Under plans to reform healthcare regulation in England set out by the government in March, doctors with health concerns who face investigation will be categorised as having ‘a lack of competence’.
Medico-legal experts at the MPS have warned this would be 'extremely demoralising' and could exacerbate doctors' health issues - and potentially endanger patients.
Medico-legal organisations have also warned that proposals to scrap the five-year limit on the GMC being able to investigate allegations against doctors could lead to more cases against GPs.
Health care regulation
They have also encouraged the government to come good on its commitment to remove the GMC’s right to appeal fitness to practise decisions in line with recommendations made in 2018.
Currently the GMC can launch an investigation into a doctor on the grounds of misconduct, lack of competence, a conviction or health. However, the proposals would remove 'health' as separate grounds for investigation.
These would instead be ‘considered as part of an assessment of competence’, with regulators deciding if the complaint met the threshold for a referral. But MPS medical director Dr Rob Hendry said the proposals could have ‘potential unintended consequences’.
He said: ‘Removing health grounds and instead categorising doctors with a health concern under ‘lack of competence’ grounds would be extremely demoralising and could exacerbate their health issue. It may also discourage doctors from seeking help at an earlier stage and this could endanger both patients and the doctor.
Fitness to practise
‘The GMC has made good progress in improving their processes and must continue to do everything possible to minimise the impact on the wellbeing of doctors under investigation, particularly those with a health concern at the outset.
‘Investigating these doctors under ‘lack of competence’ grounds feels wholly inappropriate and we believe ‘health’ should be retained as a separate category.’
MDDUS chief medical officer Dr John Holden added: ‘Health cases need to be dealt with more sensitively than other cases. This is of utmost importance with cases involving mental health problems.
‘It is simply not appropriate for health to be placed into the same ground as competency. In fact, this seems a pejorative way to view matters and highly problematic in terms of the way in which health issues amongst clinicians are viewed by their patients and the public.’
Investigation time frame
Medico-legal experts have also argued that the government must retain the five-year limit for concerns to be raised and reported to the GMC so that the number of doctors facing investigation does not increase dramatically.
Under the current five-year rule, the GMC cannot investigate allegations if they happened more than five years ago unless to do so is in the public interest. The latest proposals would remove this timeframe.
MDU deputy head of advisory services Dr Catherine Wills said: ‘Without the five-year rule, there is a risk that doctors will be routinely and needlessly subjected to fitness to practise proceedings for historic complaints where there is no question of current impairment or risk to patients.’
The GMC recently called for ‘greater autonomy’ to choose the complaints it investigates, to help combat ‘shameful’ bias against ethnic minority doctors following the publication of the government's proposals.
Chief executive of the GMC Charlie Massey said the regulator disagreed with the proposals to remove health as a grounds for investigation. He said: 'Any reform to our procedures must protect and strengthen our ability to take proactive and proportionate action.
'Where there is evidence that health concerns might pose a risk to the public, it is right that they are handled sensitively to protect the public and ensure the doctor is supported.'
In regard to plans to scrap the five-year rule, a GMC spokeperson said that concerns 'should be considered on the merits of evidence and the risk to public protection', rather than aving an not an arbitrary time-limit.
A report by the Professional Standards Authority for Health and Social Care (PSA) said in April that some fitness to practise cases may ‘prove impossible to resolve’ following delays to hearings caused by COVID-19 disruption.