Are you at high risk? – Understand your chances of GMC referral

It is possible to break down more specifically a doctor’s level of risk of GMC referrals based on age, gender, location of qualifying and other factors.

Statistics show that there are a number of factors that increase your risk of losing your medical licence. Interviews with employers lend additional weight to these statistics. Some of these factors you can’t necessarily influence, others you can – once you are aware of them.

According to data released by the GMC, the following demographics have been statistically shown to be at higher risk of complaints, investigations or sanctions:

Gender

Most doctors involved in cases which resulted in suspension or erasure were male – on average, four out of five cases involved a male doctor. In comparison, just 55% of all licensed doctors on the medical register are male.

Age

Doctors aged over 49 were over-represented in cases that resulted in suspension or erasure – 52% of all such cases involved doctors aged over 49, but only 27% of all licensed doctors were in that age group.

Data released the previous year showed that doctors aged 50 or older are twice as likely to be complained about, compared to their younger colleagues.

Black and Minority Ethnic (BME)

BAME doctors are 29% of all UK doctors but 42% of complaints by employers are made against BME doctors. UK graduate BAME doctors are 50% more likely to get a sanction or warning than white doctors.

Based on a study from 2011, doctors with primary medical qualifications from certain countries appear to be substantially more likely to get suspended or erased.

1. France
2. Bangladesh
3. Netherlands
4. Austria
5. Egypt
6. Belgium
7. Germany
8. Myanmar
9. Nigeria
10. Sweden
11. Sudan
12. Iraq
13. Ireland
14. India
15. Poland
16. Libya
17. Russian Federation
18. Malta
19. Iran
20. Hungary

Time Registered in the UK

On average, doctors who were suspended or erased had been registered in the UK for 17 years.

The limited data available suggests that doctors who qualified outside the UK may be more likely to be suspended or erased earlier in their careers (around 15 years) compared to doctors who qualified in the UK (around 23 years) – however this may not be statistically significant.

GP vs Specialist

GPs in general have a higher than average rate of being complained about.  Only 3% of licensed doctors were subject to a fitness to practise complaint in 2015. This rose to 5% for those on the GP register.

However, these complaints are slightly less likely than average to lead to a full investigation.  An analysis carried out by Dr Richard Wakeford back in 2011 suggested that hospital specialists are being erased or suspended at around half the rate of GPs and others.

Locum vs Non-Locum

A growing proportion of doctors in the UK are electing to work at least part of the time as a locum. Recent data from the GMC show an increase of nearly 12,000 locums between 2013 and 2017 – up to a total of almost 20% of all licensed doctors in the UK.

A greater proportion of locum doctors are complained about when compared to non-locum doctors – almost a quarter of all cases in 2014 that ended in suspension or erasure involved locum doctors (23%).

Poorly Performing Trusts

Data released by the GMC shows that poorly performing trusts – that is, trusts with lower CQC inspection ratings – generally have more investigations of their doctors.

The reason for this is primarily because of employer referrals, rather than patient complaints:

• Employer and organisational referrals drive the higher proportion of complaints about doctors.

• Between 2010 and 2014, employers and other organisations made double the number of referrals per doctor for trusts rated inadequate by the CQC compared with trusts requiring improvement or rated good or outstanding.”

Differences in law within the UK

The GMC is obliged to conduct fitness to practise enquiries into doctors who are convicted under UK law, and more serious convictions attract more serious sanctions – however there can be some significant differences depending on whether you are in Scotland and England.

One of the main distinctions that comes up here is that while England has Gross Negligence Manslaughter (GNM), Scotland has Culpable Homicide (CH).

To be found guilty of GNM under English Law, the defendant usually needs to have – through gross negligence – breached a duty of care, and significantly contributed to the death of the victim. This means in effect that systemic factors that may have contributed are not given as much weighting as the actions of the individual being charged.

To be found guilty of CH under Scots Law, the defendant usually needs to have intentionally, recklessly or grossly carelessly committed an unlawful act that directly caused a death – and the prosecution of the healthcare professional needs to be seen as in the public interest. This means that firstly the healthcare professional’s intent is considered, and secondly systemic factors can be considered when deciding whether prosecution is deemed to be in the public interest.

If you are a doctor working in England, you need to be aware that you are at greater risk of losing your licence – because the test for culpability in manslaughter is set far lower than in Scotland, and because the judgement does not have to serve the public interest.

High Workload

It seems an obvious suggestion that working more hours will mean that you see more patients, which will put you at greater risk of getting complaints.

A Pulse survey of 900 doctors revealed that UK GPs have an average of 41.5 patient contacts per day (including face-to-face, telephone and e-consultations) – which is 60% more than the number considered safe by European GPs.

Data quoted in this article can be verified on https://www.fitnesstopractise.uk/