Facing a disciplinary process or investigation
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 doctors along the whole disciplinary pathway; from initial complaint to any contact with the GMC/GDC 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 are developing a guide for doctors attending the GMC/GDC.
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.
Doctors 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 PHS we consider any doctor 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.
What can we 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 can 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 GP charity, 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 doctors who have been suspended or erased we can offer a place on our suspended doctors 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.
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 them, addressed to an individual, to ask them to reconsider. However, we are aware that legal representation is very expensive. A Fitness to Practice 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 – whomever 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 him. The hearing bundle needs to be edited to remove prejudicial material.