The hearing of fitness to practice cases by the General Medical Council: Current trends and future research agendas

Abstract

Over the last three decades a risk-based model of medical regulation has emerged in the United Kingdom. To promote a risk-averse operational culture of transparency and professional accountability the regulatory state has intervened in medical governance and introduced best-evidenced practice frameworks, audit and performance appraisal. Against this background the paper analyses descriptive statistical data pertaining to the General Medical Council's management of the process by which fitness to practice complaints against doctors are dealt with from initial receipt through to subsequent investigative and adjudication stages. Statistical trends are outlined regarding complaint data in relation to a doctor's gender, race and ethnicity. The data shows that there has been an increase in rehabilitative and/or punitive action against doctors. In light of its findings the paper considers what the long-term consequences may be, for both patients and doctors, of the increasing use of risk-averse administrative systems to reform medical regulation and ensure professional accountability.

Keywords:

• complaints
• fitness to practice
• General Medical Council
• medical regulation
• professional self-regulation
• risk
• risk regulation

Notes

1. The GMC is one of a number of bodies which deal with complaints against medical practitioners. NHS Hospital Trusts, Primary Care Trusts (alongside the National Clinical Assessment Service, the Healthcare Commission and the Parliamentary and Health Service Ombudsman) are all important points of contact for dealing with medical malpractice and patient complaints. The GMC remains the only body able to remove a doctor from the medical register and therefore stop them from practising medicine in the UK (Stacey 2000).

2. Undertakings are an enforceable agreement between the GMC and a doctor. Their duration can last for a maximum period of three years. They might include restrictions on a doctor's future practice or behaviour, as well as the requirement that they commit to having medical supervision or re-training. All undertakings are regularly reviewed by the GMC, operating in liaison with a doctor's employer as well as postgraduate and specialist medical training providers (i.e. the Royal Colleges). In comparison, a warning occurs when there is a significant concern about a doctors’ practice, but imposing restrictions on their practice is not held to be necessary.

3. Contact was made with the GMC requesting under the Freedom of Information Act (2000) the release of data pertaining to complaints it received against doctors between 1990 and 2009; 2010 was excluded as yearly figures would not at the time of request be available. These dates were selected as they cover a period of time when the principle of professional self-regulation came under increased scrutiny and the GMC underwent significant internal reform. The request asked that the GMC breakdown by gender and race how many cases proceeded through the complaints process, as it was felt these variables may yield interesting findings in relation to identifying possible trends in the data. The GMC provided the requested information on the hearing of fitness to practice cases for 2006–2009. It was stated that the GMC have only held fully computerised record systems since 2006 and that the resources which would need to be allocated to review the paper files to obtain the data requested would exceed the appropriate limit of costs incurred. This has been set at £450 for public authorities under the Freedom of Information (Fees and Appropriate Limit) Regulations (2004). The GMC noted it was possible to obtain some more limited data on the hearing of fitness to practice cases for the years 1999 to 2005 from documents published via the GMC website (see GMC, 2000, 2001, 2002, 2003b, 2004c, 2010).