Facing a disciplinary process or investigation
Health professionals who are undergoing disciplinary processes are often traumatised and highly stressed. They may be entering an unknown territory over which they have no control. At NHS Practitioner Health we consider any health professional with a complaint or referral for further investigation as high risk and in need of support, more so if the doctor is also suspended from work.
As a team, we have built up considerable understanding and expertise around the interface between disciplinary processes and ill health. We are able to help along the whole disciplinary pathway; from initial complaint to any contact with the regulator or Performers List/Organisational investigation. We have also built good relationships with all of the major medical defence organisations and barristers who are able to offer free or low-cost advice and, through our patient user group, we have developed this guide for health professionals facing an investigation.
Over the last ten years we have worked with the GMC to help improve the experience of doctors with mental health problems passing through their processes. We have helped the GMC redraft their correspondence to doctors and to improve how the GMC communicate.
What can Practitioner Health do to help?
We have a low threshold for offering psychological and pharmacological treatments following a complaint and we understand the traumatising effect a complaint or investigation can have on an individual. There are a number of practical things we can do to help you through the process:
- We can try to minimise distress for those doctors by asking the organisation or GMC/GDC to copy us into all correspondence and as such we are able to open these letters on behalf of the doctors (who are often paralysed into not doing so through fear).
- We can liaise directly with GMC/GDC and/or NHSE/organisational case managers where we are particularly concerned about a doctor.
- We may be able to signpost to solicitors who offer fixed price advice and they can sometimes help doctors access pro-bono services.
- We can assist doctors in accessing financial support from the healthcare charities such as the Cameron Fund and/or Royal Medical Benevolent Fund.
- We can help prepare doctors for hearings, including reports and in exceptional circumstances may also attend the hearing.
- For any healthcare professional who have been suspended or erased, we can offer a place on our suspended practitioners' group which meets on the first Friday of every month.
- We can offer support for at least one-year post erasure.
- We can sometimes help erased doctors return to the medical register (including carrying out appraisal type discussions and advising on developing a personal development plan).
- We can help doctors prepare for a review after a period of suspension and support them back to work when that period of suspension ends.
- We can advise doctors looking for supported employment after a period of suspension or to find employment if they cannot work in their capacity as a doctor.
Attending an investigation hearing
It is very difficult to give step by step advice as to what to do if asked to attend an investigation hearing as each situation will be unique, but here we try to cover the basics of what you need to know.
Legal representation – Wherever possible it is vital to have legal representation, even if the doctor has to pay for this themselves. We advise doctors, even if their medical defence organisation refuses to offer support, to write to the defence team, addressed to an individual, to ask them to reconsider. However, we are aware that legal representation is very expensive. A Fitness to Practise Hearing can easily run up £50-£70,000 bills in legal fees (solicitor and barrister costs). Sometimes a doctor may wish to represent themselves in hearings. Watching a skilled doctor trying to move into the shoes of another profession can be very painful to watch. Barristers are experienced at organising and delivering the evidence of the case, doctors are not. If you do have to represent yourself, then get organised.
Preparation – Have evidence prepared, easily accessible and tabulated (that is numbered) and stick to the facts.
Prepare a Statement – this is a substantial document and sets out:
- Comments on the charges (even though these were accepted/ proved)
- Insight/ reflection – this is key
- Good Medical Practice
- Remediation – this is key
- Steps taken to keep clinical skills up-to-date (again, proportionate to the fact that the doctor will have suffered financial hardships, so a log of journals read and reflected upon). As part of this, a number of documents will have to be exhibited, particularly steps taken, courses attended, journals read, research undertaken. As a whole, this document needs to be comprehensive, detailed, thoughtful, appropriate and backed up by evidence wherever possible.
- References – The statement must include the GMC checklist – so that it can be given full weight by the panel. These references cannot just contain general comments – they must be specific. 4-5 good references as opposed to numerous saying the same thing. They need to be professional references from a clinical setting, references from any non-medical employers (during the suspension).
- Log of journals read, courses attended, people spoken to.
- Engagement with PHS – whoever has seen the doctor should produce a statement.
- Expert evidence – have the investigation panel/GMC suggested the doctor be reviewed? If not consider a report.
The doctor needs to be prepared to give evidence and be cross examined – the panel will in all likelihood want to hear from them. The hearing bundle needs to be edited to remove prejudicial material.
Maintaining High Professional Standards, morally, ethically and fairly: what doctors need to know right now
Facing an investigation into performance concerns can be one of the most traumatic events in a doctor’s career, and badly handled investigations can lead to severe distress. This paper describes the documents and processes that doctors undergoing investigations should be aware of: Click here
Usually if the doctor is under investigation by the GMC, there will be a tribunal by the MPTS (Medical Practitioners Tribunal Service) who are closely affiliated to the GMC and based in Manchester. It is this panel who makes a recommendation as to whether or not a doctor can be erased, suspended pending further investigation, allowed to work with conditions, or allowed to work with no further action.
Any outcome except the latter can have profound consequences on the doctor in question. First there is often immediate shock, anger, guilt and resentment, but this often gives way to a complete sense of feeling immobile or frozen as the gravity of what has just happened sets in. See Stage 5 – Decisions made for suggestions on how to deal with this decision and what to do next.
Second Victim Support
Second Victim Support click here recognises the impact of involvement in a patient safety incident or complaint. A healthcare professional who experiences significant personal or professional impact as a result of a patient safety or incident can be referred to as a second victim. This web-based resource helps those (and their peers/managers) who have experience of being involved in such incidents identify the types of support they may need, and sets out to signpost them towards that help.