What can we learn from GMC cases?
None of us can help reading news of GMC cases and decisions of the Medical Practitioners Tribunal Service (MPTS). We can learn a lot from the big GMC cases but there’s much to be usefully gleaned from the ‘run of the mill’ hearings. Dr Tania Francis reports.
They have a sort of horrid fascination, perhaps because we can’t help but worry that we will one day be on the receiving end of a GMC complaint.
However, this does actually serve a useful purpose, because we can learn a lot from GMC cases and MPTS decisions.
GMC cases fall into a number of broad categories:
- Clinical cases. These range from one-off clinical errors to cases of deficient professional performance. There is invariably an allegation of poor record-keeping thrown in;
- Conduct cases. These include behavioural issues, poor communication with colleagues or patients, personal relationships with patients or allegations of sexual misconduct and dishonesty;
- Criminal convictions;
- Health cases including cases of alcohol or drug addiction.
From time to time, a high-profile GMC case will grab the headlines, at least in the medical press. We will all have heard of Mr David Sellu, Dr Hadiza Bawa-Garba and Dr Manjula Arora, for example. But we can learn from more run-of-the-mill cases too.
Chaperones
Did you know that it’s not enough to have a chaperone in the room?
If you are examining a patient behind a curtain or screen, the chaperone needs to be with you and the patient behind that curtain, so that they can see you both.
In one case, a Medical Practitioners Tribunal found that a failure to do so amounted to serious misconduct, in circumstances where the examination was intimate and the patient had not been expecting it to take place in that consultation.
Indemnity cover/insurance
Don’t forget to renew your professional indemnity cover.
A doctor was erased from the medical register when they failed to renew their insurance, knowingly practised without it, and gave misleading statements to staff at the private hospital where they worked about providing the certificate of insurance.
Amending medical records
Adding to or amending medical notes after the event can be found to be dishonest, particularly if the changes are inaccurate or self-serving.
If you need to amend or add to medical records, you should ensure that the changes are accurate, mark the changes as retrospective and provide an explanation for them.
Drugs and alcohol
Perhaps an obvious one – but being under the influence of drugs or alcohol while at work is a serious issue.
Even outside of work, issues arise if the intoxication leads to behaviour which might bring the profession into disrepute or lead to a conviction – for example, drink driving. Be careful if you are working or driving early in the morning after a big night out.
Care Quality Commission inspections
While the Care Quality Commission’s (CQC’s) remit is to regulate health service providers, rather than practitioners, if you run a service – for example, a private clinic – and a CQC inspection reveals serious failings, this could result in a referral to the GMC, either because the CQC inspection reveals issues with your own clinical practice or because you are responsible for the clinic and its failings.
Scope of practice
Make sure you are clear about your scope of practice, including to your insurer or indemnifier and to your Responsible Officer.
This is particularly important if your scope of practice changes or if you do different work in the private and public sectors. As to the latter, make sure you can justify any differences between your private and public sector work.
It’s important that you do enough of any particular type of work or procedure to ensure that you are sufficiently skilled and keep up to date. This can be a problem in private practice, where some doctors may perform a wider range of procedures than they do in the NHS, in smaller numbers.
Be careful to work within your scope of expertise. It may be tempting to stray outside your expertise, for the best motivation – to try to help your patient. However, you will be criticised for doing so and your patient will be better off being referred to a more suitably qualified and experienced colleague.
Using drugs off-licence or unusual treatments
This can be a particular issue for independent practitioners. Patients may come to you asking for specific medication which they have read about online and which they cannot obtain from their NHS doctors.
It may be that the drug is not licensed or not licensed for the use for which the patient wants it. Independent practitioners have more flexibility to specialise in less common areas of medicine, but it is important to ensure that your practice remains evidence-based.
A doctor was suspended for nine months in a case in which they were criticised for providing advice that was without biochemical, physiological or clinical evidence and prescribed medication without clinical indication.
They also provided treatment which failed to meet NICE guidance; it was not supported by any professional UK medical body or the NHS and was unproven in terms of benefits.
Prescribing outside of licence and NICE guidelines may be necessary and appropriate in some circumstances, but it must be done with great care and in accordance with the relevant GMC guidance.
Boundaries
It is vital to respect boundaries in your relationships with colleagues and with patients. Inappropriate relationships, or allegations of such, are often the subject of complaints to the GMC – or, in more serious cases, police investigations.
Internet issues
It is vital to be extremely careful in your social media and internet presence. In one case, a doctor was criticised for the information published on their website.
The tribunal took the view that the doctor should have taken measures to ensure it was clear there was no evidence, by way of studies and guidance, that the treatment they recommended would be effective.
It also determined that the doctor should have notified the public and their patients that the treatment was not licensed, not universally safe, and that there were potential health risks associated with using the treatment in the manner recommended.
The tribunal took the view that the doctor’s actions put patients at risk and undermined public health, as there were concerns that the advice on the website could have discouraged people from following other advice, which, in turn, could put them at risk of harm. The tribunal found that the doctor’s actions amounted to serious misconduct.
Doctors have also been reported to the GMC for social media posts or WhatsApp messages. Be very careful to maintain patient confidentiality and ensure that your posts and messages are appropriate.
Even if you yourself are not posting or messaging anything inappropriate, you could be criticised for not taking action if you are aware that other doctors are doing so.
Conclusion
There is a lot of guidance out there from the GMC and from professional organisations such as the BMA and royal colleges, as well as from indemnity organisations.
Read it and follow it, and if you are not sure, ask them or discuss any issues with a senior colleague. If you are the subject of a complaint, seek advice from your insurer or indemnifier or take independent legal advice.
First published in Independent Practitioner Today in May 2023.