Letter from the GMC

OFTEN the first we hear of a GMC complaint is an anguished telephone call from a member to say a letter has arrived from the regulator and they are worried that they will be struck off and crucified in the tabloid press with friends, family and colleagues reading all about what a terrible doctor they are. Whilst it might be understandable to worry, in our experience very few GMC cases make it beyond written correspondence.

The first task as an adviser – after having calmed the member down – is to try to establish the type of letter received. Is it the first notification the doctor has had stating that the GMC will be investigating a complaint – or is it a letter to say that a complaint has been received but it does not require a formal investigation to be opened at that stage?

In either case, the member will need to complete a work details form which should be sent back to the GMC as soon as possible and definitely by the date on the covering letter, usually a week after the date of the notification letter. Details of all medical work should be included, whether paid or unpaid. Normally we advise that no other information or comment should be provided at this stage.

Careful response

Members are often desperate to tell the GMC their side of the complaint, especially if they have been unaware of any dissatisfaction by the patient, or the family of a deceased patient. Sometimes it may be apparent that the complainant has misinterpreted a situation or has only partial information. It can be difficult to persuade a member that the best course of action is not to fire off a response in the heat of the moment. Anything sent in response at this stage will be copied to the complainant who will then have another opportunity to provide critical comments, or to refute the doctor’s explanation.

Sometimes we advise against sending any initial response at all as there is no obligation to do so. This is particularly the case when it is unclear what issues the complainant has with the doctor, or when there are multiple allegations of poor performance or a referral by the doctor’s employer or contractor.

The onus is on the GMC to investigate and decide whether the issues raised in a complaint are such that there is a reasonable prospect that a doctor’s fitness to practise may be impaired. In some cases, it may not be obvious why a particular doctor is being investigated. In these situations, although it may be tempting to send off detailed comments, in our experience it is unlikely to end the complaint. Furthermore, without a specific issue to focus on, the member runs the risk of saying something which opens up another avenue of investigation for the GMC. It is often better to wait for a further written stage when the GMC will provide more specific allegations, sometimes based on an expert report; these are often easier to answer.

Send MDDUS all documentation - promptly

Before making any detailed response, we will advise the member to send a copy of ALL of the documentation provided to them by the GMC, along with the covering letter as this gives the case reference and contact details of the GMC’s investigation officer. In complex complaints, this documentation may run into several pages (sometimes hundreds) and the quickest way for us to receive the papers is to photocopy the complete bundle and send them by special delivery to our Glasgow office (ensuring that your membership number is included).

Documentation should be sent as soon as possible so we can set up a file and consider the substance of the complaint. We will also ask the member to provide a report on the events giving rise to the complaint, together with their proposed response, a brief summary of their career to date, and copies of the relevant medical records. We will use all this information as the basis for a response to the GMC. It will take time to draft a response and may involve our legal team; hence the need for all relevant documentation to be sent as soon as possible.

On receipt we will write back to the member with our standard letter of agreement (LOA) for signature. An MDDUS case reference will be included on the letter and this should be quoted thereafter when making contact or sending further documentation. We require the signed LOA as confirmation that the member wishes us to assist and that we can liaise with the GMC about the complaint on their behalf.

In our experience very few GMC cases make it beyond written correspondence

Any draft response to the GMC will be sent to the member for careful review to ensure not only that you are happy with what has been written on your behalf but also that it is accurate and adequately reflects the sequence of events. Any contradictory details arising later in the case may reflect adversely. There is no compulsory timescale for responding at this initial stage but we usually try to do so within four weeks; hence the reason again for requesting that information is sent to us promptly.

Expert review

In clinical complaints, the GMC will now invariably seek an expert view from a relevant specialist of the care provided to the patient who is the focus of the complaint. It can sometimes be helpful for the member to provide detailed comments in the response as this will assist the expert when compiling their report. Any personal reflections from the doctor on the care provided can also be helpful, especially if it is a situation where this has been less than adequate in some way. This might also include any remediation, lessons learned and CPD that might help reassure the GMC that there are no ongoing concerns about fitness to practise. The expert report will be provided to the member once available and, if appropriate, further comment can be made.

The documentation will then be passed to two case examiners, one medical and one lay, who will review the case and decide whether any additional information is required or whether the investigation can be concluded. The vast majority of complaints conclude at this first stage with no further action. Sometimes the doctor will be sent a “letter of advice” to reflect on particular sections of Good Medical Practice relevant to the complaint, but no further action is required and no detail of the complaint is recorded on the GMC website.

Cases can also be concluded at this stage with a “warning”. This is considered appropriate for less serious departures from Good Medical Practice and is not an action against registration. However, it will be published on the GMC website for five years and must be declared in any job application. Whilst it is possible to challenge the proposal to issue a warning, this requires attendance at an Investigation Committee hearing in Manchester.

In complaints not concluded at this stage, there is another written stage in which a letter detailing specific allegations (often based on the conclusions of the expert report) is sent to the doctor. A response must be sent to the GMC within four weeks and our legal department will at this stage be involved in reviewing the correspondence and considering the terms of any response. Normally we will meet with the member in person to consider all the issues in detail before submitting a response.

GMC case examiners will again review the papers and may decide to conclude the case with no further action or a letter of advice, or issue a warning. They may also decide at this stage to refer the member to a fitness to practise panel, or in certain types of case to offer undertakings to be agreed by the member.

Unfortunately, the whole process can sometimes take many months and we recognise that it is very stressful for the doctor involved. The medical adviser (and solicitor) allocated to the file are there to offer support through all of the steps of an investigation, and to the (hopefully) successful conclusion.

Dr Mary Peddie is a medical adviser at MDDUS