In the Surgery: Complaints and GMC Referral

Receiving a complaint or a GMC referral is one of the greatest tests of resilience for a doctor and can have a devastating effect on wellbeing. We know that dealing with a complaint or referral can leave a doctor dealing with an avalanche of difficult emotions such as bewilderment, frustration, anger, fear, loss of confidence and motivation, questioning your own judgment, questioning whether you want to even continue as a doctor as well as having negative impacts on mental health.

We know that doctors referred to the GMC are more likely to be depressed, anxious and commit suicide. Bourne et al studied the negative impact of complaints and/or referrals to the GMC and found doctors who received a complaint of any kind were 77% more likely to suffer from moderate to severe depression than those who had never had a complaint. This is in addition to increased suicidal thoughts, poor sleep and physical health issues and relationship problems. Dr Clare Gerada suggests that ‘a complaint or referral to the GMC must be considered a red flag risk factor for both depression and suicide’.

Personal experience of undergoing a GMC Referral

This is the journey of one doctor who has undergone a GMC referral:

I just wanted to write this in case it helps anyone. After one year the GMC investigation I was dealing with in relation to a clinical incident is closed with no action taken.

When I heard from the GMC I was a GPST2 and I didn’t know anyone who had dealt with them. I didn’t know what to expect or how to handle it.

The Process Itself

– So what happens initially is you get a letter saying the GMC have received a complaint and they are deciding whether to investigate.
– Then three months later they decided to investigate which meant they got an initial expert opinion. Following their initial investigation they decide whether to close it or proceed to something called the rule 7 stage.
– The rule 7 stage is basically where they get a detailed expert opinion (that might well be the same expert as the first time) and require a response from you (this takes a few more months).
– At the rule 7 stage you have 28 days to submit a written response to a list of “allegations” – your MDO will help you with this.
– Just to mention, there were a few errors in the expert report – e.g. stating I hadn’t prescribed something when there was clear evidence (signed prescription) that I had (this isn’t a criticism of the expert, just that I am saying I wasn’t expecting this).
– The expert’s job is to comment on your standard of care of that one patient at that one time, which will involve going through everything that was documented, with a fine-toothed comb. (I was on call at the time; my documentation could have been better – it’s not ideal but it is definitely reasonable to admit to this and say that you would have actually done x, y and z but you didn’t write it down). The GMC’s job is to assess if you are fit to practice at the moment – it is important to remember that the two are different.

How to defend yourself

In your response to the allegations you also include an appendix. The following things were included in my appendix (and they all helped my case):
– To show evidence of good practice now: Testimonials from colleagues – this included consultants, GPs, registrars and juniors, a written reflection on the incident (which I asked several people to look over before uploading to e-portfolio), presenting the case at my practice meeting, looking through my ePF and accumulating paper evidence that I was good – from CBDs, MSFs, supervisor reports (obviously choosing the best ones). For “allegations” you admit it is a good idea to show evidence of improvement – this could be by a CBD, CPD (e.g. e-learning) etc.
– The MDO recommended a discussion with a particular consultant (to provide an alternative to the GMC’s expert opinion). This consultant was very busy and stated they didn’t have time to do a CBD. I still needed something in writing so I simply noted down all our discussion points, sent him an email stating thanks very much Dr X, we discussed the following points – I then included this email in my appendix.
– I also self-referred to the professional support unit of my deanery (well I filled out the form and asked my ES to sign – the GMC saw that as good evidence of CPD)
– All of the above helped in clearing my name.

How to help a colleague

– A final thing – someone nominated me for best speciality trainee when this was going on – that was REALLY useful paper evidence. If you know a colleague who is going through something similar you can help them gain paper evidence if you are in a position to do so.
– Also, it’s good if you are treated by a health care professional to give them a written thanks (all the paper evidence may come in use one day…).
– On that note – this is why I very much am against giving bad written feedback…I will happily tell someone verbally if I don’t like something but I think it’s vital to remember that those MSFs etc could form part of that person’s get out of jail card one day…
– The one thing that really saddened me when telling my colleagues my happy news today was that we got into a discussion of cases where people had reported colleagues to the GMC…I am aware I don’t know the exact ins and outs of the cases but I really, really, passionately feel that unless they are going round assaulting or killing patients or something similar, that this isn’t the right thing to do…there are many other avenues to deal with problems.

How to handle it

There are people you have to tell legally – e.g. employers. As a trainee you have a lot of employers as you are changing jobs a lot. I initially didn’t want to tell anyone when I heard from the GMC and I felt like when I did tell people I had to prove myself in every rotation by doing double the amount of work – because I had a black mark against my name (you know the saying “there is no smoke without fire” – that’s what I was worried people thought). I don’t know if that was rational and I got a bit burnt out.

My ES at the time told me to be completely open about things – and that was actually really good advice. I ended up sharing with lots of people, not just those I had to tell. People were really nice 99% of the time and 99% of people did not change their opinion of me so I guess the fears I listed above probably were irrational. Actually, talking to people about this meant we bonded over something, because when I did talk I found loads of people had experienced work-related difficulties.

I initially avoided doing OOH – I was scared with the old contract of working too many hours, getting tired and making an error (especially in a context of patients I didn’t know – who might therefore be more likely to complain). The new contract has helped with that with time off in lieu. I have let occ health know about this. I don’t know what a better way around this would have been.

I irrationally feel like I am a good doctor today because I have no GMC thing hanging over my head – but that is totally irrational because the GMC thing did not define me as a doctor…and I don’t need their validation! I want people to know what the process involves and also because I think people don’t talk about this sort of stuff very often but I think it’s good to share stories because being investigated isn’t actually a reflection of your abilities as a doctor.

How to avoid complaints

Support for Doctors facing Complaints, Investigations or Referrals

  • This Doctor Support Service information provides doctors who are involved in a fitness to practice case with independent and confidential support.
  • Through Practitioner Health, you can access excellent resources and support for doctors facing a complaint or investigation.
  • Doc Health: supported by the BMA and RMBF, Doc Health is a confidential psychotherapeutic consultation service which gives doctors an opportunity to explore difficulties, both professional and personal. This pilot service is delivered by consultant medical psychotherapists. Although located in London, the service is open to all doctors in the UK. For doctors living a considerable distance from London they are able to offer, after the initial face-to-face consultation, further consultations by Skype.
  • The Doctors’ Support Network (DSN) is a fully confidential, friendly peer support group for doctors and medical students with mental health concerns including stress, burnout, anxiety, depression, bipolar disorder, psychoses and eating disorders. They offer invaluable support and help to feel that you are not alone.
  • MPTS hearing support: Appearing before a tribunal can be daunting. The MPTS Doctor Contact Service is available to any doctor on the day of a hearing, and is particularly aimed at those attending alone or without legal representation. A member of MPTS staff unconnected to your case will be available to talk to on the day of your hearing to help lessen the isolation and stress that you might feel, signpost useful support material and services, and talk you through the hearing process.
  • British International Doctors’ Association: The association serves to maintain welfare, information and advisory services for ethnic minority doctors and dentists to protect and promote the interests of Ethnic Minority Doctors and Dentists working in the UK..
  • You are not your mistake: a secret group support network part of Tea and Empathy – send a request to admin to join.
  • Doctors Support Group: A free service with doctors attending from all across the UK whose primary aim is to enable those facing these bewildering and confusing situations to cope and eventually emerge with the minimum of professional and/or personal damage.

BMA wellbeing support services

The services offer 24 hour telephone help and structured counselling sessions. You do not have to be a BMA member to access support. It covers alcohol, substance abuse, debt as well as issues such as depression, stress, bullying and GMC issues – Tel: 0330 123 1245 or email: wellbeingsupport@bma.org.uk.

Peer Support
The Peer Support service runs alongside the Counselling service and are both included in the BMA Wellbeing Support Services, giving doctors and medical students in distress or difficulty the choice of speaking in confidence to another doctor. If you wish to use the service call 0330 123 1245 and ask to speak to a Peer Support Doctor – you will be given the name of a doctor to contact and details of their availability. This is not an emergency service and if you find yourself in such a situation, please get appropriate help from either your own GP or usual medical advisor. Doctor Advisors do not provide diagnoses or treatment, although inevitably any interaction will have a therapeutic aspect.

Doctors support service

Doctors who face GMC investigations or license withdrawal have access to a new, confidential support service from the BMA. This recognises that being subject to a complaint or learning your license is at risk can be uniquely and deeply stressful. They also understand that many doctors might not have anyone to confide in while they undergo a GMC investigation. As a result, the GMC commissioned the BMA to provide the Doctor Support Service, which offers emotional help from fellow doctors and functions independently of the GMC.’ Call 020 7383 6707 (Monday to Friday, 9am to 5pm). Email: doctorsupportservice@bma.org.uk.


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