Heath, wellbeing and fitness to practise

An important GMC report, Caring for doctors, Caring for patients, has been published including recommendations to “help deliver safe, supportive and inclusive environments” for doctors. 

The report identifies the main factors impacting doctors’ and medical students’ wellbeing and the action needed to create more compassionate working environments. 

Issues with the health and wellbeing of frontline doctors and medical students has been widely reported.  Whilst this is still a concern, the report’s authors Professor Michael West and Dame Denise Coia stated that: “It may not yet feel like it for those on the frontline, but we are seeing positive change. Intentions are becoming actions.” 

Heath, wellbeing and fitness to practise

It is becoming increasingly clear that there exists a link between the health and wellbeing of a doctor and their ability of a doctor to practise medicine safely. 

This link is acknowledged in this report: 

“There is now clear consensus across the health service on a range of issues that affect patient welfare and doctors’ wellbeing. All the evidence indicates that organisations who prioritise staff wellbeing and leadership provide higher quality patient care, see higher levels of patient satisfaction, and are better able to retain the workforce they need.” 

Contextual matters and issues are relevant considerations in fitness to practise cases involving doctors.  In 2017 BMA delegates voted in favour of a motion calling on the GMC to acknowledge that good doctors can harm patients when working in a poorly resourced environment.  The motion stated that “Mistakes can be a product of the environment and not the fault of the practitioner”. 

The GMC has acknowledged the relevance of contextual circumstances in fitness to practise cases.  Its Assistant Director for Standards and Ethics said, in response to the BMA resolution: 

“It [ the GMC] is absolutely not there to be punitive when doctors make mistakes – any doctor, no matter how experienced, can make a mistake, particularly when working under pressure. Nor are our standards a rigid rule book – we expect doctors to use their professional judgement in applying the principles in the guidance to the situations they face. It is only serious and/or persistent breaches of the guidance that pose a risk to patients, or to the public’s trust in the profession, that could call into question a doctor’s fitness to practise.”

“Understanding doctors’ environments” – GMC’s view

The GMC said: “in recent years we have become increasingly interested in the environments in which doctors practise and train – because we know they have a major influence on their actions and behaviour.” 

The Caring for doctors, Caring for patients report identifies and attempts to deal with issues affecting the health and wellbeing of doctors.  The GMC also sets clear expectations for employers in providing safe and high-quality training for doctors, and in supporting them. 

The GMC stated that:

 “We know the vast majority of doctors are committed to doing their best for their patients, despite hugely challenging circumstances, and demonstrate tremendous professionalism. We also know that doctors are human beings and that they will make mistakes, especially in those trying circumstances.”