Some years ago, while working as a GP partner, I undertook ad hoc work for one of the defence organisations and accompanied doctors to local hearings. I would talk to the doctor about the investigation or complaint before the hearing and then reflect back to them how their answers sounded.
Some were defensive and didn’t understand why they were being complained about, but many of the doctors I supported were significantly affected by their experience of complaints. This work piqued my interest in regulation, and when a GMC medical case examiner role came up, I decided to apply. As a doctor, I regarded the GMC as a key organisation that sets our professional standards.
The most interesting thing about working as a case examiner is the challenge of reaching fair decisions on a wide variety of very complex matters. We weigh up the multiple sources of evidence, consider our own guidance and legislation and bring all these things together to make a final decision. That’s what has retained my interest over the years and I’m still here 11 years later.
I’m hoping to bring that clinical role to my new position – what it’s like at the coal face, the general attitudes of doctors. Colleagues may not necessarily have that perspective. I see my new role as a conduit between senior management and the case examiner team.
A few years ago, the GMC started meeting face to face with some doctors at the end of an investigation. Meetings with doctors are facilitated by case examiners and encourage doctors to share information earlier in the process. I was keen to be involved because the doctor doesn’t always feel heard during an investigation. Feedback from doctors and their representatives suggests that these face-to-face meetings with the GMC are useful. I was struck by the emotional impact of investigations on doctors – and to have the opportunity to listen to their views and insight.
The GMC also meets with patients and families at various stages in the process to make sure that their concerns are properly considered and they understand our role and the process of investigation. These meetings, particularly at very early stages, are an important way to explain in a simple and clear way what we can do to help and where it may be more appropriate for others to help – such as the local healthcare provider where the patient was treated. It’s really important that patients have the time and space to talk about their concern with us.
Improving how the GMC works
I met with Professor Louis Appleby when he was invited into the GMC to review our processes and we worked with him to identify what we could do to improve the way we operate. He set us some difficult challenges, but he also recognised that we have a legislative framework we have to work within.
One of the proposals that struck a chord with me was making mental health a strand that runs throughout the way the GMC performs its role. My personal observation has been that in the past, the investigation process hasn’t always considered the impact on patients and doctors, and in particular doctors who are unwell or vulnerable.
Professor Appleby made a number of specific recommendations including a review of the tone of our correspondence with doctors. Doctors who are unwell can sometimes receive multiple letters from the GMC which they can find very threatening. Previously we wrote using very legalistic terms, and we’re now communicating in a more empathetic way. We are embracing Professor Appleby’s recommendations, and we’ve already made significant changes, including bringing in the BMA who provide the Doctor Support Service to train our investigation teams. We fund this service, which provides free confidential support to doctors involved in a fitness to practise case.
We have already introduced a number of changes to lessen the impact of investigations on vulnerable individuals - such as piloting a new approach to our communications, where we discuss and agree from the start how the doctor would prefer for us to communicate with them, whether it’s by phone, email or at particular times during the week
We have also provided training to staff to raise their awareness of mental health issues and suicide risk and have provided guidance to help staff feel more confident in dealing with difficult situations. The impact of this work is already influencing the culture.
Advice for doctors
I would say that doctors are no different to any other profession in terms of their vulnerability to mental health issues. Recognise there’s a problem - take advice and speak to your own doctor or the occupational health department in your workplace – now. If you do undertake treatment there’s no reason for the GMC to get involved.
I am quite keen for mental health issues to be managed safely locally. Also – be supportive of colleagues – if they have got mental health concerns – because at some point you may need their support.
The advice I would give a doctor going through an investigation would be to seek advice from your defence organisation but also to provide as much information to the GMC as possible at an early stage. We want to understand what’s happened and the nature of any future risks, and being open and demonstrating insight usually allows us to reach a faster, fairer decision. Don’t assume that having a GMC case will mean your career is over; every doctor makes mistakes, but our focus is on protecting patients rather than punishing doctors.