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We recently surveyed 114 Medical Protection members in Ireland who faced a Medical Council investigation in the last five years. We wanted to get a better understanding of their experience, the impact on their mental health and the main areas for improvement.

Of the findings, some of the key takeaways are:

  • Nearly all of those responded (93%) said the Medical Council investigation caused stress and anxiety, 73% said it impacted on their health and wellbeing, 58% on their personal life.
  • Almost 8 in 10 (77%) said the investigation had a detrimental impact on their mental health.
  • The length of the investigation (70%), and the initial unexpected notification of the investigation (78%) impacted on doctors' mental wellbeing most.
  • Over half (53%) said the tone of the communications from the Medical Council affected their mental health most.
  • 1 in 10 (12%) of the respondents experienced suicidal thoughts at some time during their investigation.
  • Nearly a quarter (24%) considered leaving the medical profession. 10% either left or retired early.

We propose changes to four areas that have the largest impact on doctors going through regulatory investigations:

Communication
Length of process
The handling of spurious or minor complaints
Mental health and wellbeing throughout the process

For each of these areas, we are making recommendations to the Medical Council, and other bodies and organisations, for reform.

Communication and notification of complaint

Over half of the respondents (53%) said the tone of communications from Medical Council affected their mental health most and 78% felt that the initial, unexpected notification of the investigation had an impact on their wellbeing. 51% said improvements in the tone of communications would make the process less stressful, and 39% felt that less legalistic language would make it less stressful. Many respondents commented that they felt they were ‘guilty until proven innocent’ in correspondence from the Medical Council. Others said the communication from the Medical Council lacked compassion.

“The first stress is that you are informed that there has been a complaint against you without details for a few days. This disturbed sleep until details were sent.”
“Felt criminalised and that I was on trial from day one. Felt isolated and that I was guilty until proven innocent. No support given from Medical Council.”

Medical Protection recommends that:

  1. The Medical Council should review all communications with registrants, on initial notification and throughout the process, focusing on:
      a.   Shortening the communications to reduce overwhelm and improve clarity.
      b.   Breaking down legalistic language to remove barriers to understanding.
      c.   Introducing a clear acknowledgment of the stress of the process and clear signposting to wellbeing support services.
  2. The Medical Council should ensure that the explanation of the statutory requirement to investigate all complaints is in plain, understandable language.
  3. When contact is made by telephone, the Medical Council should ensure that the purpose of the phone call is made clear to the registrant, so they do not enter into discussion without legal representation and advice. Colleagues contacting registrants should be provided with appropriate training.
  4. The Medical Council should ensure that where there is agreement to liaise with a specific contact regarding the case (registrant, their lawyer, MDO, all etc.), that this is followed consistently throughout the process.
  5. The Medical Council should ensure initial notifications do not land on a Friday when the doctor has more limited access to professional and wellbeing support.
  6. The Medical Council should reconsider its position regarding the naming of other healthcare professionals involved in the patient’s care in correspondence, to protect confidentiality.

Length of process and updates

88% of survey respondents reported that the investigation took longer than expected and only 12% said that the investigation was resolved in a reasonable timeframe. Nearly three quarters (74%) said that the process being completed more quickly would make the process less stressful, and 41% said that more frequent updates on how the investigation is progressing would have reduced stress levels.  
“The complaint originated from consultations that took place in 2016. The complaint was made in 2018 and was not addressed by the until 2022 by FPC. The matter is still ongoing, with no timeline from the Medical Council.”
“[The case] dragged out for 3 years, despite getting support from the MPS it didn't stop the illness that the procedure bore on me and my family relationships.”

Medical Protection recommends that:

  1. The Medical Council should acknowledge in communications with registrants that the process can and may take an extended period of time, including some kind of explanation as to why this amount of time is likely to be needed. 
  2. The Medical Council should keep doctors fully informed when there are delays, to reduce the stress around timeframes and lack of communication. 
  3. The Department of Health, working with the Medical Council, should rapidly commence the powers to triage complaints as outlined in statutory powers delegated under the Regulated Professions Act 2020; cases not requiring further action should be closed swiftly.
  4. The Medical Council should review the other powers delegated to them in the Regulated Professions Act 2020, such as the ability for the PPC to conclude a matter by way of Undertakings and the ability of the CEO to triage out vexatious and spurious complaints before opening a complaint investigation. The Medical Council should continue to work closely with the Department of Health to implement these as a priority.
  5. The Medical Council should conduct a review on the length of proceedings for regulatory investigations and report the findings of this review. 
  6. We acknowledge that the Medical Council is in some respects bound by its regulatory framework and there are statutory obligations – such as the requirement to apply to the High Court for Section 60 matters - which cause delay. The Department of Health and the Medical Council should consider changes to the regulatory framework which may facilitate faster resolution of cases. 
  7. The Medical Council should consider a review of its own processes, outside of the regulatory framework, to help reduce delay. Examples of this could include implementing a process which swiftly obtains consent from patients to avoid delaying progress, and ensuring the Preliminary Proceedings Committee is provided with all necessary information prior to Committee meetings in order to proceed.

The handling of spurious or minor complaints

Many respondents expressed frustration about the Medical Council’s inability to triage complaints that were malicious, minor or spurious. 

We’re aware that the Medical Council have been delegated the powers to triage complaints through the Regulated Professions Act 2020, however this has not yet been implemented. We know that the Medical Council is working with the Department of Health to commence this legislation as soon as possible.  
“It took a very long time for a complaint that was never going to go further. I felt that a mediation meeting with the complainer would have moved things on much quicker.”
"Having a complaint made against you as a doctor (especially when the complaint is unfounded or malicious) is very stressful and time consuming and has the potential to adversely affect your reputation as well as the personal stresses it causes with anxiety about the outcome and the process.”

Medical Protection recommends that:

  1. The Department of Health should prioritise the implementation of powers to triage complaints as set out in The Regulated Professions Act 2020 so that cases not requiring further action can be closed swiftly, and the Medical Council can focus on cases which potentially pose a risk to patient safety. 
  2. The Department of Health and the Medical Council should consider a change to the regulatory framework to include a rule to preclude the investigation of complaints arising from matters older than 5 years to encourage complaints to be made earlier, and to ensure that evidence is not lost through the passage of time. 
  3. The Medical Council should explore options to discourage complaints that clearly do not require regulatory action, including better communication with the public and profession on the threshold for a complaint.

Support for mental health and wellbeing throughout the process

Nearly all of the respondents to the survey (93%) said the Medical Council investigation caused stress or anxiety, and over three quarters (77%) believed that there was a detrimental impact on their mental health as a result of the investigation. 58% believe the process impacted on their confidence and 58% also believed that it impacted personal life. 

One of our starkest findings was that more than 1 in 10 (12%) experienced suicidal thoughts during the investigation. 
“One of the most stressful experiences I've ever had. I lay awake every night worrying about it and the consequences of a negative outcome.” 
“The complaint process of course has to be there for patients but it also needs to provide support for doctors. The provision of a mentor or advice on who to talk to would have been much appreciated at the time.”

Medical Protection recommends that:

  1. The Medical Council should work to expedite investigations when a registrant has pre-existing health conditions; having regard to the specific nature of the registrant’s health conditions and the registrant’s need for support and sensitivity.
  2. The Medical Council should review existing communications with registrants to ensure that there is always clear recognition of the stress of the process and signposting to 24/7 support services – including at the point a case is closed. 
  3. The Medical Council should make amendments to the ‘What to do if a complaint is made about you’ guidance, to acknowledge the potentially stressful nature of an investigation and clearly signpost to 24/7 wellbeing support services and resources. 
  4. The Medical Council should enhance opportunities for registrants to feedback on investigatory processes.

Contact the Policy and Public Affairs team

If you have any questions about this campaign or anything else, the MPS policy and public affairs team is available to contact during usual office hours (8.30am – 5.30pm, Monday to Friday) using the details below.

Megan Ball Policy & Public Affairs Manager
Email: [email protected]

Ceylan Simsek Policy & Public Affairs Officer
Email: [email protected]