Tuesday, 30 December 2014

How to handle a GMC complaint and stay alive

The GMC published its internal report on the deaths of 114 doctors while under investigation http://www.gmc-uk.org/Internal_review_into_suicide_in_FTP_processes.pdf_59088696.pdf . Of the 114 deaths, up to 28 were deemed as suicides. In the same year Civitas published a report on the GMC: Fit to Practice http://www.civitas.org.uk/pdf/GMCFittoPractise.pdf . In Pulse online GP magazine, numerous anonymised doctors are sharing their despair at receiving a GMC complaint and some have shared their near death experiences as they too have contemplated suicide http://www.pulsetoday.co.uk/your-practice/practice-topics/regulation/gmc-to-introduce-emotional-resilience-training-after-finding-28-doctors-under-investigation-committed-suicide/1/20008791.article?&PageNo=27&SortOrder=dateadded&PageSize=10#comments. Here is one such post I came across that struck a sad chord. This article will try to guide you and show you how to survive a GMC complaint to come out alive and not harm yourself.

Ethnicities and Primary Medical Qualification Country of 28 Doctors who committed suicide while under GMC investigation (FOIA)

Anonymous GP posted July 2014:

'I had dealings with the GMC when I was severely depressed and had been under so much stress at work that I had intended to kill myself. Instead I went off sick and sought help. I survived and was punished. The sense of shame is awful and I can't begin to explain what it was like to go through the GMC process when suffering with mental health problems. I already felt that I had let everyone down and then the GMC process reinforced my sick view. I shall never get over it. A proper legal process would have been fairer. At no point did anyone question the motives of the referrer, indeed the GMC specifically said that was not within their remit. I had to attend an interim orders panel pending investigation and later worked with undertakings. The investigation took 9 months and then I had to serve a 'sentence' of over 2 years before the final procedure to let me go started. The case examiner deciding on the timing of this applied guidance to me that was relevant for doctors with drug and alcohol problems though I had neither and did so despite recommendations from my medical supervisors to the contrary. The GMC letter telling me I had at least another 6 months to serve ended with 'if you have any questions etc' . I broke down in tears and shouted 'Yes, I have a question, What about me?' I had already learned though, as the presumed guilty accused, not to phone the GMC. My medical defence union gave me advice at the outset to keep my head down and jump through the hoops in order to get out of the other side as quickly as possible. When I signed my undertakings for continued supervision I had been advised by my solicitor that if I asserted that I was now well then 
the view would be taken that I must in fact be ill and lacking in insight and would therefore most likely be referred to a Fitness To Practice panel. I could not have survived that. Today I read the Civitas report and BMJ article on the GMC and found that my experience was not unique and a bit more healing has happened. I am here to write this- many are not.'

Doctors who have committed suicide..

(Added November 2015: Newly qualified doctor voted 'Trainee GP of the Year' hung himself after self -referring himself for alcohol use, was placed under GMC restrictions and feared the results of an alcohol test following a third GMC interviewer who took a dim view to drinking socially if the restrictions were lifted. R.I.P. Dr James Halcrow, aged 34.  http://www.dailymail.co.uk/news/article-3331748/Newly-qualified-doctor-voted-Trainee-GP-Year-hanged-worrying-failed-alcohol-test-work.html. My advice is to take a few months to a year out so patients and you are safe, a sabbatical and get help and counselling to sort out depression or addiction but try not to self refer to the GMC, as the scrutiny and restrictions are too severe in my opinion based on reports I have read from those who were placed on restrictions and kept under restrictions for years despite passing GMC knowledge and clinical simulated surgery tests repeatedly.)

January 2014 an overworked 53 yo male Liverpool NHS GP partner took an overdose to end his life and was unable to be revived in A&E. His surviving son would like to keep the suicide private.

October 2013 suicide fraud allegation made against 53 yo NHS GP Dr Allim. She was publicly shamed by police who entered her GP surgery to arrest her in front of her patients! NHSE were investigating her along with police. She stated in her suicide note she could not face enduring years of an enquiry. http://www.dailymail.co.uk/news/article-2581009/GP-killed-bath-fraud-arrest.html.


Feb 2013 suicide/depression overcame a 53 yo NHS GP Martin Bell. http://www.essexchronicle.co.uk/GP-took-life-admitting-suicidal-thoughts/story-19631858-detail/story.html.

Sept 2012 age 51 NHS GP John King commits suicide. http://www.parentdish.co.uk/2013/03/19/perfect-family-gp-killed-himself-after-sons-kidney-failure/.

June 2012 age 26 NHS GP Elizabeth Foubister hanged herself. Thought text message was break up. Stressed from NHS work. http://www.worcesternews.co.uk/news/9941517.Doctor_killed_herself_after_partner_sent_an_angry_text/.

Feb 2012 NHS GP Festus Ojagbemi aged 49 hanged himself. Feared double life exposure. http://www.telegraph.co.uk/news/9591098/Suicide-of-GP-who-led-secret-double-life-with-two-women.html.

Feb 2012 53 yo NHS GP David John Weddell took a lethal overdose at a Hilton Hotel. Sometimes worked 7 days a week! Worked to death. http://www.bromsgrovestandard.co.uk/2012/06/27/news-Coroner-describes-popular-Rubery-GP-as-remarkable-42553.html.

Dec 2006 47 yo locum NHS GP David Scarfe faced a large tax bill and divorce, self asphyxiated with a plastic bag. http://www.thisisoxfordshire.co.uk/news/1624975.depressed_gp_killed_himself/.

May 2006 46 yo GP Mark Gradwell jumped in front of train. Being investigated by PCT. http://www.thisisoxfordshire.co.uk/news/1624975.depressed_gp_killed_himself/.

Jan 2005 45 yo NHS ICU doctor slit his own throat. Dr Andrew Scott had burned out. http://www.theguardian.com/society/2005/jun/01/nhsstaff.health.

10 tips on handling a GMC complaint (especially if malicious/vexatious)

1. When an envelope from the GMC arrives unexpectedly through the letterbox, make sure you find your partner or surgery colleague to sit down with (think breaking bad news) and have them open it if you are brave enough to allow them to. You may be flooded with feelings of anxiety and despair, especially if you have done nothing wrong, have never met the complainant and this letter comes out of the blue with no warning shot.

2. The GMC case investigating officer will instruct you in the letter to fill out a form with the contact details of your employer and your revalidation officer/CCG. Your initial impulse will be to do this immediately and write a lengthy rebuttal to each of the allegations. Stop. Call and email your medical defence organisation. This is now a legal investigation and you are not a lawyer! This is where it gets tricky as medical defence orgs now choose to show discretion (cherry pick?) as to which doctors they represent. So you may have paid them several £10,000s total from annual subscriptions but when it comes to seeking their legal support, they may simply just say NO! They will then suggest you may appeal their decision not to represent you by writing to their Council who will then discuss your appeal at the next Council meeting and may still say NO. 

What happens if you are fortunate and your MDO agrees to provide you legal assistance?  Be prepared to hear them suggest you reply with 'no comment.' You may be flummoxed, as it may make you appear guilty with such a terse reply but there is method to the madness. The MDO will look at the GMC complaint and may have decided there is no evidence to substantiate the string of allegations so yes, 'no comment' becomes the best defence.

3. Post off your reply with a completed form giving details of employer, etc. for the GMC to contact to enquire about any 'adverse outcomes'.  Best to sit down with your employer, a senior GP partner, and give your side. If it is a malicious referral by a stranger, then say so. Often times a senior GP partner will have also been through the GMC system at some point in his or her long career and survived. Yes even innocent good doctors may get hauled through the GMC but fortunately come out the other end.

4. Get some counselling and try your best to manage the overwhelming feelings of sadness with CBT counselling and not SSRIs if possible. You do not want to be referred or have to self refer if you are now depressed on medication! That brings on another set of GMC health assessments, investigation etc. Here is a lengthy list of counselling services compiled by another GP.

One suicide is one too many, anyone distressed consider all the excellent help available. Caring people are all around you and prepared to help. 

BMA Counselling is staffed by professional telephone counsellors 24 hours a day, 7 days a week. They are all members of the British Association for Counselling and Psychotherapy and are bound by strict codes of confidentiality and ethical practice. You can even choose to remain anonymous when you call. 

Call 08459 200 169 (landline: 01455 254 189) - 24 hours a day, 7 days a week 

The Doctor Advisor service runs alongside BMA Counselling giving doctors and medical students in distress or difficulty the choice of speaking in confidence to another doctor. 

If you wish to use the service call 08459 200 169 and ask to speak to a Doctor Advisor - you will be given the name of a doctor to contact and details of their availability. 

CAPITA Insurance Services 

Stress Counselling & Confidential Tax 

Telephone service only 

for GPs and GP families 

0800 174 883 

British Doctors and Dentists Group 

Website: www.bddg.org 

Telephone: 07771 642 682 

British International Doctors Association 

Address: ODA House, 316A Buxton Road, Great Moor, Stockport, SK2 7DD. 

Telephone: 0161 456 7828 

Doctors' Support Network

Peer support group for doctors with a wide range of mental health problems. 

Email: info@dsn.org.uk 

Website: www.dsn.org.uk 

Telephone: 0844 395 3010 

Doctors’ Support Line 
Helpline dealing with any problem from career and family to mental health problems. Staffed by doctors and fully confidential. 
Telephone: 0844 395 3010 

NHS Practitioner health programme 
Free and confidential services for doctors with a mental health, addiction or physical health problem affecting their work. Patients outside London area will be dealt with on a case by case basis and maybe required to seek funding for inpatient or specialist case if required. They ensure confidentiality by asking you to provide a different name to go by while you are receiving counselling.
Website: www.php.nhs.uk 
Telephone: 020 3049 4505 

Primary Care Support Service 
The Primary Care Support Service is a direct access, confidential counselling, support and educational service for GPs (doctors), general dental practitioners and community pharmacists working in Wales. It is funded by the Welsh Assembly Government but is run as an independent service with co-ordinator input in each of the three Welsh regions. 
Email: pcssinformation@wales.nhs.uk 
Phone: 01248 675899 

Royal Medical Benevolent Fund 
RMBF offers support to members of the medical profession and their dependants who, through illness or misfortune, find themselves in financial hardship. The website www.support4doctors.org also provides a wide range of other sources of help and support. 
Email: enquiries@rmbf.org 
Website: www.rmbf.org 
Telephone: 020 8540 9194 
Fax: 020 8542 0494 

Royal Medical Foundation 
The Royal Medical Foundation exists to support doctors and their dependants who find themselves in financial hardship. 
Email: caseworker@royalmedicalfoundation.org 
Telephone: 01372 821 010 
Fax: 01372 821 013 

Confidential emotional support 24 hours a day. 
Email: jo@samaritans.org 
Website: www.samaritans.org 
Telephone: 08457 90 90 90 

Sick Doctors Trust 
24 hour confidential telephone helpline for doctors with drug and alcohol problems.
Website: www.sick-doctors-trust.co.uk 
Telephone: 0370 444 5163 

"CONTACT” West Midlands Region 
Clinical Psychology for GPs by phone 
and face to face 
0121 558 0278 
Confidential Service 

5. With counselling in place, brace yourself for a 6-month waiting period while the complaint is undergoing an initial investigation. You are now going back to work full time, seeing patients every 10 minutes, yet at the back of your mind you may be suffering from chronic stress and anxiety, not knowing the outcome and fearing the worse. Try not to ruminate or spiral downwards. If this happens, see the counsellor more often and pick up the phone and speak to a BMA counsellor also. You do not have to be a BMA member to access their counselling service as they have an arrangement with the GMC to provide counselling for any doctor who has been referred. They can arrange a one hour session by phone once a week. Your GP can also refer you for local counselling. If there is a delay, consider private Efficacy with reasonable rates. Counselling will address this chronic state of stress, adrenaline rushes, poor appetite, tearfulness, despair, insomnia, isolation and will replace with logic, calm, clarity, reasoning and perspective. The worst feeling is being referred by a vexatious referrer and knowing that you are innocent and feel you must prove your innocence. And when cleared know you will receive no GMC apology and there is no comeback on the referrer for wasting your time and that of the GMC.

6. It takes up to 6 months for your case with responses from your employer and health trust/revalidation officer or CCG to be presented to 2 case examiners, one lay with legal experience and one medical. The lay legal case examiner will have the final vote, if the two reach different conclusions. If you have been unlucky and your MDO has decided NOT to offer you with any legal advice or support, then your choices are to pen a response yourself (remember the GMC wants to be assured you are safe with patients. Refer to the GMC's Good Medical Practice guides, show evidence that you abide by the relevant passages and show some insight and reflection) or you may have to pay £1000s to a private lawyer to write a response for you. This response is vital, as it will help determine whether the complaint is closed at initial investigation or proceed up to an interims order panel or fitness to practice hearing/trial. Show empathy, emotional intelligence and insight in your response. The good news is they cannot see you and judge you on your looks or accent so there is no subconscious bias at play. However you may be subconsciously judged on grammar and content so have a colleague proof read your response especially if English is a second language. During this time be polite in all email exchanges and phone calls with the GMC investigating officer. I know you want to keep calling and say when will the decision be made as every day, week, month you wait, wears you down when you are innocent but are made to feel guilty until proven innocent. Use these months to take up a new hobby, exercise, sport and remember you have lots of supportive friends on private social media sites too. One GP trainee flew to sunny California while under GMC investigation (for not sending a patient with a false spurious elevated potassium to A&E by ambulance as he spoke to her on the phone and deemed her well, suggesting she get a repeat blood test in the morning) and loved it so much there he has now been cleared and has emigrated there permanently to join his mother. The patient was well. The blood test result was erroneous and only the doctor suffered.

7. If the decision is closed at initial investigation, celebrate! Remember, to keep sane over 6 months means including all your family, friends, workplace, etc. Isolation takes you to a dark place as fears or 'false evidence appears real' tries to flood you with fears of a GMC FTP trial with no lawyer to represent you and pits you against a GMC barrister, fear of being suspended or struck off, fear of public media naming and shaming but without your side of the story, fear of blacklisting, fear of not being able to work with GMC undertakings for years (restrictions on work) and being supervised with regular reports back to the GMC, fear of joblessness, fear of not being able to pay one's mortgage spiral and spiral until one contemplates suicide. Yes this may have happened to your colleagues but you cannot predict or control what happens next in the chain of events, if the decision is made to advance to an interim measures panel or fitness to practice hearing.

8. Your choices if the complaint is not closed at initial investigation. You may wish to fight for your innocence and hire a private lawyer and barrister (John Hendy QC and Mary O'Rourke QC both come highly recommended by doctors) to take on the GMC; you may wish to hand back your GMC registration and licence and not fight; or you may wish to accept 'guilt' and undertakings which then may drag on for 2-5 years with assessments like a knowledge based test and GMC simulated surgery with actors exam even if you have MRCGP by exam and hope that you may find a hospital or GP surgery who will offer you a job with such stringent GMC restrictions and need for the employer to make regular reports back to the GMC.

9. Should you find yourself in a 2-5 year process with the GMC, you may need long term counselling to stay sane, you may need to find a second source of income, and you may need to question whether it is worth continuing to work as a NHS doctor. One female NHS GP gave up after 5 years of undertakings, repeated sittings of the GMC mcq and simulated surgery exams, only able to work supervised and changed careers. Even her MP former Prime Minister Gordon Brown's intervention could not release her. Another male GP was cleared and let free after 5 years of undertakings with the help of his local Londonwide LMC.

10. If you have been referred by a malicious colleague or stranger, or are a NHS whistleblower, brace yourself as it may not be the last. The cycle may repeat itself and you may expect to receive another letter through the letterbox in years to come. The good news is now the GMC uses triage with complaints so some complaints you may never get to see, as they may be closed before initial investigation. Under the data subject access, you may request to see your complete GMC dossier of closed complaints or not, but don't expect compensation, an apology or comeback on the referrers when you are cleared time and time again. Whatever happens, value yourself. You are worthy and being a NHS GP or NHS doctor is just a job, a high risk job but still only a job which you may need to change the tv channel and change jobs if you get stuck in a bureaucratic loop or hamster wheel.

Advice for the GMC

Provide a lawyer for all doctors facing a FTP trial. MDOs may exercise discretion not to provide a doctor with legal support.

Might I suggest they use part of their £42.3 million free reserve to provide a doctor with a lawyer or barrister at a fitness to practice trial against a GMC appointed barrister so that doctors who cannot afford a lawyer or who are turned down by their MDO may be represented fairly and not have to self represent against a GMC barrister. Also if part of the multimillion pound free reserves could be used to hire more case examiners to expedite initial investigations and triage. Protracted initial investigations when a doctor is innocent may cause more harm to the stressed and overworked NHS doctor.

No penalties for wasting GMC time and resources so serial complainants may continue to lodge frivolous complaints

If a member of the public decides to appeal a traffic conviction and then loses, he or she has to pay court expenses. Why is it that a member of the public or an institution may refer a doctor directly to the GMC behind their back and when the complaint is found to be groundless, lacking in evidence, unsubstantiated, etc., the GMC expense is subsumed in the annual subs paid by doctors, and not by the complainant, and the doctor is left out of pocket for loss of income and personal legal expenses not covered by their own medical defence organisation?

Even the police may charge members of the public for wasting police time and impose a fine and/or 6 months imprisonment. 'In England and Wales, one can be charged with the offence under Section 5(2) of the Criminal Law Act 1967[1] when one "causes any wasteful employment of the police" by "knowingly making to any person a false report".'

Without any comeback on members of the public who make complaints (who are not even the doctor's patient) or on institutions who may waste GMC's time and money, these complaints may continue to flood the GMC and may be another reason why our nation is haemorrhaging its finest doctors.

The GMC has an online complaint feature on its main webpage and may even confer anonymity to any complainant, even if the complainant is not a patient of the doctor and has never met the doctor! This suggests that any member of the public may 'waste' the GMC's time by clicking online complaint and make up false allegations of any doctor for whatever motive, whether it be public trolling, trust management trying to get rid of a whistleblower, ex partners, ex employees, ex girl friends, etc. I would suggest the GMC may wish to address these flaws in process.

No redress or compensation for innocent doctors

There is no redress when cleared from a frivolous, malicious or vexatious complaint. The collateral damage on a doctor and his or her family are enormous.

Conferring anonymity to complainants who may never have met the doctor appears to defy the laws of natural justice, the right to face one's accuser to cross examine.

Advice for Maureen Baker and the RCGP

Please do not refer GP members to the GMC without abiding by the GMC's Code of Good Medical Practice working with colleagues and sitting down with the GP. The GMC must not be used as a commercial weapon to intimidate a private course competitor.

Thank you for paying for mediation with a QC in 2009 but I was saddened to receive further formal complaints from the RCGP in 2013-14 for donating to Bapio's fight against discrimination against IMGs (as the BMA also donated), for raising money for a jobless single mother IMG GP trainee and for blogging and tweeting (raising awareness) about the effects of unconscious bias in a subjective exam in which good doctors of colour may have been failed and was denied any informal meeting or mediation with you now as RCGP Chair and Prof Nigel Sparrow as the current RCGP Secretary. Intimidation through formal complaints and disciplinaries are not on! If IMGs are not made to feel welcome by their own college of GPs, they may join the Australian College and work in peace without fear of GMC complaints from institutions.

Dr Liz Miller founder of the Doctors Support Network drew attention to doctor suicides under GMC investigation in 2010 and met with the GMC in an attempt to suggest reform.

"In 2003/4 9 of 215 doctors under investigation by the Health procedures died - three were known to me and were suicide.

I have spoken to numerous doctors over the years on the brink of suicide because of the GMC.

Nowadays I also have medical students calling me.
I have the figures for deaths during FTP cases since 2004 - approx 10 per year - I have asked, under FOI for causes of death, the deadline for that inquiry has almost expired, and I am pursuing it.

I have a meeting with Niall Dickson 8th September based on my concerns. My points will be that

a - The health of the medical profession, must be managed by Occupational Health not the regulatory body

This is the case with all other safety critical professions, such as train drivers, and pilots.

b - All doctors undergoing FTP must have an occupational health assessment.

This is standard practice outside the medical profession, where companies request occupational health assessments before instituting conduct or performance proceedings. This assessment protects the company in the event of an employment or other tribunal.

c - Medical students must be excluded from the jurisdiction of the GMC

The standards by which medical students are judged, need to be in the context of other students rather than of mature doctors. GMC intervention prevents disabled medical students from qualifying as doctors.

d - Good medical practice contains such contradictions that, in the face of a good lawyer, all doctors are guilty of breaching its standards every day of their working lives. The GMC has such lawyers. Good Medical Practice needs to reflect realistic standards to which doctors can aspire.

GMC process, procedures and sanctions literally scar doctors for life. Few recover, even if they can get a job, few are ever fit to work again. The GMC approach drives mental health problems underground because no one will come forward because a declared mental illness as a doctor almost certainly means the end of your career. As you know once a doctor has had dealings with the GMC their career is over.

Whether it is possible to reform the GMC in this stage of its history is questionable. If there is no reform, it will be the end of the medical profession in this country.

I wrote the attached report in 2005, my views have not changed and neither have the circumstances which gave rise to it.

With best wishes


Dr Liz Miller AKC FRCSE MRCGP BA MSc DoccMed"

In memory of the NHS doctors who took their lives either due to a GMC referral or being worked to death...