Sent in tonight.

I’m very concerned that it’s going backwards in terms of having a safer NHS, more transparent doctors acting professionally in the best interests of their patients. A blame and shame culture ultimately harms patients.

http://www.gmc-uk.org/concerns/fitness_to_practise_consultations.asp

I’m very concerned about the proposed changes.

1) Taking action in all cases where a doctor’s fitness to practice is impaired unless there are exceptional circumstances.

– doctors who are ill may be advised not to work and return to work when well. This is good practice, should be normal, and is encouraged.

-The GMC should take no action in these circumstances. The fact that you do not mention this or make it clear is worrying.

-you make no note of the circumstances where FTP is impaired. If a doctor is working in war zone, a unit where nurses numbers have been cut this will have an impact on how doctors perform. You seek to place all blame onto the doctor. You do not seek to understand what has happened or to make healthcare systems safer.

-nor do you distinguish between FTP being impaired and whether this goes on to lead to harm or patients or others, or not.

-you have not given examples of what ‘exceptional circumstances’ are ,which is concerning.

-you have explictly said that you will use, as a barometer of how to treat doctors undergoing FTP hearings and deciding on sanctions, what the public attitude is. This is absurd. The GMC should have clear standards which are unaffected by public sympathies or not. Otherwise it is simply playing to the crowd, not to clear standards and transparent frameworks.

2) Taking more serious action in specific questions

-You are recommending that doctors could be sanctioned for failing to raise concerns

-you have not set any standards clearly for what this means

-you have failed to examine how this would work in practice together with exploring the unintended consequences such as a creation of fear, or of overreporting

-you have said that doctors could be sanctioned for failing to uphold the public’s trust in the profession

-however you have not said what this is, how it  will be judged, or what standards you will use. This is particularly concerning given your previous statements of sanctions because of public judgement more broadly; are doctors allowed to have private lives, and how much judgement does the GMC want to place in what doctors do when they are off duty?

3) Doctors lives outside of medicine

“any other behaviour that may undermine public confidence in doctors ”

-this is an absurd and dangerous position

-it is entirely subjective

-it is grossly broad and without example or clarity

-doctors are entitled to a private life

-this statement threatens the human rights of doctors

4) Drugs and alcohol misuse

-doctors who run into problems with addiction should be treated as patients first

-the GMC should publish it’s enquiry into suicides of doctors under investigation

-the GMC should have a separate investigations process for doctors who are mentally ill

-the GMC should defer any further judgements on how it deals with sick doctors until it has been transparent about its’ own procedures and harms resulting from it’s investigations.

5) Deciding whether a doctor has insight

-the proposals favour doctors who say they wish to behave differently and express insight before a hearing

-however this means that doctors who wish to defend themselves because they do not believe the charges to be true are automatically disadvantaged

-it means that doctors may be better to plead guilt rather than seeking a fair hearing because they are likely to be accused of insightlessness otherwise

6) testimonials

if you continue to use these with the criteria you have set out, many people are unlikely to wish to take up the onorous responsibility for doing so. You should consider how useful and reliable testimonials have been in the past. If you are going to use these in the future you should research the past predictions of testimonials and how useful they have been in terms of accuracy or not. It is not right to continue using them without audit and evaluation of how they have worked in the past. The GMC should publish peer reviewed accounts of what they have done.

7) responsible officers

What evidence does the GMC have that responsible officers are able to monitor them. Could it be the case that they provide false reassurance? Are you asking for a level of knowledge that the doctor may not have?

The RO should not be part of the management structure employing the doctor but be independent.

8) suspending doctors with health issues.

The GMC has become very frightening to many doctors with health issues. The  GMC should make it clear that they have no interest in doctors who are being treated for a physical or mental health condition and who are taking their own doctors’ advice on their health and ability to work. The GMC should make it clear that it is possible for doctors with mental and physical health conditions to contribute fully to medical practice.

9) Giving patients a voice.

Currently patients can complain on social media, where doctors cannot correct or explain versions of events, they can complain to the practice, the local health board or hospital, the PALs service, the GMC, MPs, ombudsman, CQC, and the local press, NHS CHoices rating websites, as well as patient opinion and iwantgreatcare.org.

The proposals do not support good medical practice. Instead you propose to impose a meeting with the patient and the regulator present. This is likely to become defensive and threatening for doctors. You have not tested or trialled this to see whether it will help doctors or patients. You do not recognise that doctors may be themselves the ‘second victim’ of error. You seem to be proposing this as an extra layer of punishment for doctors, rather than a means of examination of events, understanding, learning, and  healing. It is likely to be traumatic for many people. The purpose is unclear. Is it to make the doctor feel worse, is it to allow the patient to interrogate the doctor, is it to promote understanding or reconcliation?

It would be far better for the GMC to engage with the large body of research about medical errors, why they happen, uncertainty in practice, and enable doctors to have safe spaces to discuss errors, to improve their practice rather than seeking to shame doctors and enforce meetings which may not be in the best interests of patients or carers.