The fatal impact of fitness to practise investigations on doctors

The British Medical Association (BMA) has called a vote of no confidence in the General Medical Council (GMC) and Medical Practitioners Tribunal Service (MPTS) following the GMC’s report on doctors who have died while under investigation or during a period of monitoring.

The motion — which was passed at the BMA’s annual representative meeting on 4 July — said that “too many MPTS fitness to practise decisions are disproportionate to the error of the doctors mistake”. 

Here, Legal Director and professional conduct specialist Deepika Raino explores criticism of the GMC’s fitness to practise investigations and their impact on doctors.

The impact of fitness to practise investigations on mental health

The Medical Protection Society — a defence organisation for doctors — recently carried out a survey of doctors investigated by the GMC over the past five years.

An overwhelming 91% said that the experience had triggered stress and anxiety, 78% said it had damaged their mental health, 31% had experienced suicidal thoughts and nearly the same number of doctors had thought about quitting the profession as a result. 

What has the GMC done to address the impact of fitness to practise investigations to date?

In 2014, the GMC conducted an independent review on doctors who had died while under investigation or during a period of monitoring in the previous eight years. The report revealed that 28 doctors had died from suicide or suspected suicide during a fitness to practise investigation in this period. As a result, the GMC instructed mental health specialist Professor Louis Appleby to provide recommendations.

Professor Appleby’s recommendations for change 

Professor Appleby identified key issues that could be addressed to reduce the stress and impact of fitness to practise investigations.

His recommendations included:

• Ensuring that formal investigations only take place where necessary.
• Improving how the GMC communicates with doctors under investigation.
• Introducing a single point of contact during the process.
• Establishing a team to handle cases where a doctor is unwell and allowing an investigation to be paused while a doctor seeks treatment.

After implementing Professor’s Appleby’s recommendations, the GMC committed to sharing this data annually as part of their fitness to practice reporting.

Other causes of stress in fitness to practise investigations 

In my experience, fitness to practise investigations can include other causes of stress for the doctor under investigation.

Duration of investigations

Fitness to practise investigations can go on for years and the 2014 report showed that over half of deaths by suicide had been in cases where the doctor was under investigation for over one year (some even lasted over five years). This suggests an understandable correlation between the length of the investigation and its impact on the doctor.

The Department of Health and Social Care (DHSC) has promised to reform healthcare regulations to speed up the investigatory process — but will this go far enough?

Inconsistent timescales

Closely related to the duration of the investigation is the lack of consistency in timescales. For example, the GMC has been known to investigate a case for years before giving the doctor only 28 days or three months' notice to prepare a defence and evidence — depending on the stage of the investigation. The GMC can also raise new allegations late in the process. Both circumstances are beyond the control of the doctor under investigation and incredibly stressful. 

The GMC must give greater thought to working within pre-defined timescales and progressing the case as quickly as possible to avoid drawing out the process.

Costs

Professional indemnity insurance does not cover all types of fitness to practise investigations. The associated costs are a more significant issue for doctors who do not have professional indemnity. 

As solicitors, we perform balancing acts during these investigations to manage the doctor’s anxiety and pick the right moments to discuss difficult issues in their case and the legal costs they face.

The real impact of fitness to practise investigations

The significant impact of fitness to practise investigations goes beyond the limits of the investigation process itself.

I remain friends with a doctor client of mine who came to be investigated by the GMC many years ago because he had attempted to commit suicide. Thankfully his suicide was unsuccessful, but it led to a lengthy investigation by the GMC before many years of monitoring. 

He remains more affected by the GMC investigation process — which grew legs and started investigating his clinical work as well as his health — than by his suicide attempt. He still talks about his fitness to practise process, which he found lacked compassion. 

Recently, he sent me a message to say that an old doctor friend — who had been cleared of wrongdoing — still relinquished his licence to practise after going through a traumatic GMC investigation. 

Has anything changed? The BMA vote of no confidence

A recent report on the number of deaths that occurred between 2018 and 2020 confirmed that five doctors under investigation died by suicide during this period. While this suggests a reduction since the 2014 review, it’s still troubling and doesn’t show the full picture. We have seen improvements in how the GMC has responded to concerns in the past, yet there is still more to be done.

The latest vote of no confidence reiterates that failings continue within the GMC's fitness to practise investigation process. While regulators do have a function, the current investigation process needs reform — including finding better ways to avoid damaging the confidence and mental wellbeing of the doctor under investigation.

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Our professional conduct and regulatory law team has significant experience in handling fitness to practise investigations.