Written evidence from Dr Douglas G Fowlie
I seek to emphasise:
- The vital link between failed revalidation and
- The importance of establishing specialised clinical
- The prospects for effective Remediation when
"hidden" illness is identified.
- The economic and public safety benefits arising
from endorsed services.
1. I am Clinical Advisor to the Practitioner
Health Programme [www.php.nhs.uk]. I contributed written and oral
evidence to the Shipman Inquiry on behalf of the Royal College
of Psychiatrists. The submissions were incorporated into Dame
Janet Smith's 5th report.
2. I am a project member for the development
of competencies under the Health for Health Professionals initiative.
The document Enhanced Competencies for Psychiatrists was submitted
to the Department of Health by the Royal College of Psychiatrists
on 31 March 2010.
3. I have been involved in providing and promoting
clinical services for clinical staff for 30 years. I am licensed
to practise by the General Medical Council  in general
psychiatry and old age psychiatry and am recognised as having
special experience in addictive disorders.
4. I sat on Dame Deirdre Hine's General Medical
Council Health Review Group. It recommended Departmental recognition
of the need for dedicated clinical services for doctors.
5. Subsequently Sir Liam Donaldson's Regulatory
Review proposed establishing specialised services to deal with
mental illness and addictive disorder in clinicians.
6. A White paper commitment led to the prototype
Practitioner Health Programme being commissioned by the Department
7. The imminent report on the first two years
work at php highlights the clear association between impaired
fitness to practise and undeclared, unrecognised concealed, undiagnosed
and untreated mental illness and/or addictive disorder. Those
clinical conditions account for the vast majority of the 400 [approximately]
cases arising from the medical workforce within the London Strategic
Health Authority Area during that period [an annual prevalence
of about 0.4%].
8. Clinical conditions which compromise insight,
alter mood, interfere with perception and impair memory, intermittently
or progressively, are diagnosable in their early stages. The illnesses
may, on occasions, be preventable.
9. Behaviour which is inconsistent with revalidation
may be determined by these identifiable disorders.
10. Once identified there is a good chance of
successful treatment and consequently a real prospect for restoration
of full capacity to practise. Eligibility for revalidation would
likely then be restored.
11. Dedicated clinical services which are trusted
and accessed by doctors, are endorsed by employers and are validated
by the General Medical Council would seem to provide a means of
promoting public safety
12. If that tripartite consideration prevails
then the Remediation component of Revalidation would be enhanced
given the limited prospects for remediation when doctors are found
unfit to practise for other reasons [not associated with ill health].
13. The importance of recognising doctors' idiosyncratic
approaches to their own health and it's management was re-emphasised
in the Report of the working group on the Health of Health Professionals
[Department of Health, 5 March 2010]. Recommendation 4.7 calls
for clarity in dealing with health concerns within revalidation
14. Fostering the principles embodied in the
founding of the Practitioner Health Programme and supporting a
specialised approach in clinical services for clinical staff [including
doctors] throughout the United Kingdom would uncover an economic
saving. Greater numbers of expensively trained clinical staff
would be likely to return to effective working in a shorter time.
15. Those benefits would become doubly relevant
to the general public through shortening any periods of ineffective
practice and/or discontinuity of care.
16. My point in making this brief submission
is to emphasise that Revalidation will probably unmask numbers
of doctors manifesting complex reasons for becoming unfit to practise.
The likeliest remediable cause within that group will be mental
illness coupled with addictive disorder.
17. The chances of making a correct diagnosis,
formulating and implementing a recovery plan and promoting rehabilitation
are enhanced by espousing the principles underpinning the provision
of clinical services for doctors.
18. A UK network of psychiatrists, general practitioners
and occupational health physicians with enhanced competencies
could form the core of that dedicated clinical response.
19. An endorsed specialised service would become
complimentary to the appraiser, medical director and responsible
officer roles identified in the revalidation proposals.
20. Adding the numbers of doctors likely to need
remediation because of illness augments the overall justification
for promoting clinical services for these invisible patients.
The detail underpinning this submission can be provided
at the Health Committee's discretion.
Dr Douglas G Fowlie MB
Consultant Psychiatrist and Honorary Research Fellow - University