Dr Heidi Mounsey, Medicolegal Consultant at Medical Protection, looks in detail at the work of the regulator, and how Medical Protection can assist in any cases brought before them.
The GMC investigates complaints or concerns when issues are raised about the ability of the doctor to practice safely, or when public confidence in the profession may be brought in question.
An investigation would usually be opened in the event that if the concerns were found proven, the GMC would consider that restrictions would need to be placed on the clinician’s practice. Concerns can include (but are not limited to) matters of misconduct; poor performance; criminal convictions or cautions; and ill health that may affect the ability of the doctor to practise medicine.
It’s also worth mentioning that the vast majority of cases are closed with no further action and that we at Medical Protection work with our members to get the best outcomes possible.
How does a GMC investigation start?
At the point of opening an investigation, the GMC will write to inform you and will provide details of the complaint or concern they are investigating. This initial contact is generally by email and it is advisable to ensure the GMC holds an up to date email address.
It is likely that the GMC will provide correspondence including a work details form, which requests that you list your Responsible Officer and the organisations you work for. The GMC will also ask for your comments on the concerns that have been raised.
The work details form must be completed and returned within the time frame specified (usually seven days) but it is usually preferable not to provide any additional comments to the GMC on the matter at this stage. This is because there is a risk that a statement at the early stages of an investigation may open up other lines of inquiry, and it is also likely to be shared with the complainant who will then have the option to comment further. This is usually unhelpful, especially in those situations where there is a factual dispute between the doctor and the complainant – where providing comments may well invite additional debate of the matter. If you are considering offering comments it is essential that you first discuss this with Medical Protection.
It is important to note that your case will not be prejudiced by choosing not to provide comments at an early stage.
It is prudent to advise the individuals or organisations listed on the work details form of the investigation, as the GMC are likely to contact them to ask if they have any concerns about your fitness to practice, and it is preferable if they are forewarned.
What happens during an investigation?
During the investigation process, the GMC has the option to refer the matter to the Medical Practitioners Tribunal Service (MPTS) for an interim orders tribunal, if they consider that your practice should be restricted or suspended while the concerns are investigated: for example, if it is considered there is an immediate risk to patient safety if you were permitted to continue to practise unrestricted.
An interim orders tribunal is often held at short notice and therefore it is important to contact Medical Protection as soon as possible should you be informed such a referral has taken place. This allows Medical Protection to provide you with appropriate legal representation at the tribunal.
Once the GMC have collected all of the information they require – which may include medical records; witness statements; a report from an expert; or potentially health or performance assessments – they may seek to put specific allegations to you relating to the concerns raised.
It is at this point where it is advisable to provide a statement to the GMC, and this is usually done via a solicitor instructed by Medical Protection. The solicitor will meet with you and the medicolegal consultant to discuss the allegations and formulate a response on your behalf.
The matter is then considered by two senior decision makers at the GMC (the case examiners; one medical and one lay) who will decide which of the following courses of action should be taken:
• Close the case
• Issue a warning
• Agree undertakings (restrictions on your practice) to address the concerns
• Refer the case to the MPTS for a hearing, at which the most severe sanction is erasure from the medical register.
What are provisional enquiries?
In 2014 the GMC introduced provisional enquiries, which are intended to reduce the number of cases being opened for full investigation. A provisional enquiry involves obtaining limited information (such as the relevant medical records and an expert opinion) at a very early stage to determine whether the matter can be closed or whether it should be promoted to a full investigation. The GMC will still request the completion of a work details form and will still offer the opportunity for a doctor to make comments on the case, although it usually remains advisable to refrain from making a statement to the GMC at this stage.
A provisional enquiry should take place over a shorter time period than a full investigation (within 63 days compared to six months), and many of these are closed with no action, meaning a full investigation is not necessary.
It is advisable to discuss any correspondence from the GMC relating to an investigation or a provisional enquiry with Medical Protection, as this article is a very brief overview of what may ultimately be a lengthy and complex process.