Consulting editor James Watts gives a brief seminar on the complaints processes at the General Medical Council (GMC)
The role of the General Medical Council (GMC) as the regulator of medical practitioners is confirmed in statute by the Medical Act 1983 and its subsequent revisions [1]. The Medical Act empowers the GMC to maintain a register of approved practitioners, and to take disciplinary action against the registration of those who have failed to maintain appropriate standards, as well as governing other duties such as those related to education and standard setting.
This disciplinary action can range from the issuing of an official warning to the erasure of the individual from the register. The latter effectively stops the individual working legally as a doctor. This affects the civil rights of the doctor, and so the GMC must act within the law when making its decisions. The GMC therefore has strict rules governing its processes for the handling of complaints to ensure that it can maintain both the confidence of the public and the trust of the profession.
The standards that all doctors are supposed to apply to their personal and professional conduct are published in Good Medical Practice and its associated guidance [2,3]. Ignorance of this guidance is not regarded as a defence. Key paragraphs include:
- 1 You must have the necessary knowledge of the English language to provide a good standard of practice and care in the UK
- You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession
- You must tell us without delay if, anywhere in the world:
(a) you have accepted a caution from the police or been criticised by an official inquiry
(b) you have been charged with or found guilty of a criminal offence
(c) another professional body has made a finding against your registration as a result of fitness to practise procedures.
Here I will outline briefly the complex GMC processes for handling complaints
Anaesthetists and the GMC
Campbell and colleagues compiled a study of the cases concerning anaesthetists who had been referred to the GMC in 2009, using the GMC’s own data [4]. They found that there were 105 cases where anaesthetists were referred to the GMC in this year, of which 81 cases were referred for detailed investigation. At this time they estimated that there were approximately 9000 registered anaesthetists in the UK [5]. The referral rate of anaesthetists to the GMC was therefore lower than the average for all doctors (0.095% vs 0.2%), but they were more likely to be referred by employing bodies rather than the public. Over 50% of the referrals related to either probity or clinical care issues. There were on average two different complaints per referred anaesthetist.
For those who may be anxious about the possibility of vexatious or undeserved referral to the GMC, a simple Internet search confirms that those who do end up having sanctions placed against them at a panel hearing are judged to have committed serious breaches of Good Medical Practice [6–9].
Initial complaints handling processes
Complaints to the GMC can arise from the public, the employer, a public body or official (such as the CQC, the PHSO, the Coroner, etc.) or, on occasion, can arise from media coverage. Occasionally, there may be an internal GMC referral (for example, a doctor who fails to comply with conditions on their registration).
For the GMC to investigate a complaint further it must be about an individual doctor, and it must be a serious complaint which, if proven, has a realistic prospect of establishing that their fitness to practise could be impaired. It is important to remember that it is the civil standard of proof (i.e. the balance of probabilities) rather than the criminal standard (i.e. beyond a reasonable doubt) which applies in this regard.
Investigations can be divided into three broad categories:
- Health – i.e. it is alleged that the doctor has a health issue which may affect their fitness to practise. This would typically be a serious health or addiction issue at risk of relapse and impairing patient care and insight.
- Conduct – i.e. it is alleged that the doctor’s professional or personal conduct is such that the doctor’s fitness to practise is impaired. This will include circumstances such as the doctor being subject to criminal charges, prosecution, a caution or similar sanction, or a guilty verdict in a criminal trial. It may also include failure to adhere to quality control and appraisal processes, and failure to comply with the reasonable requests of the employer.
- Capability – i.e. the doctor’s clinical work is poor, such that it indicates their fitness to practise is impaired. This can relate to one individual episode of serious poor practice; or several incidents; or long-term performance issues which have not been resolved locally.
It is possible that one investigation may span several different categories. For example, a doctor may have been found guilty of drunk driving, and have been found to suffer from a mental health issue, and there may also be concerns about clinical performance.
The Medical Act allows the GMC Investigation Committee to make decisions on the doctor’s registration based on the seriousness of the incidents. The Act allows the Committee to delegate this work to appropriate individuals. These individuals include the Registrar, the investigation department and its officers, and the Medical Practitioners Tribunal Service (MPTS). The MPTS is the adjudication service, separate to the GMC, which holds fitness to practise panels [10].
A complaint may be closed by the GMC at the initial triage stages if it is felt that the issue being raised has no impact on any of the above matters; and if there is no indication that a failure to consider it would undermine the public confidence in either the profession as a whole, or the regulator.
It may also be decided that the allegation, although serious, is ‘stale’ and therefore cannot be pursued. While there is no statute of limitations in British law for criminal acts, in civil actions the regulator is allowed to impose one. It may be, for example, that alleged malpractice occurred many years ago, in which case it is unlikely that it can be t