Responsible Officers can make a referral to the GMC if there have been “serious concerns” raised about a doctor’s fitness to practise.
A Responsible Officer (ROs) is a statutory position responsible and accountable for the local clinical governance processes in their particular healthcare organisation (also referred to as designated body). ROs are responsible for focusing on the conduct and performance of doctors, including evaluating a doctor’s fitness to practise, and liaising with the GMC over relevant procedures.
If a concern is raised about the fitness to practise of a doctor, ROs have a responsibility to take all “reasonable steps” to investigate those concerns, and where appropriate, refer those concerns to us. Fitness to practise concerns, in this context, generally refers to circumstances where a doctor’s behaviour poses a risk to patients, public confidence in the profession or to proper professional standards and conduct.
Referral to the GMC
The GMC will assess the ROs referral against its threshold guidance. GMC guidance to ROs explain that its threshold for referral “is likely to be met” when certain features occur and, it is no longer appropriate to manage the concerns locally, including (but not limited to):
- doctor’s conduct or performance falls below the standard set out in Good medical practice and (including where attempts to improve the doctor’s performance locally have failed) there remains an unacceptable risk to patient safety.
- a doctor about whom the responsible officer, employer or contractor has developed significant concerns disconnects from the responsible officer or leaves the employer or contractor’s employment and the responsible officer, employer or contractor is not confident that alternative safeguards are in place.
- local measures to address the concerns have failed, either because the doctor is not complying with them or the concerns are too significant to be remediated at a local level.
The vast majority (75% plus) of complaints referred to the GMC are closed at the triage stage. Of increasing importance is an emphasis on local investigations, and the expectation is that a thorough investigation be undertaken and issues managed locally before considering a GMC referral. The GMC itself states that “the majority of concerns can be safely managed at a local level”.
If a referral is made to the GMC, in general, they will close cases without any investigation where the issues relate to:
- minor motoring offences not involving drugs or alcohol such as speeding or traffic light
- a delay of less than six months in providing a medical report
- a minor non-clinical matter such as rudeness
- a complaint about the cost of private medical treatment
However, certain allegations are “likely” to always meet the GMC threshold, including:
- a sexual assault or indecency
- sexual or improper emotional relationships with a patient or someone close to them
- unlawfully discriminating in relation to characteristics protected by law
- knowingly practising without a licence
- gross negligence or recklessness about a risk of serious harm to patients.
The very well published case of Dr Manjula Arora and the GMC’s (mis)handling of her case has driven home the importance and need to manage fitness to practise issues locally before making a referral to the GMC. The review of Dr Auror’s case, concluded that “the GMC should continue to encourage a culture which seek to resolve issues locally first, if possible” and “Regulators should judge their success not by how many fitness to practise referrals they handle but in how they support local systems towards local resolution and remediation when needed.”
The GMC’s guidance to ROs and employers state:
In order to make sure that referrals are accurate and fair, you may first need to:
- complete your own local investigation and consider the conclusions
- understand the outcomes of any external investigation and/or
- take any other reasonably practicable steps necessary to understand whether the concerns raise a question about the fitness to practise of the doctor.
Mistakes, often, do not happen in isolation and there are usually other factors that contribute to mistakes such as staff and time pressures and IT faults etc. Focussing on the individual means that contextual factors go unnoticed and are ultimately not addressed.
It is also important to say that contextual factors are often beyond the control of doctors. Focussing on the individual will therefore make the process fundamentally unfair and unjust. Research found that doctor “want to be certain that all contextual factors had been accounted for by the GMC before accepting individual responsibility”.
“The effects of contextual factors” are relevant in GMC fitness to practise investigations. The GMC indicates that contextual factors are taken into consideration from the outset of a complaint or allegation (i.e. triage stage) against a doctor.
For example, in its guidance to responsible officer (ROs) referrals, the guidance suggests that ROs must address “whether the effects of contextual factors have been equally and fully considered for all doctors” referred by it. The guidance goes on to give the following examples:
- What impact did poor lighting have on the doctor’s action?
- How did an IT failure contribute to a particular error?
- How did poorly designed packaging of a drug create confusion?
- How affected was a doctor by inadequate PPE?
- What part did fatigue play?
What to report to your employer
There is a requirement on doctors to report certain details to the employers. Generally speaking, doctors have to tell their employers, when/if:
- The GMC has placed restrictions on their licence to practise (for whatever reason);
- You have restrictions on your practise or removed you from clinical duties as a result of a fitness to practise concern or referred you to the GMC; and or
- If you have been involved in an incident outside of work/training that has or may result in a criminal investigation or charge.
Legal Representation and advice
With over 30 years combined experience, Kings View Chambers have established itself as one of the best when it comes to fitness to practise defence. We fully understand that fitness to practise defence is not merely about processes and procedures. We also understand that we are working with people who are anxious and worried about what investigations might mean for them, their professions and the reputations.
We are proud to be rated ‘excellent’ by our clients. Our commitment to client care is genuine in both seeking the very best outcomes for our clients, but also ensuring we do what we can to support them through the process.
Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.
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