Complaits about doctors This chapter sets out the types of complait received by the GMC ad how these complaits are resolved. Over the five years from 2010 14, complaits about doctors to the GMC icreased by 54%. However, there has bee a slowdow from 2012 13, which cotiued i 2014. It is ot possible to tell whether this is the ed of a rapid icrease i complaits or if the five-year tred of icreasig complaits will cotiue i the log term. The fitess to practise processes that ca occur after a complait is made are show i figure 25, page 60 61. 58 Geeral Medical Coucil
The umber of complaits received decreased i 2014 2014 saw a small drop of 2.3% i the umber of complaits the GMC received compared with 2013 (figure 24). There were also fewer complaits that the GMC ivestigated (8.8% fewer) or referred back to the doctor s employer to deal with (dow 40%). The umber of complaits the GMC closed immediately followig receipt icreased by 8.4%. The data i this chapter refer to complaits made ad ivestigatios opeed, alog with the outcomes of these cases, based o the year the equiry is received by the GMC, rather tha the year i which the complait or ivestigatio is closed. * Figure 24: The umbers of complaits ad ivestigatios received by the GMC durig 2010 14 10,000 8,000 6,000 Complaits closed 4,000 Referred back to employer 2,000 GMC ivestigatios 0 2010 2011 2012 2013 2014 * The exceptio to this is figure 26 (page 63) which is based o activity occurrig withi the year. Geeral Medical Coucil 59
Figure 25: How the GMC hadled equiries about doctors i 2014 Equiries received 9,746 A equiry is ay piece of iformatio received by the GMC that eeds to be assessed to cosider whether it raises a questio about a doctor s fitess to practise. This assessmet is called triage. Complaits 8,884 A complait is a equiry that raises a cocer about a doctor s fitess to practise. Other complaits 6,134 These are complaits that do ot meet the threshold for a full ivestigatio. Equiry still ope 41 These are equiries where o decisio has yet bee made o whether or ot to ivestigate; this icludes where the GMC is waitig for exteral data. Closed immediately 5,500 These complaits did ot questio the doctors fitess to practise for example, cases about coflictig diagosis, disagreemet with a medical report or a doctor beig late for a routie appoitmet. GMC ivestigatios 2,750 A ivestigated complait meets the threshold for a full GMC ivestigatio. This is for the most serious cocers, which call ito questio a doctor s right to retai urestricted registratio. * The Medical Practitioers Tribual Service (MPTS) iterim orders pael decided to restrict the practice of 562 doctors while the complaits were beig ivestigated. Closed with o further actio 1,428 This decisio was made by a GMC case examier at the ed of a ivestigatio or by a MPTS fitess to practise pael at the ed of a hearig. This is because: followig ivestigatio it became clear the cocer was ot serious eough to questio the doctor's fitess to practise the complait had isufficiet evidece to go forward (eg because the complaiat did ot wat to cooperate with the ivestigatio). Referred to employer 593 These complaits did ot merit a full ivestigatio uless they formed part of a wider patter of cocers, ad were referred to the doctor s Resposible Officer or employer. 60 Geeral Medical Coucil
Equiries ot about a doctor s fitess to practise 862 There were over 800 equiries recorded that were ot about a doctor s fitess to practise. This is just over half the umber of such equiries received i 2012. * These are complaits about: a doctor s coduct ad professioal performace (eg serious or persistet cliical errors, failures to provide appropriate treatmet or care, serious breaches of our guidace); serious impairmet of a doctor s practice because of physical or metal ill health; a doctor receivig a covictio or cautio iside or outside the UK; or a doctor beig a risk to patiets. These iclude 75 resolved cases of volutary erasure ad oe resolved case of admiistrative erasure, ad 15 cases where the complait has bee withdraw. These decisios will be take by the MPTS fitess to practise pael. I some cases, case examiers are able to issue a warig or agree a udertakig with the doctor after the ivestigatio. Closed with advice 213 These complaits were closed after a ivestigatio, with advice give to a doctor about their coduct by a GMC case examier. Still beig ivestigated 957 These complaits were uresolved o 8 July 2015. Sactio or warig give 152 These complaits led to a sactio or a warig, which icluded agreeig or imposig restrictios o a doctor s practice, or suspedig or erasig them from the register. Warig give 79 These complaits led to the doctor beig give a warig about some aspect of their work, but they ca cotiue workig as a doctor i the UK without ay restrictios. Coditios or udertakigs 51 These complaits led to the doctor agreeig to restrictios, or havig restrictios imposed, o their work eg workig oly uder medical supervisio or committig to retraiig. Suspeded or erased 22 These complaits led to the doctor beig suspeded or erased permaetly from the register, prevetig them from workig as a doctor i the UK. Geeral Medical Coucil 61
What outcomes do cases result i? Figure 25 o pages 60-61 shows the rage of outcomes possible after a complait is raised with the GMC. I the most serious cases it may be cocluded that is ot safe or appropriate for the doctor to cotiue practisig ad the doctor will be suspeded or erased. If the doctor s practice is impaired, but it is safe for the doctor to cotiue practicig with appropriate support, supervisio or re-traiig the coditios or udertakigs will be applied to esure this. If the doctor s practice is ot impaired, but there is evidece of a smaller breach of stadards the a warig will be issued. Other cases are closed without sactio or warig. Sometimes whe they are closed some advice will also be provided where there has bee a very low-level breach of stadards that does ot merit a warig. The fitess to practice processes that ca occur after a complait is made are show i figure 25 o the previous page. I this sectio the data refer to cases that were closed i the five-year period from 2010 14. Most of the variatio i the umber of cases simply reflects the variety of cases raised each year, but some is caused by chages i the GMC s processes. Figure 26 (page 63) shows that the umber of cases that were closed with o further actio icreased by 121% durig 2010 14 ad that the umber of cases edig i coditios or udertakigs icreased by 23%. The icrease i the umber of cases closed with o further actio is liked to the icrease i the umber of complaits overall. May of these additioal cases appeared serious eough to warrat ivestigatio, but subsequetly tured out ot to be serious, or were cases where the doctor had already remediated ad was o loger judged to be at risk of repeatig the icidet. I respose to this tred, the GMC is reformig the iitial triage process so it ca more accurately judge which equiries merit a ivestigatio. The icrease i the umber of udertakigs has arise as a result of a public cosultatio i 2009, which resulted i a exteded rage of cases beig made eligible for udertakigs. 61 Coversely, the umber of cases closed with advice decreased by 42% betwee 2010 ad 2014. This is due to a chage i the GMC s process for issuig advice, which led to advice beig issued oly for low-level breaches of Good medical practice ad where the facts are admitted or beyod doubt. This meas that more cases are ow closed with o further actio. 62 The umber of warigs also decreased by 29%. This was ot due to a chage i policy ad may reflect the ormal variatio i cases see each year. 62 Geeral Medical Coucil
Figure 26: Outcomes of ivestigated cases closed each year 2010 2011 2012 2013 2014 INVESTIGATIONS COMPLETED Ivestigated 1,856 2,263 2,348 2,596 2,696 CASES INVESTIGATED NOT RESULTING IN A SANCTION OR A WARNING No further 884 983 1,062 1,900 1,952 actio Closed with 460 726 831 217 265 advice CASES INVESTIGATED RESULTING IN A SANCTION OR A WARNING Warig give Coditios or udertakigs Suspesio 184 207 176 149 131 132 170 155 182 162 99 111 63 77 101 Erasure 97 66 61 70 85 Geeral Medical Coucil 63
Where do complaits come from? Who makes complaits about doctors? The GMC receives complaits from a wide rage of sources (figure 27, page 65). I 2014, the police referred 13% fewer complaits tha they did i 2010, the oly source to make fewer complaits i this period. The largest icrease was i complaits from doctors, * which almost doubled (up 95%). There were also substatial icreases from those actig i a public capacity (72%), members of the public (51%), the GMC itself (45%) ad employers (37%). The public which icludes patiets ad patiets relatives has made the greatest umber of complaits every year sice 2010. The proportio of complaits from the public remaied similar betwee 2010 ad 2014. The proportio of complaits from the police fell by 43% (from 2.9% i 2010 to 1.7% i 2014), ad the proportio from doctors rose by 27% (from 11% i 2010 to 14% i 2014). Cases opeed by the GMC o its ow iitiative, for example as a result of media coverage, icreased i 2010-12 but have falle agai more recetly. This may be due to improved commuicatio betwee the GMC ad the Resposible Officers i orgaisatios, resultig i a better iitial uderstadig of the issues before decidig whether there is a eed to ope a case. As the umber of complaits from the public rose sharply i 2011, the proportio that resulted i a ivestigatio fell. Although the proportio rose agai i 2013, it has still ot reached 2010 levels. Across this five-year period from 2010 14, the umber of complaits from almost all sources has icreased, but there has bee a slight fall i most areas betwee 2013 ad 2014. * If a seior doctor (for example, the cliical director) or huma resources maager or similar raises a cocer o behalf of the orgaisatio they work for, the GMC cosiders it to be raised by the employer. If a doctor at ay level raises a cocer that is ot o behalf of the orgaisatio for example, a persoal grievace it is categorised as a cocer raised by aother doctor. A self-referral by a doctor will cout as a complait i this category as well. This icludes people actig o behalf of other public orgaisatios, such as the coroers office or other regulatory bodies. Resposible Officers are resposible for the revalidatio of doctors, ad makig sure doctors with restrictios are safely ad appropriately maaged. 64 Geeral Medical Coucil
Figure 27: Number of complaits ad ivestigatios from each source i 2010 14 2010 2011 2012 2013 2014 EMPLOYERS POLICE Complaits % ivestigated Ivestigatios Complaits % ivestigated Ivestigatios OTHERS ACTING IN A PUBLIC CAPACITY GMC Complaits % ivestigated Ivestigatios DOCTORS PUBLIC Complaits % ivestigated Ivestigatios Complaits % ivestigated Ivestigatios Complaits % ivestigated Ivestigatios 431 493 610 596 589 89% 86% 83% 93% 81% 385 425 508 553 478 170 176 165 161 148 64% 67% 69% 63% 60% 109 118 114 101 89 410 495 565 721 705 63% 65% 67% 64% 56% 260 320 379 459 396 246 530 955 535 357 66% 47% 31% 30% 36% 162 249 295 162 128 654 833 900 1,151 1,277 55% 51% 45% 46% 38% 362 427 404 526 489 3,858 4,955 5,504 5,929 5,808 21% 16% 18% 20% 20% 793 770 996 1,214 1,170 Geeral Medical Coucil 65
BOX 1: The types of allegatio assiged to complaits Whe the GMC receives a complait about a doctor, the allegatios are assessed ad assiged to differet categories such as crimiality or failig to act hoestly ad fairly. Oe or more allegatios ca be assiged to help categorise the case. To aalyse the complaits, we have grouped the most commo ad distict types of allegatio. These groups are used throughout this chapter. Each group is mutually exclusive a case appears oly oce i ay group. All health allegatios: these cases are about the doctor s physical or metal health. All crimiality allegatios except health: these cases have arise because of crimial behaviour by the doctor, that led to a covictio this group icludes cases with other allegatios, but excludes those liked to allegatios about the doctor s health. Actig hoestly ad fairly allegatios oly: these cases are about the doctor s failure to act hoestly ad fairly towards patiets ad others this group excludes cases where there are also other types of allegatio. Actig hoestly ad fairly ad other allegatios: these cases are about a doctor s failure to act hoestly ad fairly towards patiets ad others this group icludes cases which have other allegatios, but excludes those with health, crimiality ad cliical competece allegatios. deliver good quality cliical care to patiets this group excludes cases which have other allegatios. Cliical competece allegatios oly: these cases are about a doctor s failure to deliver good quality cliical care to patiets this group excludes cases which have other allegatios. Cliical competece ad commuicatio ad respect for patiets allegatios oly: these cases are about a doctor s failure to deliver good quality cliical care to patiets, ad to commuicate appropriately ad respectfully with patiets this group excludes cases which have other allegatios. Commuicatio ad respect for patiets allegatios oly: these cases are about a doctor s failure to commuicate appropriately ad respectfully with patiets this group excludes cases which have other allegatios. Professioal performace allegatios: these cases are about a doctor s poor performace i the o-cliical aspects of their role for example, failig to work well with colleagues, failig to appropriately report o cases or share iformatio, or bullyig ad udermiig colleagues. This group icludes other allegatios but excludes cases which have health, actig hoestly ad fairly, ad crimiality allegatios. Actig hoestly ad fairly ad cliical competece allegatios oly: these cases are about a doctor s failure to act hoestly ad fairly towards patiets ad others, ad to Cases with other allegatios: these cases are about ay allegatio or combiatio of allegatios ot icluded above. 66 Geeral Medical Coucil
The types of complait raised by the public differ from cocers raised by other sources Figure 28 shows that most cases followig complaits raised by the public were about cliical competece (51%) with early half of these also ivolvig cocers about commuicatio ad respect for patiets. A further 9% were oly about commuicatio ad respect for patiets oly, ad 17% were about professioal performace. 14% of cases stemmig from complaits made by the public did ot ivolve oe of these three types of allegatio. Figure 28: Types of allegatio assiged to cases from the public that were received by the GMC 2010 14 All other cases 23% Cliical competece allegatios oly 28% Professioal performace allegatios 17% Commuicatio ad respect for patiets allegatios oly 9% Cliical competece ad commuicatio ad respect for patiets allegatios oly 23% 10,336 cases Geeral Medical Coucil 67
Figure 29 shows that cases ivolvig oly cliical competece were more likely to origiate from the public (28%) or the GMC (18%). However, as we show later i figure 31, oly a tiy proportio of cases ivolvig cliical competece oly from the public led to a sactio or a warig (3%) compared with 6% of those from cocers raised by all other sources. s are much more likely to raise matters relatig to crimiality tha other sources apart from the police 28% of cocers raised by doctors are about this. This is almost etirely due to self-reportig. Oly a very small proportio of cocers raised by doctors i relatio to other allegatios are selfreportig, with the vast majority beig made about a doctor by aother doctor. These cases had a relatively high likelihood of edig i a sactio or a warig: 36% ad 12% respectively. Health cocers accouted for about oe i seve cocers raised by employers or doctors. For employers, cocers about professioal performace were also importat, accoutig for oe i four cases. Over 50% of cases from cocers raised by the police were usurprisigly about crimiality, with a further 12% ivolvig allegatios of doctors failig to act hoestly ad fairly. Figure 29: Types of allegatio assiged to cases from a rage of sources that were received by the GMC durig 2010 14 * 23% 9% 26% 12% 14% 18% 6% 13% 5% 2% 10% 9% 15% 6% 12% EMPLOYERS 2,380 cases 9% 14% 18% GMC 1,029 cases 5% 18% POLICE 536 cases 54% 14% 18% 28% 9% 16% 9% 6% 20% 9% 6% 21% 13% 21% 10% Cliical competece allegatios oly Professioal performace allegatios Actig hoestly ad fairly ad other allegatios Actig hoestly ad fairly allegatios oly All crimiality allegatios except those ivolvig health allegatios All health allegatios All other cases DOCTORS 2,440 cases OTHERS ACTING IN A PUBLIC CAPACITY 1,956 cases * We have put all cases with a health allegatio uder the health category. This icludes a small proportio of the cases that also had a crimiality allegatio (15%). I this figure, cases ivolvig allegatios of actig hoestly ad fairly ad cliical competece oly are couted i All other cases. 68 Geeral Medical Coucil
Complaits about cliical competece ad commuicatio ad respect for patiets predomiatly come from members of the public As show below i figure 30, differet sources have differet profiles of allegatios i the cases which they refer to the GMC. Over three-quarters of cases ivolvig cliical competece ad/or commuicatio ad respect for patiets arose from complaits made by the public. By cotrast, over half of health ad crimiality cases arose from cocers raised by employers or doctors, with a further 20% of crimiality cases comig from the police. The majority of cases from doctors for crimiality are self-referrals. Cases ivolvig hoesty ad fairess stemmed from a greater variety of sources, with about a third arisig from the public, about a third from employers ad other doctors, ad about a third from other sources. While 52% of cases about professioal performace came from public complaits, a substatial proportio (30%) came from employers ad other doctors. Figure 30: Types of allegatio assiged to cases from differet sources received i 2010 14 ALLEGATION TYPE NUMBER OF CASES % FROM EACH SOURCE s s Other * All health allegatios 1,194 30% 30% 30% 11% All crimiality allegatios except health Actig hoestly ad fairly allegatios oly Actig hoestly ad fairly ad other allegatios Cliical competece ad actig hoestly ad fairly allegatios oly 1,435 9% 47% 38% 6% 1,638 18% 14% 39% 29% 1,119 20% 13% 24% 44% 498 14% 10% 17% 60% Cliical competece allegatios oly 3,798 6% 6% 12% 76% Cliical competece ad commuicatio ad respect for patiets allegatios oly Commuicatio ad respect for patiet allegatios oly 2,604 2% 4% 4% 90% 1,154 7% 4% 6% 82% Professioal performace allegatios 3,432 18% 12% 18% 52% * This icludes complaits raised the police, other orgaisatios (icludig people actig i a public capacity) ad the GMC. Geeral Medical Coucil 69
The likelihood of allegatios resultig i a sactio or a warig varies depedig o the type of allegatio Figure 31 (page 71) shows that 92% of ivestigatios ivolvig cliical competece from members of the public resulted i o sactio or warig. Moreover, oly a very small percetage of cliical competece ivestigatios resulted i a sactio or a warig: 71% from other doctors ad employers, ad 76% from all others resulted i o sactio or warig. Similarly, a very small proportio of ivestigatios about professioal performace ad about commuicatio ad respect for patiets resulted i a sactio or a warig, especially those from the public: 85% ad 93% respectively resulted i o sactio or warig. Ivestigatios ivolvig crimiality allegatios from the police ad employers were also amog those more likely to result i a sactio. 35% of crimiality cases from doctors resulted i a warig. This is partly due to self reportig of fairly mior offeces, such as mior traffic offeces. Most ivestigatios ivolvig hoesty ad fairess allegatios made by the public resulted i o sactio or warig (89%), but 20% from doctors ad employers ad 17% from others did result i a sactio or a warig. Ivestigatios ivolvig health allegatios made by employers or other doctors were the oes that were most likely to result i a sactio, with 49% ad 52% respectively doig so. 70 Geeral Medical Coucil
Figure 31: Proportio of GMC ivestigatios * of complaits received i 2010 14 from differet sources ad with differet types of allegatio ad their outcome as at July 2015 ALLEGATION TYPE AND SOURCE ALL HEALTH ALLEGATIONS NUMBER OF INVESTIGATIONS % WITH EACH OUTCOME No sactio or warig Warig Sactio No decisio o sactio or warig made 51% s 347 25% 1% 52% 22% s 356 27% 1% 49% 23% All others 460 41% 2% 34% 23% ALL CRIMINALITY ALLEGATIONS EXCEPT HEALTH 35% s 673 52% 35% 6% 7% s 132 53% 10% Police 288 46% 25% 81% ACTING HONESTLY AND FAIRLY ALLEGATIONS ONLY 18% 19% 10% 19% s ad employers 494 67% 11% 9% 13% 348 89% 1% 2% 8% All others 627 67% 7% 11% 16% CLINICAL COMPETENCE ALLEGATIONS ONLY s ad employers 402 71% 2% 4% 22% 1,511 92% 2% 1% 5% All others 414 76% 4% 2% CLINICAL COMPETENCE AND COMMUNICATION AND RESPECT FOR PATIENTS ONLY s ad employers 125 82% 1% 3% 18% 14% 852 93% 1% 1% 5% All others 94 81% 2% 3% PROFESSIONAL PERFORMANCE ALLEGATIONS 14% s ad employers 929 61% 3% 13% 22% 1,040 85% 5% 3% 8% All others 580 70% 3% 7% 20% * Figure 31 is based o ivestigatios, ot cases, ad so excludes those cases where actio is take by a doctor s Resposible Officer or employer. The outcomes couted are fial outcomes after all review stages. The majority of the ivestigatios i the No decisio o sactio or warig made colum are o-goig, but some did ot result i a decisio for other reasos, for istace, the death of the doctor ivolved. Ivestigatios followig applicatios for doctors to be restored to the register after a sactio are also couted i this colum. Geeral Medical Coucil 71
Which doctors are most likely to be the subject of complaits raised by differet sources? Idividual doctors are less likely tha employers to raise cocers about older doctors Nearly half (49%) of cases i 2010 14 were about doctors aged 50 years old or over, ad oly oe i 23 were about those uder 30 years old. Male doctors are sigificatly more likely to face allegatios tha female doctors; this is especially marked whe it comes to cases ivolvig crimiality * There is relatively little differece i the sources of complaits across differet types of allegatio with respect to geder. I most cases, male doctors accouted for 70 85% of cases. But some differeces ca be oted. s complaits are less likely tha those from employers to be about doctors 50 years old ad older. 50% of cocers raised by employers were about doctors i this age group. I cotrast, oly 43% of complaits from doctors were about those aged 50 years or older. Female doctors accouted for aroud a third of cases ivolvig health that came from ay source other tha the police. s ad the police were particularly likely to report cocers about male doctors that led to cases ivolvig crimiality: 88% of these ivestigatios from employers ad 87% from the police were about male doctors. 77% of cases with allegatios assiged that oly ivolve commuicatio ad respect for patiets were about male doctors, ad this is particularly true of cocers raised by employers (90%) ad others actig i a public capacity (85%). * Accordig to the Miistry of Justice, the most recet available data for Eglad ad Wales show that i 2012 13 85% of those arrested were male, ad oly 15% female. For covictios i 2013 the data were 75% male ad 25% female. 63 Older research idicates a similar situatio i Scotlad. 64 72 Geeral Medical Coucil
BME ad o-uk graduates are overrepreseted i all allegatio groups 44% of all cases were about o-uk graduates ad 56% were about UK graduates. A little uder a quarter (22%) of the o-uk graduates ivestigated were Europea Ecoomic Area (EEA) graduates ad predomiatly idetified as white. There were variatios i the proportio of cases comig from differet sources that were about BME doctors or about o-uk graduates. * Cocers raised by istitutios employers, the police ad those people actig i a public capacity were more likely to be about BME doctors ad about o-uk graduates tha cocers raised by idividual doctors, the public or the GMC (figure 32, page 74). A greater proportio of o-uk graduates are BME tha UK graduates. It is possible that some of the higher icidece of BME doctors beig referred by employers, the police or those actig i a public capacity may be a reflectio of the higher referral rates for o-uk doctors rather tha a issue for BME doctors specifically. As figure 33 (page 74) shows, the differece betwee sources i the proportio of cases referred ivolvig UK graduate BME doctors is smaller. * Just over a fifth of cases i 2010 14 were about doctors whose ethicity is ukow this does ot vary greatly betwee differet sources. 44% of the remaiig cases were about BME doctors ad 56% were about white doctors. Geeral Medical Coucil 73
Figure 32: Proportio of cases that are about BME doctors ad about o-uk graduates, by the source of the complait, i 2010 14 70 s 2,380 Police 536 % o-uk Others actig i a public capacity 1,956 GMC 1,029 10,336 s 2,440 Sources that refer more o-uk doctors also refer more BME doctors, primarily due to the large proportio of o-uk doctors who are BME. The sources with higher referral of o-uk ad BME doctors are show i the top right of the chart. 30 70 % BME Figure 33: Proportio of UK graduates who are BME i cases arisig from cocers raised by differet sources i 2010 14 * Police 33% s GMC Others actig i a public capacity s 29% 27% 25% 24% 20% * 22% of licesed UK graduates were BME i 2014. 74 Geeral Medical Coucil
I last year s report we oted that BME ad o-uk doctors receive proportioally more complaits from employers, ad proportioally more crimiality cases. This year we have ivestigated whether the two are liked, ad asked if the higher proportio of ivestigatios stemmig from employers cocers about BME ad o-uk graduates are a result of employers referrig differet types of cases i terms of the allegatios ivolved. A high proportio of cases resultig from cocers raised by the police ivolve crimiality. The relatively high share of BME doctors i these cases (figure 31, page 71) may i part reflect the higher proportio of BME people i parts of the crimial justice system overall. 65 The aswer is, broadly, that this is ot the reaso. Some of this aalysis is summarised i figures 34, 35, ad 36. We have looked at the proportio of cases accouted for by IMGs, EEA graduates ad BME doctors. The patter of proportioally more ivestigatios of these groups stemmig from employers is ot due to the differece i the types of allegatios that employers make because this fidig is true across all types of allegatios apart from health. Geeral Medical Coucil 75
Figure 34: Idex of the proportio of cases that ivolve iteratioal medical graduate (IMG) doctors relative to the proportio they accout for i all cases with the same allegatios, 2010 14 Allegatio group Source of complait AVERAGE PROPORTION OF CASES INVOLVING IMG DOCTORS 0 Idex of proportio of cases ivolvig IMGs relative to the average for all sources Average for cases with this allegatio from all sources 100 200 = twice as likely as the average for all sources ALL HEALTH ALLEGATIONS 78 114 101 ALL CRIMINALITY ALLEGATIONS EXCEPT HEALTH 78 115 159 ACTING HONESTLY AND FAIRLY ALLEGATIONS ONLY 80 134 80 ACTING HONESTLY AND FAIRLY AND OTHER ALLEGATIONS 67 85 123 CLINICAL COMPETENCE ALLEGATIONS ONLY 93 144 96 CLINICAL COMPETENCE AND COMMUNICATION AND RESPECT FOR PATIENTS ALLEGATIONS ONLY 80 99 140 COMMUNICATION AND RESPECT FOR PATIENTS ALLEGATIONS ONLY 102 95 128 PROFESSIONAL PERFORMANCE ALLEGATIONS 79 88 128 76 Geeral Medical Coucil
Figure 36: Idex of the proportio of cases that ivolve BME doctors relative to the proportio they accout for i all cases with the same allegatios, 2010 14 Allegatio group Source of complait AVERAGE PROPORTION OF CASES INVOLVING BME DOCTORS 0 Idex of proportio of cases ivolvig BME relative to the average for all sources Average for cases with this allegatio from all sources 100 200 = twice as likely as the average for all sources ALL HEALTH ALLEGATIONS 85 98 97 ALL CRIMINALITY ALLEGATIONS EXCEPT HEALTH 88 102 133 ACTING HONESTLY AND FAIRLY ALLEGATIONS ONLY 82 133 78 ACTING HONESTLY AND FAIRLY AND OTHER ALLEGATIONS 83 91 121 CLINICAL COMPETENCE ALLEGATIONS ONLY 83 130 99 CLINICAL COMPETENCE AND COMMUNICATION AND RESPECT FOR PATIENTS ALLEGATIONS ONLY 105 99 161 COMMUNICATION AND RESPECT FOR PATIENTS ALLEGATIONS ONLY 94 104 143 PROFESSIONAL PERFORMANCE ALLEGATIONS 91 93 123 78 Geeral Medical Coucil
Figure 36: Idex of the proportio of cases that ivolve BME doctors relative to the proportio they accout for i all cases with the same allegatios, 2010 14 Allegatio group Source of complait AVERAGE PROPORTION OF CASES INVOLVING BME DOCTORS 0 Idex of proportio of cases ivolvig BME relative to the average for all sources Average for cases with this allegatio from all sources 100 200 = twice as likely as the average for all sources ALL HEALTH ALLEGATIONS 85 98 97 ALL CRIMINALITY ALLEGATIONS EXCEPT HEALTH 88 102 133 ACTING HONESTLY AND FAIRLY ALLEGATIONS ONLY 82 133 78 ACTING HONESTLY AND FAIRLY AND OTHER ALLEGATIONS 83 91 121 CLINICAL COMPETENCE ALLEGATIONS ONLY 83 130 99 CLINICAL COMPETENCE AND COMMUNICATION AND RESPECT FOR PATIENTS ALLEGATIONS ONLY 106 99 152 COMMUNICATION AND RESPECT FOR PATIENTS ALLEGATIONS ONLY 94 104 143 PROFESSIONAL PERFORMANCE ALLEGATIONS 91 93 123 78 Geeral Medical Coucil
What factors ifluece how log it takes to resolve a case? Most cases are resolved i just over six moths The GMC ca either resolve cases directly or, i the most serious cases, refer them to the MPTS for a pael hearig. A case resolved directly by the GMC ca: be closed with o actio be closed with advice give to the doctor o their practice or behaviour be resolved by givig the doctor a formal warig be resolved whe the doctor accepts their fitess to practise is impaired ad agrees to udertakigs. If a case is referred to a MPTS pael hearig ad the doctor s fitess to practise is foud to be impaired, the the pael ca: 46% of the 10,309 cases reachig a closure date which were ivestigated or referred to employers i 2010 14 without the eed for a MPTS pael hearig were closed withi six moths, ad 80% were closed withi a year (figure 37, page 80). The media case legth was 6.2 moths. Of the cases that had a pael hearig, the media legth was 27 moths ad 81% were completed i three years or less. The data below differ from those foud i reports made by the GMC elsewhere, as we look specifically at the media time from the equiry beig received to the doctor beig told the outcome of the ivestigatio. I other reports the case may be cosidered closed oly after a appeal period is eded ad the doctor does ot lodge a appeal, or the time may be measured up to the poit at which the GMC s processes ed, whe the MPTS hearig begis. We also look at the upper ad lower deciles of case legth to give a top ad bottom rage, but exclude the more exceptioal outliers. decide to take o further actio impose coditios o a doctor s registratio susped or erase a doctor from the medical register. If the doctor s fitess to practise is ot foud to be impaired, the the pael ca decide whether to impose a warig. Geeral Medical Coucil 79
2,000 Figure 37: Legth of time take to complete cases, by whether the cases had a MPTS pael hearig or were closed directly by the GMC 1,848 1,500 1,156 1,000 Number of cases closed 500 638 911 700 650 613 479 431 388 337 296 0 100 0 0 0 223 206 185 163 123 110 70 93 67 55 39 51 49 48 49 48 37 41 42 35 31 38 18 17 3 5 8 10 8 13 14 14 19 24 36 31 56 46 15 24 14 18 45 49 36 40 36 38 8 8 37 28 18 26 27 15 11 7 12 17 12 8 6 4 17 15 11 8 13 7 3 6 6 8 9 3 2 6 6 3 2 1 0 2 2 1 12 2 4 7 2 5 5 3 5 3 1 4 0 1 2 1 3 0 1 3 2 2 0 2 1 1 1 2 0 0 1 1 2 1 4 0 Cases closed followig a MPTS pael hearig * 4 2 0 1 0 0 Cases closed directly by the GMC Moths 1 12 24 36 48 60 72 1 year 2 years 3 years 4 years 5 years 6 years * The total umber of cases closed after a pael hearig i >72 moths were 23. The total umber of cases closed by a case ivestigator i >48 moths were 59. 80 Geeral Medical Coucil
Gatherig evidece ca affect the legth of the case Cases ca be delayed while the GMC waits for iformatio or other ivestigatios. For example, the GMC caot usually progress a case while a crimial ivestigatio ito the same matters is ogoig. The GMC is also depedet o the cooperatio of outside bodies, such as the NHS, for access to evidece such as medical records. Delay i receivig medical records i secodary care settigs adversely affects the progress of cases. The GMC couts timescales from whe we first receive iformatio about a possible cocer, eve if we the have to wait for outside bodies to complete ivestigatios or idepedet iquiries. This aalysis looks oly at complaits about a doctors fitess to practise that are ivestigated or referred to employers. It does ot iclude those cases that are closed immediately ad ot ivestigated. For this reaso these data may ot match exactly other published data. It is worth otig that more tha oe case ca be heard by the same MPTS hearig for example, where several similar complaits are made about the same doctor, or ew complaits are made durig a ogoig ivestigatio. Over the period 2010 14, where a MPTS hearig hadled oly oe case, the media legth was 22 moths. For multiple cases at oe hearig, the media legth was 31 moths. About 12% of cases were heard alogside other cases i the same hearig. Figures 38 ad 39 (pages 82 83) show how the legth of ivestigated cases are affected by the outcome as well as whether there was a delay while waitig for a o-gmc ivestigatio to complete. The severity of the outcome affects the legth of the case: cases that did ot go to a MPTS pael but that eded i a sactio took a media of te moths to be closed by the GMC; cases closed by the GMC with advice or o further actio took a media of six moths. Cases closed by the GMC ad a MPTS pael both took substatially loger if ew iformatio was received after six moths. This is oe of a umber of factors that is difficult or impossible to cotrol. Geeral Medical Coucil 81
Figure 38: Number ad legth of cases that were closed without goig to a MPTS hearig i 2010 14 TYPE OF CASE NUMBER OF CASES Bottom decile Media CASE LENGTH IN MONTHS Top decile 0 35 All cases closed by a case ivestigator 10,309 6.2 2.2 22 Overall cases last for a media of 6.2 moths, with the lowest decile of cases takig oly 2.2 moths from the equiry beig received to a outcome beig give. OUTCOME OF CASE Advice or o actio Warig Sactio (udertakigs or coditios) 8,880 761 668 6 2 21 3.7 5 8 10 22 28 Cases leadig to udertakigs or coditios take a average of 4 moths loger tha those edig with advice or o actio. WAITING FOR NON-GMC INVESTIGATION TO COMPLETE No waitig 8,462 2.1 6 19 With waitig 1,847 2.4 8.2 34 0 35 Bottom decile Media Top decile 82 Geeral Medical Coucil
Figure 39: Number ad legth of cases that were closed followig a MPTS hearig i 2010 14 TYPE OF CASE NUMBER OF CASES CASE LENGTH IN MONTHS Bottom decile Media Top decile 5 70 All cases closed by a pael 1,194 23 10 56 Cases that go to a MPTS hearig last a similar legth of time regardless of their outcome. This suggests that the pael process is cosistet irrespective of the severity of the allegatios. OUTCOME OF CASE Advice or o actio 296 7.4 22 68 Warig 79 11 22 44 Udertakigs or coditios 105 14 24 57 Suspesio or erasure 714 11 23 52 WAITING FOR NON-GMC INVESTIGATION TO COMPLETE No waitig 848 11 23 52 The top decile of cases that had to wait for a o-gmc ivestigatio to complete took seve moths loger tha those that did ot have to wait. With waitig 346 8.6 24 59 24 5 70 Bottom decile Media Top decile Geeral Medical Coucil 83