you and the patient means you cannot provide good clinical care to the patient’.
Seek advice about this from your medico-legal adviser before taking such action.
4. Review the concerns raised and see what you can learn
The GMC is concerned about whether a doctor’s fitness to practice may be impaired, rather than investigating the complaint itself. The GMC will consider, among other things, whether a doctor could be a risk to patients in the future.
Doctors who are able to demonstrate insight, for example, by apologising and remediating, are considered to be lower risk. According to the GMC’s own statistics, doctors who showed insight at Medical Practitioners Tribunal Service (MPTS) panel hearings were almost ten times less likely to be erased than those who did not.
Review the case with a trusted senior colleague, asking for their honest feedback and advice regarding any learning points that you can take forward for future practice. You may wish to list the case for discussion at your practice or departmental significant event meeting and at your next appraisal. Document such discussions carefully.
Add any learning points to your personal development plan, and provide certificates from relevant courses or online learning as part of your defence to the GMC.
5. Ask for support
GMC investigations can be very stressful and protracted, sometimes taking several years to conclude. Some doctors feel ashamed when under investigation, and try to hide it from their family and colleagues. Don’t underestimate the effect an investigation can have on your health and wellbeing, and make sure you confide in someone.
As well as discussing your concerns with your medico-legal adviser, you can discuss the investigation with family members, trusted colleague or friend, ensuring you protect the patient’s confidentiality at all times.
The GMC has set up a confidential support service in conjunction with the BMA which is open to all doctors who have had a complaint made about them to the GMC.
It can be difficult not to take a GMC complaint personally, but obtaining advice from those used to dealing with such cases and support from family, friends and colleagues can help to maintain your confidence and protect your health.