The former RCGP chairwoman Clare Gerada believes the medical regulator needs to rethink the way it treats doctors with health problems. Tom Moberly reports
The General Medical Council is “traumatising” doctors and may be undermining the safety of patients through its adversarial approach to doctors with health problems, Clare Gerada, former chairwoman of the Royal College of General Practitioners, has said.
Gerada is now NHS England’s chair of primary care transformation for London and medical director of the Practitioner Health Programme (PHP), a confidential London based health service for doctors and dentists. Speaking at a conference held last week to examine the lessons learnt during the first five years of the programme, she argued that there were “serious problems” with the GMC’s treatment of doctors with health problems.
She said that although the GMC’s treatment of such doctors had improved over the past five years, the organisation still had “a long way to go” to improve its processes. “Our clinicians and our patients tell us that being involved with the regulator for mental health problems is either making them sick or, if they were sick to start with, not helping their mental health improve,” she said.
“Whilst the regulator, of course, has to protect patients, it must start to look at what it is doing in supporting doctors,” she said. “It is not good news to have doctors who have mental health issues go through an adversarial process where they have to prove, without any possible doubt, that they are never going to get a mental health problem again.”
She added, “We also have to ask the regulator why its processes take so long and why [it] continues to send letters in a way that causes considerable distress. They have gone a long way. But I think that there is a long way to go.”
Gerada also argued that the NHS’s approach to medical training was putting doctors at increased risk of health problems. She said that change was needed in “the way we train doctors, and the way we then put young doctors into a system with very little support where we expect them to work—not in teams, not in firms, but in shifts.”
“All the doctors in this room will remember bursting into tears when you were very tired. To be sent home and told you have a mental illness doesn’t actually help you very much. What you want is a bit of love. I think we have to do something pretty urgently about looking at why the NHS is making people sick and why we have an increased number of suspensions, mental illness in doctors, and bullying.”
Talking to BMJ Careers after her speech, Gerada argued that the GMC needed to “move on from the catastrophic events of Shipman a decade and a half ago and swing the pendulum back towards a kinder, less adversarial system of regulation.”
She said, “The GMC website says, ‘We are not here to protect the medical profession—our job is to protect patients.’ Of course it’s important to protect patients from rogue doctors. Who can argue against that? But my experience running PHP is that the regulatory system has gone too far and skewed the balance to assuming that doctors are guilty just by virtue of being referred to them [the GMC].”
Gerada said that many doctors who have been referred to the GMC have mental health problems, have made minor transgressions, or have been referred by disgruntled colleagues. “The number of referrals to the GMC has been increasing year on year, yet most are eventually closed with no sanctions or findings made on the doctor,” she said. “During the process a doctor is made to feel tarnished, and for many their personal and professional lives are impaired as the process grinds forward.”
She added, “The current system has created fear and paradoxically may actually harm patients. Doctors aren’t willing to admit when something is going wrong, because the chances of them being suspended or of having to go through a GMC process would be very high.
“Doctors are assumed guilty until proved otherwise, and the process they go through can take years, leaving doctors traumatised and unable to progress their careers or, even worse, unable to work. For doctors with mental health problems the punitive and unpredictable system drives secrets underground.”
Commenting on Gerada’s comments, Niall Dickson, the GMC’s chief executive, said, “Clare Gerada makes some important points, and we know that this is a sensitive issue. I am pleased she recognises the steps we’ve taken to make the investigation process less stressful for doctors, but we know that there is still more to do. We are looking at how we communicate with doctors, and we are looking at a number of measures to see how we can best support doctors going through our fitness to practise procedures.”
Dickson said that some doctors were referred to the GMC because they had serious mental health problems, including severe depression and various forms of addiction, that could affect the care they provided to patients.
“We recognise that these can be very vulnerable individuals and that being part of a fitness to practise investigation is almost always a stressful experience for everyone and especially for the doctor involved,” he said. “Doctors with mental health problems in our procedures all have a supervising doctor in their place of work. They are also regularly examined by two practising psychiatrists. Our aim is to get them back to safe, effective practice whenever that is possible. We also seek wherever possible to agree any restrictions on practice without the need for a panel hearing.”
He added, “Our priority, though, must always be to protect the public while at the same time being fair to the doctor—sometimes that does mean having to take immediate action when we believe patients may be at risk.”
Tom Moberly editor, BMJ Careers
The original article can be found in this link http://careers.bmj.com/careers/advice/view-article.html?id=20017662