Revalidation of Doctors - Health Committee Contents

Written evidence from Dr Douglas G Fowlie (REV 15)

I seek to emphasise:

  • The vital link between failed revalidation and mental illness.
  • The importance of establishing specialised clinical services.
  • 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 []. 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 [1319934] 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 of Health.

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 procedures.

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 ChB, FRCPsych
Consultant Psychiatrist and Honorary Research Fellow - University of Aberdeen.

November 2010

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