GMC reforms 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 - have helped reduce the number of investigations by around 400 each year.
Mental health expert Professor Louis Appleby, who has worked closely with the GMC’s fitness to practise directorate since 2015 to make the processes more supportive to doctors, said: ‘Together with the GMC I looked at each stage of the investigation process and recommended improvements so that fewer complaints would escalate to investigation, the process would be more compassionate and a different approach would be available to any doctors who might be unwell.’
Recommendations for an overhaul of fitness to practise procedures published in 2017 by Professor Appleby were accepted in full by the GMC and many have now been implemented.
Fitness to practise
Professor Appleby added: ‘Investigations can be punitive in effect, even if that is not the intention. Being able to see things from the point of view of the hardworking, perfectionist, sometimes distressed and probably remorseful doctor, was key to reforming the process. The GMC has kept me informed since my report two years ago. It has made significant progress, but that work does not end here.’
Speaking to GPonline, GMC assistant director for fitness to practise and GP Dr John Smyth said: ‘Since we’ve started to think about these things more carefully and working with Professor Appleby, what I’ve seen and what I’ve observed is a real culture change within the organisation when it comes to recognising the effect that the investigation process has on doctors.'
He said the regulator had become ‘more acutely aware of the pressure that investigations put on [doctors] and the high stakes that there are’.
Pilot schemes including the introduction of provisional enquiries - described by Dr Smyth as ‘an extra step before we decide to open a full investigation’ - and increased information sharing have seen the proportion of escalated investigations drop significantly - from 33% in 2013 to just 18% in 2016.
Although these were previously only enforced on select individual cases, Dr Smyth says the GMC is now applying the provisional enquiry model to cases where doctors' ill health affects their fitness to practise as well.
‘Let me make it clear - the GMC doesn’t need to be involved simply because a doctor is unwell. It’s only when the nature of that illness might impact on the doctor’s ability to do their job safely when we have to become involved.
‘So what we’re piloting at the moment is exploring whether we can apply the same principles of provisional enquiries [to health cases] to get this extra bit of information. That might be some reassurance from the doctor’s local support that everything’s being managed and actually if that’s the case then there’s no real need for the GMC to get involved in some types of health cases.’
The GMC has also taken steps to change the organisation’s approach to correspondence to try to limit the impact it can have on doctors.
‘In relation to the health cases obviously there’s a team that specifically supports doctors with health problems when we’re aware of those things and they will ring people up, communicate with them, talk to them about their preferences in communication or if at some point they become particularly unwell, they will agree to pause communication and actually pause the investigation for a period of time.’
The GMC has also announced plans to appoint a wellbeing advisory board to help ‘push the boundaries’ of legislation surrounding fitness to practise enquiries and promote the wellbeing of GPs undergoing investigation.
The board will be made up of representatives from several royal colleges and may also include a doctor-as-patient representative body as well. It is expected to be formally launched in Autumn 2018.
‘The idea is that there might be some policy issues for the GMC to consider in relation to mental health or wellbeing and equally there might be questions that arise from those people that are part of the board that they want to ask of the GMC,’ said Dr Smyth.
He added: ‘The prospect of legislative reform seems quite remote but we’ll do what we can to push the boundaries of what we currently do to make it more flexible to make it as proportionate as it can be and to lessen the effect of the individual going through it.’