GMC’s Fitness to Practise Data

The General Medical Council’s (GMC) fitness to practise data shows that the highest number of allegations received by it relates to doctors not acting with honesty and integrity.  This has consistently been the highest category of GMC complaints for several years.

Acting with honesty and integrity – What does this mean in practice?

Honesty and integrity are central to probity and the doctor–patient relationship.  Honesty and integrity covers a range of aspects of a doctor’s practice, including, but not limited to:

• defrauding an employer
• falsifying or improperly amending patient records
• submitting or providing false references
• inaccurate or misleading information on a CV
• failing to take reasonable steps to make sure that statements made in formal documents are accurate.

Personal Life v Medical Practise

Many doctors and medical students make the mistake of thinking that the requirement on them to act with honesty and integrity is limited to clinical practise.  This is however not the case.  The GMC is interested in any aspect of a doctor’s conduct, which could raise a concern about the doctor’s fitness to practise or  undermine the public’s trust in the medical profession.

Conflicts of interests

Doctors must also be very careful to avoid allegations of any conflict of interest, especially where a patient’s best interests are compromised.  Managing Conflicts of Interest in clinical commissioning groups, RCGP Centre for Commissioning identifies the following types of conflicts of interest:

• Direct financial interest – a clear conflict of interest that arise when an individual involved in taking or influencing the decisions of an organisation could receive a direct financial benefit as a result of the decisions being taken.
• Indirect financial interest – arises when a close relative of a director or other key person benefits from a decision of the organisation.
• Non-financial or personal interests – where doctors receive no financial benefit, but are influenced by external factors such as gaining some other intangible benefits.
• Conflicts of loyalty – Doctors may have competing loyalties between the organisation to which they owe a primary duty and some other person or entity.
• Conflicts in professional duties and responsibilities – Clinical commissioners may feel that their responsibilities as commissioners for prioritisation and resource management at a population level could conflict with their professional duty to advocate for and protect the interests of individual registered patients.

This is not an exhaustive list, but serves to identify the different conflicts of interest doctors might face.

GMC’s expectations

The GMC takes dishonest and inappropriate behaviour very seriously. The GMC expects that registered doctors must be honest and trustworthy, and must make sure that their conduct justifies their patients’ trust in them and the public’s trust in the profession.

Good Medical Practice

Good Medical Practice issued by the GMC sets out the full range of the GMC’s expectations on doctors when it comes to honesty and integrity, including (summarised):

• You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.
• You must always be honest about your experience, qualifications and current role.
• You must act with honesty and integrity when designing, organising or carrying out research, and follow national research governance guidelines and our guidance.
• You must be honest and trustworthy when giving evidence to courts or tribunals.
• You must be honest in financial and commercial dealings with patients, employers, insurers and other organisations or individuals.

MPT guidance

The GMC’s guidance for medical practitioner’s tribunals (MPT) makes clear that “Dishonesty, if persistent and/or covered up, is likely to result in erasure.”

The guidance recognise that dishonesty related to matters outside a doctor’s clinical responsibility is relevant, stating:

“Although it may not result in direct harm to patients, dishonesty related to matters outside the doctor’s clinical responsibility (eg providing false statements or fraudulent claims for monies) is particularly serious. This is because it can undermine the trust the public place in the medical profession. Health authorities should be able to trust the integrity of doctors, and where a doctor undermines that trust there is a risk to public confidence in the profession.

“Evidence of clinical competence cannot mitigate serious and/or persistent dishonesty.”

Medical students

Acting with honesty and integrity is not limited to doctors.  The same requirements apply to medical students.  Medical students found not to have acted with honesty and/or integrity might face expulsion or difficulties registering with the GMC.

An example often given to demonstrate this is that of  Dr Hassan who was out celebrating the completion of her F1 year, and her impending full registration with the GMC, when she got embroiled in a fight in the city centre. During the fight, the police arrived and arrested all those who appeared to be involved. After this, Dr Hassan subsequently accepted a caution for assault.

When she came to apply for full registration with the GMC, Dr Hassan completed the declaration on fitness to practise. She didn’t think that the caution was relevant, since it did not arise from her professional conduct, and was embarrassed, so filled in the forms without disclosing the caution.

A few months into Dr Hassan’s first job as an F2, a CRB check highlighted the issue. Dr Hassan’s trust referred the matter to the GMC. The GMC soon instigated fitness to practise proceedings on the basis of dishonest failure to disclose, which led to her being dismissed from her post.

Insight and remediation

Dishonesty is generally considered to be very difficult to remediate because it often points to a character flaw.  Character flaws are different to deficiencies in competency or health, because the latter two can be addressed through training or treatment whereas the dishonesty, as a character flaw, cannot be easily addressed.

It is not impossible, however.  The GMC recognise that remediation can take a number of forms, including coaching, mentoring, training, and rehabilitation – all, or some, of which can address dishonesty.

Kings View offers Insight Works Training, unique and practical courses focusing on impairment, reflection, insight, and remediation at highly competitive prices.

Expert legal advice and representation

Doctors notified by the GMC that they are subject to an allegation and/or GMC complaint should seek legal advice at an early stage.  Doing so will assist the doctor in understanding the process, how and when to engage and submit information to the GMC, and to agree the correct strategy at an early stage.

The latter is of particular importance in cases involving dishonest behaviour or conduct, given the difficulties involved in remediation.

We have a proven track record of success, acting for a range of health and care professionals facing fitness to practise issues.  You can read more about our case success, our excellent reviews and contact us for a free, no obligation case assessment.