Supplementary written evidence submitted by the General Medical Council

(GMC0019)

This memorandum provides information that was requested by the Health Select Committee during our annual accountability hearing on 6 January 2015.

Locum doctors

David Tredinnick MP asked if foreign doctors working in the UK were more likely to be employed as locums than UK graduates (Question 15).

We can confirm that a disproportionality high number of doctors who are attached to locum agencies attained their primary medical qualification outside of the UK.

Doctors who qualified in another European Economic Area country are approximately twice as likely to be attached to a locum agency as those who qualified in the UK, whereas International Medical Graduates (doctors who qualified outside of the European Economic Area) are two and a half times more likely.

Doctors who commit suicide while under GMC investigations

The Chair asked about the number of possible deaths in the review commissioned by the GMC which may have been suicides but not identified as such by the coroner system (Question 40). 

The review identified 114 doctors that had died during 2005 and 2013 inclusive and had an open and disclosed GMC case at the time of death.

An assessment was then undertaken of each case to ascertain the cause of death against case definitions of suicide and suspected suicide. The cases under review were not limited to those that had been identified as suicide in a coroner’s report. Page 13 of the report provides a description of how the cases were identified[i]. The case definition used as the basis of the report included other sources of information that indicated suicide, for example, multiple media references to the strong possibility of suicidal intent.

The review found that of the 114 cases, 28 doctors undergoing fitness to practise investigations died by suicide or a suspected suicide. 24 cases were classified as ‘suicide’ and 4 as ‘suspected suicide’.

There is evidence that an inquest was held in 22 of the 28 suicide and suspected suicide cases. In 19 cases, the verdict was suicide, in one misadventure, one narrative and one where we do not know the verdict.

In the 6 remaining cases, we do not have evidence that an inquest had been conducted. Reasons for this include a) recent cases where an inquest had not yet happened or b) death had occurred abroad.

Our case review found no evidence that any of the remaining 86 doctors who died whilst under GMC investigation committed suicide.

The Chair also asked whether it would be possible to compare the suicide rate of doctors under investigation to a control group of doctors who are not under investigation matched for age and gender (Question 45).

Unfortunately, such a comparison is currently not possible as we are not aware of any available data that would allow us to make such a control group comparison in a way that would be accurate or meaningful.

We can however provide a detailed breakdown of the gender and age at death of doctors under our procedures who died by suicide (see following tables).

Our understanding is that the main question being posed by the Chair of the Committee was with regard to whether we are seeing a higher rate of doctors taking their own lives during the fitness to practise proceedings than those who are not. We can confirm from our previous uncontrolled comparisons that the suicide rate among doctors under investigation is significantly greater than among other doctors. This is likely to be for a range of reasons outlined in our oral evidence, including that they may already be suffering a recognised mental disorder, addictions, personal difficulties and the stress that comes with the involvement of the police and the impact of the GMC investigation.

Rise in complaints

The Chair asked for clarification on the percentage rise of serious complaints (Stream 1) over the time period 2010-2013 (Question 34).

We can confirm that serious complaints (Stream 1) were up 48% between 2010 and 2013. ‘The state of medical education and practice in the UK report: 2014’ depicts this in figure 30 of the report - see below[ii]:

Complaints against multiple doctors from one organisation

In response to questions from Charlotte Leslie MP, we committed to clarifying the legal framework with regard to how we handle complaints against multiple doctors from one organisation (Question 76).

Under Section 35 of the Medical Act, our investigatory powers are engaged if an allegation is made to the GMC that the fitness to practise of a registered doctor is impaired. We then investigate to decide whether we need to restrict or remove the doctor’s registration. If more than one doctor is involved in an incident then we have to make separate decisions about the fitness to practise of each doctor.

Our remit does not extend to reviewing events at systems or organisation level. These wider issues fall to bodies such as the Care Quality Commission, with whom we share information whenever appropriate.

Complaints about revalidation

In response to questions from Charlotte Leslie MP we committed to provide details about the number of complaints received from doctors about revalidation (Question 70 & 71).

Revalidation was introduced in December 2012 and, in the two years between 1 January 2013 and 31 December 2014, we received expressions of dissatisfaction from 46 doctors that we categorised as being ‘Objections to the revalidation process’ – by which we meant fundamental objections, rather than issues that related to the practicalities involved, or to the standard of our service. 15 of the doctors were retired or about to retire and 17 were practising overseas. Therefore, we have had expressions of dissatisfaction from 14 practising UK doctors

The most common objections came from doctors who, for one reason or another, believed they were not able to engage in the process; and most of the doctors who expressed broader concerns about revalidation were in fact doing so because meeting the requirements presented particular challenges to them.

All but one of these expressions of dissatisfaction were dealt with by operational staff. We can and do escalate issues to Directors, our Chief Operating Officer and her team and the Chief Executive as necessary and in line with our corporate complaints process if they cannot be resolved at this level, or if they raise a particularly significant issue. We escalated one complaint from an overseas doctor in November 2013 to this level and again in January 2015. The Chief Executive also dealt directly with one complaint from a doctor retired from clinical practice.

26 February 2015