Tone of communications
64% of doctors said the tone of communications from GMC impacted them most during the investigation.
51% said improvements in the tone of communications was something the GMC could do make the process less stressful.
Many of the survey comments in this area focussed on tone of the letter received at the point of a case being closed, particularly when being notified that there is no further action being taken. While the case may have closed, the tone and language used appears to be stopping many doctors having closure.
Many other comments focussed on the tone of the initial communication which assumed guilt even before the case had been looked into.
“It took a lot of counselling to come to terms with this, even though no fault was found. The language in their comms is abysmal - we didn’t get you this time but we are watching you.” “The letter made me feel guilty and I was not good enough to be a doctor even before i had been listened to or investigated. Wish the process was more open minded in its approach rather than starting with the premise that you are not fit to practice. At least that’s how one feels when they get the letter.” |
Recommendations:
- While the GMC has worked to improve the tone of its communications in recent years, this should be reviewed on an ongoing basis to make continual improvements.
- The GMC should explain in the initial communication that it is required by law to review all complaints and allegations that a doctor’s fitness to practise may be impaired. This would offer some reassurance that the GMC is fulfilling its legal obligation, and not starting from a position that the doctor’s fitness to practise is impaired.
- The GMC should review its communication with doctors when a case is closed with no action, to help doctors obtain closure. Members have reported that in some instances, the GMC's language can imply that they will always be looking over a doctor's shoulder. After a long and stressful process, this can have a significant impact on mental wellbeing.
- When the GMC closes a case with no action, they should provide guidance and reassurance to doctors regarding what circumstances a doctor would be expected to disclose the investigation when completing an employment form.
Vexatious/malicious complaints
Many respondents expressed frustration about complaints to the GMC being malicious or unnecessary; particularly the GMC’s inability to triage these, deter such complaints, or (when subsequently found to be baseless) hold the complainant to account.
“Better triage of trivial, vexatious or malicious complaints would be an easy improvement for the GMC.” “The case dragged on for one year before it was dismissed. It seems very unfair that a malicious actor is even entertained for that long, and essentially given free rein to damage the doctor’s life with no repercussions for the complainant. Surely there should be a better system devised to dissuade people from making baseless accusations?” |
Recommendations:
- The GMC should explore options to discourage complaints that clearly do not require regulatory action, including better communication to the public and profession on the threshold for a complaint.
- In its initial communication with doctors, the GMC should include information, or a link to its policy, for dealing with vexatious complaints.
- The GMC should acknowledge any stress caused to doctors as a result of an investigation which is subsequently found to be based on a vexatious or spurious complaint, and where appropriate offer an apology for the stress caused – reflecting its own guidance to doctors on duty of candour and an apology not being an admission of liability.
Process too adversarial
Over half of doctors (53%) say that if the GMC had made the process less legalistic/adversarial, it would have been less stressful. 27% say less legalistic language in communications would have made the process less stressful.
Many doctors commented that they felt they were in a court of law being cross examined, or that it felt more like a criminal investigation. Some concerns were also raised about how anyone unrepresented would manage.
“I felt that the hearing was very adversarial. I felt like I was in a court of law being cross examined by a barrister. I was tearful, remorseful, and frightened.” “I was well represented by Medical Protection & feel that if they could do anything it would be to lobby for a change in the way hearings are run. The current adversarial process is, in my view, unsuited to the objective & must present extreme difficulty for those who are unrepresented.” |
Recommendations:
- The DHSC and GMC should consider the role of mediation for some cases, as part of the long overdue amendments to the Medical Act aimed at making the system of professional regulation less adversarial.
Initial notification
71% of doctors said the initial, unexpected notification of the investigation impacted on their mental wellbeing most.
60% believe the GMC should offer more support to those facing an investigation.
Survey respondents commented on notifications being received on a Friday, the timing of when employers receive a notification, and the need for more signposting to professional and wellbeing support resources.
| “I received notification by email that I was being investigated with no details of the allegation which left me feeling very anxious. Communication regarding investigation could be improved.” |
Recommendations:
- While the GMC have worked to make improvements regarding the initial notification – including recently introducing an initial phone call following a pilot - this must be reviewed on an ongoing basis to make continual improvements.
- The GMC should continue to take steps to ensure initial notifications do not land on a Friday when the doctor has more limited access to professional and wellbeing support.
- The GMC should notify a doctor of the outcome of an investigation a few days before their employer is notified.
Length of process and lack of updates
69% of doctors said the length of the investigation impacted on their mental wellbeing most, and 68% said that if the process was completed more quickly it would have made it less stressful. Two in five (41%) also said more frequent updates on how the investigation was progressing would have made the process less stressful.
There were many comments in the survey on lack of updates, length of process overall, and how these made a stressful situation worse. There were also suggestions that investigators do not have the experience required to expediate complaints.
| “The case was closed without any action after two years, which I felt was far too long to investigate what emerged as a straightforward investigation.” |
Recommendations:
- The GMC should keep doctors fully informed when there are delays, to reduce the stress around timeframes and lack of communication.
- The GMC should ensure investigators dealing with complaints at an early stage are suitably experienced in order to be able to close those cases not requiring further action swiftly.
- The DHSC should prioritise legislation to amend the Medical Act which would enable the GMC to process complaints, and close those cases requiring no further action, more quickly.
Wellbeing support
Almost 8 in 10 (78%) said the investigation had a detrimental impact on their mental health.
Nearly a third (31%) of the 197 respondents experienced suicidal thoughts during their investigation.
60% believe the GMC should offer more support to a doctor facing an investigation.
Anonymous comments from doctors show how important it is that all doctors facing investigation know where they can access 24/7 mental wellbeing support.
“I did feel my life was not worth living after how much I had dedicated to being a doctor. To now to have it all called in question and jeopardised was devastating.” “From the first notification by the GMC of an investigation till after the tribunal I had regular suicidal thoughts.” |
Recommendations:
- The GMC should ensure all communication and material for doctors facing a fitness to practise investigation includes details of how they can access mental wellbeing support that is available 24/7, not just Monday-Friday 9-5pm. Medical Protection offers counselling to any members experiencing work-related stress, or stress that they feel could impact their practice, however there are registrants who may not have an MDO so accessibility and awareness of the GMC support service is vital.