News Release

Embargo: not for publication or broadcast before 00:01 am Wednesday 2 August 2000

The Handling of Complaints by the GMC

A new independent study has found no evidence of discrimination or racial bias in the handling of complaints against doctors by the General Medical Council (GMC). However, there are still questions about the extent to which the disciplinary procedures of the GMC are consistent, transparent and fair to all doctors and all patients.

This is the main message from a new report by Professor Isobel Allen, The Handling of Complaints by the GMC, published today (2 August 2000) by the independent Policy Studies Institute (PSI), based on a two-year wide-ranging investigation of the GMC's disciplinary procedures.

The report makes 18 recommendations for changes in the present GMC procedures for dealing with complaints, which the GMC has pledged to address urgently. The new report notes the many changes and improvements in process made by the GMC since an earlier PSI investigation in 1996. But the study draws attention to unexplained differences in the referral of doctors to the GMC's professional conduct committee which could lead to accusations of bias by the GMC against overseas qualified doctors, even though there was no finding of discrimination.

One of the main problems identified is that there is no commonly understood working definition of 'serious professional misconduct', through which a doctor may be disciplined or struck off the register. This has undoubtedly led to a lack of clarity among GMC members and staff on the criteria, standards and threshold to be applied in reaching a judgment on cases at the different stages of the complaints procedures.

The research also found marked differences in outcome between different GMC committees, and concluded that this lack of consistency was difficult to account for in the absence of clear reasons given for decisions. Much greater transparency had been introduced at the screening stage of the GMC procedures, but there were still inconsistencies which could not be explained.

Over 50 per cent of the doctors appearing before the professional conduct committee are overseas qualified doctors, although they account for only just over a quarter of complaints received by the GMC. A detailed statistical analysis by PSI shows that one of the main reasons for this is that overseas doctors account for around half of the complaints to the GMC from public bodies, such as the police, courts and the NHS, but only around 20 per cent of complaints from members of the public.

Complaints from public bodies are regarded by the GMC screeners as much more serious, regardless of country of medical qualification, mainly because of the greater level of evidence supplied and the fact that doctors in these cases have often already been found culpable of some misdemeanour in another forum.

However, the researchers found it impossible to explain why relatively more overseas qualified doctors were sent on to the professional conduct committee from the next stage of the GMC's conduct procedures. It could be that the cases were more serious than those against UK qualified doctors, but there were clearly anomalies, especially in regard to the disproportionate referral rates for overseas doctors with convictions.

In 1999, 50 per cent of overseas doctors appearing before the GMC's professional conduct committee were erased from the medical register, compared with 38 per cent of UK qualified doctors. Overseas qualified doctors were also more likely than UK qualified doctors to be found guilty of serious professional misconduct in both 1998 and 1999.

The report concludes that in the absence of evidence of consistency, transparency and fairness of decision-making in all cases considered by the GMC at all stages of its conduct procedures, it cannot be asserted that each doctor is treated in the same way according to the same criteria and principles. But this goes further than issues of ethnicity or country of medical qualification and has broader implications.

The main recommendations of the report highlight the need for:

• Urgent development of a commonly agreed working definition of what does and does not constitute 'serious professional misconduct'
• Efficiency and speed in dealing with complaints which pose a risk to the public, those which allege dishonesty, dysfunctional behaviour, sexual assault and violence, and those about doctors who have been convicted
• The development of clear protocols defining the types of cases which come within the jurisdiction of the GMC's fitness to practise procedures
• Much greater liaison and partnership between the GMC and other bodies, such as the NHS and the Ombudsman, in defining what kind of complaints against doctors are relevant to what body, so that complaints are made to the most appropriate body and dealt with speedily
• The development of clear protocols for dealing with complaints alleging poor treatment or sub-standard clinical practice, which account for some 70 per cent of complaints received by the GMC but relatively rarely reach the professional conduct committee
• A formal record of reasons for all decisions taken by GMC members and staff within the fitness to practise procedures
• A continuing audit of all decisions and outcomes at all stages of the GMC's conduct procedures, with particular attention to country of qualification of the doctor
• Racial awareness training on a regular basis for all GMC staff, screeners and members of committees
• Discussions between the GMC and public bodies on the reasons why overseas qualified doctors are relatively more likely to be the subject of complaints from them

Contact details:

Policy Studies Institute 020 7468 0468. The author can be contacted on 020 7468 2250 or 0374 756921

Notes for editors:

1. The Handling of Complaints by the GMC: a Study of Decision-making and Outcomes by Isobel Allen is published by Policy Studies Institute and is available from the Publications Department, PSI, 100 Park Village East, London NW1 3SR. Telephone: 020 7468 0468. FAX: 020 7388 0914. Price £15.00 plus £2.50 p and p (ISBN 0 85374 773 3)
2. The research was commissioned and funded by the General Medical Council and is a follow-up study to The Handling of Complaints against Doctors by Isobel Allen, Elizabeth Perkins and Sharon Witherspoon published by Policy Studies Institute, 1996
3. Isobel Allen is Professor of Health and Social Policy at Policy Studies Institute/University of Westminster.
4. PSI is a registered educational charity (no 313819) and has no association with any political party, pressure group or commercial interest