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Guide to... Coping with a GMC investigation

In the first of two articles, Dr Stephanie Bown and Sarah Whitehouse look at what the process involves.


Dr M received a letter from the GMC: an enquiry had been launched into his fitness to practise (FtP).


One of his female patients complained that she had been assaulted during an intimate examination. As Dr M always used the practice nurse as a chaperone when examining a female patient, and this was documented in his records, he was sure that he had not done anything wrong.


But that didn't stop him feeling anxious and fearful of an FtP panel hearing. Dr M contacted the MPS by phone the same day he received the GMC's letter.


A medico-legal adviser took personal responsibility for the case, meeting the doctor to explain the process and reassure him that the matter would be dealt with professionally and supportively. The MPS responded on behalf of Dr M and the GMC shared its response with the complainant who subsequently withdrew the allegation.


The case was closed by the GMC.

The morning post arrives at the start of your busy surgery. Amid pharmaceutical advertisements, medical journals and this week's GP is a letter from the GMC.

The letter outlines that you are the subject of a GMC investigation. Your stomach lurches. What happens next?

The GMC has a statutory duty to 'protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine', dealing with doctors who fail to maintain these high standards through fitness to practise (FtP) procedures.

According to the GMC's annual statistics for 2009, FtP panel hearings numbered 270 - an increase of 32 per cent compared with 2008.

With FtP hearings on the rise, GPs need to be informed about what happens at them, every step of the way. Outlined here are the different stages an investigation can pass through.

The process begins when the GMC receives any information that raises questions about one or more doctors' practice. In 2009, the GMC received 5,773 enquiries. They can come from a member of the public or a 'person acting in a public capacity' (PAPC). The latter are usually health bodies or police forces.

Interestingly, there has been an increase in PAPC enquiries - from 628 in 2008 to 1,030 in 2009. The GMC has noted that the reasons for the increase are not entirely clear, and has signalled that it will be conducting some qualitative research, asking NHS trusts why they think there has been such an increase. They expect the research to conclude by the end of the year.

All enquiries are usually assessed, or 'triaged,' within one week of receipt, to see whether or not the information received raises questions about a doctor's FtP. If the information does not give cause for concern, the enquiry is closed and no case is taken forward.

Why might your fitness to practise be impaired?
  • Misconduct
  • Deficient performanceA criminal conviction or caution in the British Isles (or elsewhere for an offence which would be a criminal offence if committed in England or Wales)
  • Physical or mental ill-health
  • A determination (decision) by a regulatory body either in the British Isles or overseas

Investigation streams
If there are concerns, however, one of two investigations could take place. If there are serious allegations which would call into question a doctor's FtP if they prove to be correct, the doctor will be subject to a full 'stream 1' investigation.

If the information received is less serious, but could cause concern if part of a wider pattern, a 'stream 2' investigation is launched.

The doctor's employer (or with a GP, the primary care organisation) is contacted in the first instance to see whether there are any wider concerns about the doctor's FtP.

Case examiners
Each case is looked over by one medical and one non-medical case examiner. At the end of the investigation they can:

  • Close the case
  • Issue a warning where FtP is not impaired, but the GMC's Good Medical Practice guidance has been significantly disregarded
  • Refer the case to a FtP panel hearing
  • Agree undertakings with the doctor.

Investigation committee
This committee judges whether there is a realistic chance of establishing that a doctor's FtP is impaired to the extent that taking action over their GMC registration (such as suspension or removal from the register) may be justified.

Fitness to practise panel
Around one in five cases resulted in a FtP panel hearing in 2009. The panel hears the cases against doctors and decides whether the facts are proven and whether FtP is impaired. If it is, the FtP panel then determines what sanctions are appropriate.

The Medical Protection Society (MPS) opened 227 new GMC cases for GPs in 2009 and is experienced in helping GPs deal with responses to enquiries and investigations.

If you receive any correspondence from the GMC outlining that an investigation has been launched into your FtP, contact your medical defence body as soon as possible, to allow a speedy response to any requests from the GMC for information.

  • Dr Bown is director of policy and communications, and Sarah Whitehouse is a staff writer at the Medical Protection Society, www.medicalprotection.org/uk

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