Doctors less likely to be investigated for 'one-off' mistakes under new GMC rules

The GMC is introducing new measures to reduce the number of full investigations in instances where doctors make 'one-off' clinical mistakes, after a successful pilot closed more than 200 cases 'at an early stage'.

GMC chief executive Charlie Massey
GMC chief executive Charlie Massey

The new process means that, following a clinical incident, the GMC will ‘quickly’ gather additional information at the initial enquiry stage, including ‘input from independent experts, doctors’ responsible officers and the doctors themselves’, as well as medical records and other relevant details.

The regulator will then decide whether to open a full investigation or close the complaint following the initial enquiries.

Over a two-year trial period using the new measures 65% of single clinical incident cases (202 out of 309) were closed without the need for a full investigation.

The GMC said that the pilot had shown it was possible to properly assess ongoing risk to patients without undertaking a full investigation in cases involving allegations of one-off clinical mistakes.

Procedural changes

GMC chief executive Charlie Massey said: ‘Protecting patients is our priority. But opening full investigations unless absolutely necessary is not in the interests of patients or doctors, and causes additional stress and delay. We’ve found that getting more information quickly in certain cases clarifies if there is any ongoing risk to patients, and so whether we need to take action.

‘Not all complaints are suitable for this process but during the pilot we were able to avoid the need for full investigations in many cases that involved single clinical incidents. Even where doctors had made a mistake we were able to check if they understood what had gone wrong and had taken steps to make sure it wouldn’t happen again, avoiding the need for action.’

MDU head of advisory services Dr Caroline Fryar said: ‘A single clinical incident is rarely an indicator of concern about patient safety and we have long used our knowledge and experience of supporting MDU members to work with the GMC in improving the speed and fairness of its procedures.

‘Early identification and closures of cases that are unlikely to amount to impaired fitness to practise is a great improvement for doctors, for whom GMC investigation is extremely stressful. We continue to work with the GMC to suggest other types of cases that we believe are suitable for the same procedure.’

GMC reform

The procedural change is the latest in a number of fitness to practise reforms at the GMC, including the introduction of provisional enquiries, case co-ordinators and specialised mental health training for staff working on cases in which doctors' health affects their fitness to practise.

At present the GMC is still required by law to investigate any allegation that a doctor’s fitness to practise is impaired, but Mr Massey said the regulator was continuing to call on the UK government for ‘legislation to give us more flexibility, and which would allow us to further improve the ways we can resolve fitness to practise concerns’.

Medical Protection welcomed these latest changes, but said the new process represented 'a small fraction of the reform that is needed at the GMC'.

Dr Rob Hendry, medical director at Medical Protection, said: ‘Although this is an important and welcomed decision, the government now needs to get on with introducing root and branch reform to the laws that underpin how the GMC operates.

‘The current legislative framework is outdated and does not give the regulator sufficient discretion to go further in sifting out the number of less serious complaints where no action is required. This translates into unnecessary stress and delays for doctors and patients.’

How the new system works: A case study

As an example of how and when the new measures will be used, the GMC has published a case study based on a case that occured during the trial period.

A young child was taken to A&E with a cut forehead after falling off his bike and a plastic surgeon was called and attempted to glue the laceration. However, he failed to sufficiently tilt back the patient’s head, resulting in glue running into the child’s right eye, gluing it shut.

The patient’s eyelashes had to be cut and there was a risk the cornea might be damaged. The child was also left traumatised.

After gathering information from various parties – including the doctor and the doctor’s responsible officer – and speaking to an independent expert, who noted that this type of medical procedure posed a ‘rare predicament’ for a plastic surgeon, the GMC concluded that the case ‘did not raise any risk to future patients’. Therefore the case was closed without the need for a full investigation or any further action.

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