How to avoid a GMC referral

The title of this article is misleading. There is probably nothing anyone can do to entirely eliminate the risk of a GMC referral.  Sometimes, it is down to just plain bad luck.  It is certainly often nothing to do with your abilities as a doctor, and that’s important to remember if you are unlucky enough to receive the dreaded GMC letter.

It’s important to bear in mind that not all complaints to the GMC go anywhere.  Many are weeded out by the GMC at an early stage (sometimes without you even knowing anything about them).  Others are investigated and then closed.  You may be asked for your comments on a complaint or allegation.  If that happens – take advice from your medical defence organisation or insurer.  You may be advised to say nothing at all at the very earliest stages.  This could be because it’s better to wait until you know more about the allegations and the evidence there is to support them.  At this early stage, you will not yet have access to all the relevant documentation (and any other evidence) and you should not rely on your memory.  By making comments early, you may say something that is inaccurate or unhelpful.  That’s not always the case of course – if you have a straightforward defence (you’ve got the wrong doctor – it was the other Dr Bloggs) – then that’s certainly worth saying!

It’s also important to know what sort of issues the GMC will investigate.  The worst case scenario if you are referred to the GMC is that the complaint is eventually referred to a hearing before a Medical Practitioners Tribunal (MPT).  That Tribunal will have to decide whether the facts are proved, and if they are, whether they amount to one of the statutory grounds for impairment.  Those grounds are misconduct, deficient professional performance, a criminal conviction or caution, adverse physical or mental health, or an adverse decision by another UK regulatory body.  If one of those grounds is made out, the GMC will need to decide whether it amounts to current impairment of fitness to practise – taking into account factors such as remediation, insight and personal mitigation.

When thinking about how to minimise the risk of a GMC referral it’s therefore instructive to look at the statutory grounds, and also to look at the types of cases which fall within the various categories.

Health:

Poor physical or mental health can lead to a GMC referral.  Your health is important.  If you become unwell, put yourself in the hands of a GP or specialist.  Don’t ignore your health, don’t try to deal with ill-health by yourself.  Certainly don’t prescribe for yourself (see further below).  Mental ill-health can be particularly difficult, and difficulties with drug and alcohol addiction are common.  There are a number of support groups for doctors in this sort of difficulty – call them.  And most importantly (in the context of this article) – don’t work if you are not fit to work, and keep your workload to a manageable level.  That may seem like a ridiculous thing to say if you are overworked, and in a department with staff shortages and rota gaps.  However, if you make your employer/medical personnel/occupational health department aware that you are unwell, they will have an obligation to look after you.  If they don’t know, they can’t do anything to help.  I realise that this is a very difficult step to take, and that you will be afraid of harming your career by going down this route, and possibly prompting a GMC referral or other action against you by self-declaring your ill-health.  Those risks are real – but it is far, far worse for your ill-health to be reported by someone else because something has gone wrong.

Criminal convictions and cautions:

I will not go into details about these in this article, but you should be aware that you have a duty to report convictions and cautions to the GMC.  If you don’t, someone else is likely to (either the police or someone involved in the case – or the GMC sometimes find out from the press).  You must also inform the GMC if you are charged with a criminal offence.  You should be particularly wary of cautions – these are sometimes offered by police officers on the promise that a caution is an easy way out, will avoid a criminal trial and that will be the end of the matter.  That is not necessarily the case – you will need to report the caution to the GMC (and if you don’t, someone else might) and you may then face a GMC investigation.  It may not go to a hearing (depending on how serious the offence was), but you may have to go through a stressful investigation.  If you are offered a caution, take advice from lawyers with experience of both GMC and criminal matters, so that you can properly balance the risk of a more serious criminal record and a GMC investigation.

Deficient professional performance:

This ground perhaps requires little explanation.  You must keep up to date, obtain feedback from patients and colleagues, audit your practice, and work within your scope of competence.  Don’t be tempted into carrying out procedures which are not part of your usual practice without adequate further training.  Be wary of carrying out procedures where the number you are doing is low – think about whether the patient would be better off elsewhere.  That is particularly important in private practice, where numbers may be lower and where you risk being perceived as motivated by financial gain rather than the patient’s best interests.

Misconduct:

This is a broad category which includes both clinical and non-clinical issues.  It’s important to remember that it can (if sufficiently serious) include misconduct in your personal life as well as your professional life.  Behaviour that you may (rightly) feel has nothing at all to do with your job or your profession as a doctor may still attract the attention of the GMC.  Examples of misconduct include isolated clinical incidents which are particularly serious, fraud, sexually motivated examinations, prescribing for yourself or your friends/family, working without insurance, etc.

How can you protect yourself from an allegation of misconduct?

• Keep full, accurate and contemporaneous clinical records. Record the process of taking informed consent and make a note of any documentation you have provided the patient (such as
• Work in a team – consult with colleagues and the wider MDT – this will not only help prevent errors but also help you to defend your clinical decision making, should the worse happen.
• Use a chaperone. Chaperones are there to protect you (as well as the patient).
• Be aware of professional boundaries with patients and colleagues
• Be careful in any financial dealings, such as billing patients and insurance companies.
• Don’t see private patients during NHS contracted time – you are putting yourself at risk of an allegation of fraud. If you consider that you make up the time by doing NHS work in the evenings or at other times, make sure that this is understood and agreed (in writing).
• Don’t self-prescribe and don’t prescribe for your friends and family – the GMC’s guidance is that this should be avoided wherever possible. If you have to do so, be prepared to justify your decision, make a clear record of what you have done, and let the patient’s GP know (unless the patient objects).
• Communication – it’s hard to emphasise enough the importance of good communication – with patients and colleagues.
• Be open and honest and apologise if something goes wrong.
• Make sure that you have appropriate insurance arrangements in place.
• Be careful when using social media – don’t post anything related to patients, and don’t post anything you wouldn’t want the GMC to see.
• Be a good colleague and allow your colleagues to support you. Asking for help can prevent a situation escalating out of control.  Being a supportive colleague, and accepting support from colleagues, can prevent errors (systemic and personal).  If something goes wrong in a cohesive and supportive department, there is a greater chance of the issue being dealt with locally rather than referred to the GMC.  If the worst should happen and you are referred to the GMC, testimonial references from colleagues will stand you in good stead.

If, despite your best efforts, you receive notification of a complaint to the GMC – don’t panic.  Don’t ignore it.  Take advice early.  Most situations can be handled effectively and although the process of going through a GMC investigation is undoubtedly stressful, in most cases there is a way through, and the earlier you start, the better.