Written evidence from the General Medical
Council (CAL 20)|
1. The General Medical Council (GMC) is the independent
regulator of doctors in the UK. The GMC protects, promotes and
maintains the health and safety of the public by ensuring proper
standards in the practice of medicine.
2. We do this in four ways:
- (a) By controlling entry to and maintaining
the list of registered and licensed doctors.
- (b) By setting standards for and co-ordinating
all stages of medical education and training.
- (c) By determining the principles and values
that underpin Good Medical Practice.
- (d) By dealing firmly and fairly with doctors
whose fitness to practise is in doubt.
3. The GMC is pleased to respond to this inquiry
into Complaints and Litigation. We note that the inquiry addresses
a number of issues that fall outside the GMC's remit. We would
however like to clarify the role of the GMC as a regulator of
the medical profession and our role in dealing with enquiries
about doctor's fitness to practise. We have also submitted evidence
detailing the rise in enquiries that we have received and the
work that we have undertook to ensure that our procedures are
more accessible and easier to understand.
GMC IN DEALING
4. One of the GMC's four main functions is to
deal firmly and fairly with doctors whose fitness to practise
is in doubt. The purpose of our fitness to practise procedures
is to consider whether action needs to be taken to protect the
public interest for the future, by removal or restriction of a
doctor's right to practise. The purpose is not in order to punish
doctors or to provide redress for complainants. Where appropriate,
in cases that do not require GMC action on registration, we redirect
the complaint or enquiry to the NHS or other healthcare provider.
5. Listed below are examples of the types of
cases where the GMC may need to act:
- (a) serious or repeated mistakes in carrying
out medical procedures or in diagnosis, such as prescribing drugs
in a dangerous way;
- (b) failure to examine a patient properly
or to respond reasonably to a patient's needs;
- (c) fraud or dishonesty;
- (d) serious breaches of a patient's confidentiality;
- (e) any serious criminal offence.
6. Anyone can make a complaint to the GMC if
they have a fitness to practice concern about a doctor. We categorise
the sources of these complaints into "members of the public",
"people acting in a public capacity" and "other
7. In 2009 the GMC received a total of 5,773
enquiries regarding a doctor's fitness to practise.
8. The majority of enquiries regarding a doctor's
fitness to practise come from members of public. This accounted
for 3,689 enquiries of the 5,773 received in 2009 (64%).
9. There has however been a notable increase
in the proportion of enquiries referred to us by "persons
acting in a public capacity" (an individual acting on behalf
of a public organisation, most commonly health bodies or police
forces). The number of enquiries received from persons acting
in a public capacity has gone from 394 in 2006 to 1,030 in 2009,
an increase of 160%.
10. The GMC has also experienced a marked increase
in the number of Stream 1 cases (enquiries which appear to require
GMC investigation into potentially serious concerns). The number
of cases that the GMC investigated as Stream 1 increased from
1,465 in 2008 to 1,758 in 2009 (an increase of 20%).
11. The increase in Stream 1 cases in turn has
resulted in an increase in the number and length of fitness to
practise panel hearings. 270 Fitness to Practise Panel hearings
took place in 2009 compared with 204 in 2008 - an increase of
32%. As a result, a total of 68 doctors were erased from the Medical
Register at Fitness to Practise Panel in 2009, more than in the
previous three years.
12. The GMC is keen to understand what may be
influencing this increase in enquiries, particularly the notable
increase that we have experienced in enquiries coming from a "person
acting in a public capacity". We have therefore commissioned
a programme of research, which will include in-depth interviews
and surveys among those responsible for referrals from public
bodies. We expect this report to be finished by the end of Quarter
1 in 2011 and the GMC would be very happy to present this information
to the Health Select Committee once it is published.
13. We understand that it can be stressful for
patients and members of the public who feel they have cause to
complain about a doctor. The process of making a complaint can
however be easier and less stressful if the complaints procedure
is easy to understand and that patients complain to the right
organisation the first time around.
14. The GMC has therefore developed our services
to help patients, the public and organisations that employ doctors
to know how and when to make a complaint. We provide a helpline
service that ensures that potential complainants can discuss their
concerns directly with us. Through our publications and our website
we provide extensive information for those who wish to raise concerns
about a doctor.
15. "How to complain about a doctor",
a publication aimed at patients, includes information about the
areas in which the GMC handles complaints, and when complaints
are more appropriately dealt with at a local level and by other
organisations. We have published separate versions of this publication
for each of the four UK countries to take account of differences
in local complaints systems. A Welsh language version is also
available, and we have produced a consolidated version in Arabic,
Bengali, Chinese, Gujarati, Hindi, Punjabi and Urdu. We have also
published an Easy Read version.
16. In 2008 we launched Patient's Help,
an interactive online information resource aimed at educating
the public and advice organisations. It shows the public how and
where to lodge a complaint about a doctor and includes an interactive
map for local advice centres across the UK. Patients' Help
provides case studies of typical complaints; an overview of the
complaints process and what patients can expect if they make a
complaint; and information on where they can go for more advice.
Where a concern is outside our remit, the website signposts the
reader to other complaints procedures.
17. We have also aimed to make the process of
filling in the complaint easier; complainants now have the option
of completing either an online or a hard copy complaint form.
18. We are in the process of developing regional
services to improve our understanding of and relationships with
regional healthcare arrangements. We are extending the local liaison
model we currently have in Scotland, Wales and Northern Ireland
to every region in England. The aim is to enhance relationships
with our key interests and will enable us to work more closely
with patient groups to explain our role, how and when to complain
to us and to better understand local issues.
19. As part of this work we are developing an
employer liaison service to enhance our relationship with the
employers of doctors and, in particular, medical directors and
responsible officers. We will be recruiting a team of employer
liaison advisers, who will be fitness to practise experts, to
work closely with medical directors in each region in England
and in Scotland, Wales and Northern Ireland to share information
about concerns about doctors and to improve the speed and quality
of decision making. A key role of employer liaison advisers will
be to work with medical directors to improve understanding of
our threshold for when a case should be referred to the GMC rather
than dealt with locally.
20. The GMC is committed to ensuring our complaints
procedure as accessible as possible. We believe that if people
know how and when to make a complaint about a doctor's fitness
to practice their complaints will be dealt with more quickly and
effectively. Ultimately this will therefore help the GMC towards
achieving our aim of protecting the public by ensuring proper
standards in the practice of medicine.