HICFG Conference – November 2013
Regulating Doctors: investigating concerns about
fitness to practice
Dr Kirstyn Shaw
(ELA South Central)
Employer Liaison Advisors

Regular meetings with Responsible Officers and Medical
Directors in South Central region

Discuss all open and recently closed GMC cases

Provide advice and guidance about GMC thresholds

Discuss any local concerns including anonymously

Provide advice and support about revalidation recommendations

Act as a point of contact for any queries related to GMC

Presentations on revalidation and fitness to practise
The standards expected of a doctor
Fitness to practice enquiries
Sources of enquiries
1. Complaints
 Patients, Carers or Family Members
 Other doctors
2. Referrals (PAPC)
 Employers
 Police
 Coroners or other judicial bodies
 Pharmacists
 Other regulators
Why are doctors referred to the GMC?
The fitness to practise procedure
Three stage process:
Triage
Investigation
stage
Adjudication
stage
Triage – categories for opening a case
The medical act requires the GMC to investigate
allegations that a doctor’s ftp might be impaired.
A conviction or
caution
Deficient
professional
performance
Misconduct
Impairment
Adverse physical
or mental health
Determination
of another body
Public Interest Test – the 5 year rule and consent
Possible new category – English Language
Triage – when we do not open a case
 More than half of all enquiries are never opened as
cases for investigation. The GMC cannot:
 Deal with concerns about anyone who is not a registered doctor
 Arrange an apology, help with compensation, provide an explanation
of what happened or order a doctor to provide a particular
treatment
 Arbitrate in practice or departmental disputes or intervene in local
disciplinary procedures
Triage 2011
8,781
complaints
assessed
4,914
closed
1,917 cases
considered by
Case Examiners
1,537 employer
Follow-up
Clinical underperformance – common issues
1. Poor record keeping
2. Poor communication skills
3. Poor clinical examination skills
4. Failure to diagnose
5. Poor prescribing
Misconduct – common issues
1. Fraud and/or Financial Misappropriation
2. Dishonesty including plagiarism or
misrepresentation on CVs or applications
3. Sexual Misconduct and Relationships with
Patients
4. Violence, Bullying and Harassment
5. Social Media
Health – common issues
1. Alcohol and/or drug dependence
2. Depression
3. Stress
4. Other mental health
5. Physical health
Criminal Convictions – common issues
1.Drink Driving
2.Other Motoring Offences
3.Public Order Offences
4.Assault
5.Domestic Violence
Investigation Process
Case assigned to an Investigation Officer (IO)
Interim Orders – risk assessment
Doctor Disclosure (Rule 4) and EDF Form
RO/Employer Disclosure
•
•
•
•
Expert Reports
• Trust Investigations • College Reviews
Witness Statements • Performance
• Fraud Investigation
Court Documents
Assessment
• Regulator Actions
Health Assessments • Police Investigation
Final Disclosure (Rule 7)
Case Examiner Decisions - 2011
Close
1,358 (70%)
Issue a warning
199 (10%)
Undertakings
148 (8%)
Refer to a
Fitness to Practise
Panel
212 (11%)
1,917 cases
considered by
Case Examiners
How does a Panel determine sanctions?
In our guidance for
Protection
of patients
panellists, the Public
Interest test is defined
as:
Declaring and
upholding proper
standards
of conduct
and behaviour
Maintenance
of public
confidence
in the
profession
Enabling a
doctor’s return to
safe practice
Panel Decisions - 2011
Refer to a
Fitness to Practise
Panel
Fitness to
Practise Panel
hearing
Close
35 (14.4%)
Warning
23 (9.5%)
Undertakings
1 (0.5%)
Conditions
24 (10%)
Suspension
93 (38%)
Erasure
65 (27%)
Fitness to Practise Reform
Revalidation
Employer
Liaison
Advisers
Changes to
investigation process
Changes to the way
we deal with cases at the
end of an investigation
Adjudication
reform
Encouraging ROs/employers to identify and tackle concerns early
Fitness to practise experts with close links with ROs
supporting revalidation and early identification of concerns
Early identification of likely outcome and faster progression of
case. Regional teams with better local links.
More discussions with doctors so we better understand
seriousness of case and encouraging them to accept our proposed
sanction as alternative to a hearing.
Enhancing confidence in independence of panel decisions and
streamlining and modernisation of the hearings process.
Case Study: Dr J

The police notify GMC that Dr arrested and cautioned for Assault

The doctor says he was out at a bar with some friends celebrating a Birthday. A
disagreement broke out between himself and friend and resulted in the friend
punching the doctor. The doctor claims retaliated by punching his friend which
resulted in a black eye.

Police attended the scene and took statements from both men and the doctor
assumed this was the end of the incident. He claims he has never received any
paperwork from the Police and was only made aware that he had been cautioned
when he applied for a CRB check.

The doctor claims that after finding out about the caution he informed his
employer, explained the situation and assured them that this was an isolated
incident. He has also consulted with the MDU who advised that he should
immediately inform the GMC and locum agency where he is registered.

The police send a copy of the doctor’s caution. Feedback from all of the doctor’s
employers indicates that they have no concerns about his practise.
Case Study: Dr C

Cardiologist is aware that there is a family history of hearing loss at a relatively
young age, and during his first appraisal mentions his father has just had a new
hearing aid fitted. He currently feels no hearing loss, but is planning to get tested
in the near future.

Next year, he notices that he does have high frequency hearing loss in both ears,
preventing him from hearing high-pitched sounds very well. He worries this will
interfere with him using his stethoscope and begins to keep a diary of when he
used his stethoscope and what he hears – though he does not make any changes
to his practice.

He didn’t make a health statement but bought an enhanced stethoscope. The
following year he has become very insecure about his clinical judgement when
auscultation was involved, despite him using an “enhanced” stethoscope. He
switches to hearing aids and is delighted with the results, in all aspects of his life.

He has admitted to his colleagues he needs and uses hearing aids, and they have
offered to provide a second opinion if he ever feels insecure again. To date, he has
received no clinical complaints or missed any obvious diagnoses.
Case Study: Dr E

GP in his mid-50s and is the senior partner in a practice which has four partners

Is a member of the LMC which he has been active for several years.

Has a reputation for being difficult to work with, sometimes dismissive of colleagues
within the practice and in local hospitals and community services

Steady trickle of patient complaints about his rudeness, condescending attitude and
resistance to engaging in listening and responding to complaints.

Dr E has had three new complaints about him in the last year

The CCG medical chair and the area team medical director has asked the LMC Chair
to try to get him to reflect on his attitude and behaviour but he states that he has
been practising medicine for 30 years and has no intention of changing how he
responds to patients and colleagues.
Case Study: Mr F

Newly appointed consultant cardiothoracic surgeon, in post for about 9 months.

Concerns have been raised by Mr F’s clinical director (CD) about his performance:






Appears to have a high rate of operative complications in cardiac surgical patients – a
disproportionate number of patients have had to be returned to theatre urgently for control of
postoperative haemorrhage
Operative mortality rates following first time coronary artery surgery appear to be higher than those
of his consultant colleagues, although the actual numbers are small
Anaesthetists and pump technicians report that Mr F’s patients seem to remain on cardiopulmonary
bypass for longer periods than those of his colleagues and on occasions Mr F apparently has
difficulty in performing technical procedures – he reportedly has to ‘redo’ coronary arterial grafts on
a fairly frequent basis
Senior theatre nurses report that Mr F can be demanding and volatile when things are not going well
in theatre – apparently on one occasion he threw a soiled swab across the theatre in the direction of
a nurse, but in the event it did not hit her and she made no formal complaint about the incident
A patient complained that Mr F was ‘brusque and dismissive’ during a recent outpatient consultation
When your ask Mr F about these concerns he becomes very defensive, arguing
that his workload is excessive and that his high rate of complications can be
explained entirely as a result of his colleagues ‘palming off’ more complex cases
to him so that they can concentrate on their lucrative private practice. He says he
gets little or no support from the junior staff, who are far too inexperienced to
help in technically-difficult cases; and he considers that the senior nursing staff
had ‘got it in for him’.