Regulating doctors, ensuring good medical practice

Introducing the report

Our second report on the UK’s medical profession looks at what has changed since 2010 and what barriers doctors might face in delivering high quality care.

The report uses GMC data from 2011 as well as data and insight from other organisations. In it, we examine three main areas.

The first chapter looks at key indicators about the profession including demographics and complaints data. For example it considers the continued increase in the number and proportion of female doctors and the implications for workforce modelling and career structures. It also looks at changes in complaints including a 23% rise since 2010.

The second chapter looks at how types of complaints vary depending on the stage doctors have reached in their careers, and how support might be tailored to address this.

The third chapter assesses how practice can vary across different settings and  how differences in where doctors qualify, train or work can constrain or support good medical practice.

Although not statistically significant, we found that smaller hospital Trusts in England tended to have more complaints per doctor than larger ones. We also found that organisations where doctors in training reported below average satisfaction with their clinical supervision also tended to have more fitness to practise complaints.

Much of the data raises questions rather than providing definitive answers but we hope it will encourage reflection and debate and help to identify practical steps to improve patient care.

By starting to analyse patterns of variation, we all should be able to find ways to overcome some of these barriers to good medical practice.

Find out more

To find out more and to read the context for our findings, you can:

Comments

11 comments

Dr M Roberts (3 months ago)

I heard 7 adverts on the radio this morning on my way to work asking patients to sue their doctors. Could this be a partial cause for the rise in complaints?

Dr Michael Atkins (4 months ago)

The NHS is an organisation in crisis. It was never designed or now equipped to deal with the volume of care and retain high quality whilst containing costs. Pushed to limits and beyond, the cracks have inevitably shown. When health care becomes an all party priority rather than a vote winner, progess can be made. In the meantime, patient expectations are often too high and sometimes unreasonable. What is reasonable is to expect respect and courtesy - often sadly missing with NHS staff who are stretched and stressed. The NHS can only survive if some tough and politically unpalitable decisons are made.

Shaba Nabi (4 months ago)

I find it amusing that so much of this report talks about doctor and organisational factors and none of it on patient factors. The most straight forward explanation for the hike in GMC complaints is this.....we have become a far more complaining society than ever before. For the last ten years, patients have been fed a diet of patients charters, choice, extended hours and a supermarket mentality to their health. This does not come without casualties - namely a rise in complaints as they are now "customers" rather than patients. Every year, undergraduate and postgraduate training has more and more emphasis on good communication and consultation skills. We are not regressing....patients are becoming more demanding. And reading about some harrowing personal experiences by doctors who have been under GMC investigation, there is clearly little vetting procedure that is attached to this activity. Revalidation will do nothing to reduce the exponential rise in complaints.

Dermot Ryan (4 months ago)

Insufficient prominence has been given to the organisational factors affecting work in either depth or breadth. the obvious raising of expectations beyond the capacity of the NHS to deliver by politicians; the rigid recommendations and measurement of clinical adherence to guidelines which are not really fit for purpose, which are deprofessionialsing doctors; time spent for appraisals for every different sector of activity ( I have 5 jobs). Preparation for CQC; hand offs; because that service is not commissioned; lack of leadership academic, clinical and managerial; obstacles placed in the path of change; limited educational resources; limited time; lack of control within the job; understaffing or not staffed with the appropriate skill level. The GMC have a responsibility, as the organisation that protects patients, to consider where else it should direct it's energies to empower the medical profession to achieve what it desires: good clinical care.

NP Ewuzie FRCA (4 months ago)

Good report. I will however suggests that people read the document properly before making sweeping comments.

The report made it clear that:
How doctors gained specialist or GP registration did not influence the likelihood of them being complained about.

People suggesting that Doctors obtaining specialist registration through route(s) other than CCT are inferior should go through the document once more.

Dr. J. D. Baines (4 months ago)

I agree with Dr. Alison MacDonald, and would add to her point 2 thus 'and hearing Government pronouncements about the service'.
I would add to her point 4 to suggest that the 'revalidation' system be scrapped in favour of a similar system for relicensing to that used in the USA.

habib subhani chaudhry (4 months ago)

Dr Emma you have hit the nail on the head. How many times has ANYONE asked how do doctors feel. How can you offer others what you lack ??? How??
Especially junior and middle grade doctors I believe are the unhappiest lot as a proportion. No wonder you have higher complaints from hospitals who have doctors under training.
I have seen doctors in misery , there ONLY hope being the thought that "this rotation will either end in these many wks/months" OR I am applying for other jobs and I will leave the present one asap.
Something needs changing somewhere or this will continue.

Dr. Mustafa Rahim (4 months ago)

When A PCT imposes a practice on a salaried single handed Genera Practitioner without Dictaphone,Secretary and Scanner.Then the same PCT imposes a error generalting AltGP system on the same GP.When The Medical Director of that PCtTgets angry when he is asked to rectify this situation,When IT Chief of the PCT Condemns this It system as not fit for use,and PCT continues using it to abandon it after suspendeing the salaried GP,should not the PCT be referred to GMC for inefficiency ,rather than than the GP

Dr Emma Allende (4 months ago)

The main barrier doctors have to face is the barrier they have within themselves. Nothing will ever change it from outside. No matter how much you would like to control the profession, no rules could ever prevent the mistakes originated because of this as it is an inside job. Many doctors become drained, unhappy souls. You can not give to others what you lack of. You can not care for others unless you take care of yourself first and find peace inside.You can not offer your best unless you feel your best and want to share it. How a doctor feels is what makes the difference between the results obtained comparing two different consultants in the same department. We all prescribe the same medications and follow NICE guidelines. What makes the difference between doctors is how they feel inside as this is reflected in how they treat their patients. All this have a direct effect in patient care.

Dr. Patrick O'Brien (4 months ago)

To improve standards in medical practice especially in my own specialty, Psychiatry, let us remind ourselves of the philosophy of care applied by the father of modern medicine, the great Sir William Osler.

Give me, he said, the very best staff applying the very best treatments available, all the time, never cutting corners and always facing up to their mistakes. And the 'best preparation for tomorrow is to do today's work superbly well'.

To achieve this, consultants in medicine must lead, must take responsibility for ensuring that the best is only good enough - ever - and no compromises!

The Royal Colleges and the GMC should insist on specialist accreditation beginning by by achieving a credible standard ie the Membership or Fellowship examinations and nothing less - and abandon this appalling 'back-door' CESR scheme for once and for all and drive up standards.

The days of mere expediency to make up for shortage of properly qualified specialists should be ancient history.

DR. ALISON MACDONALD (4 months ago)

I qualified in 1974 and am still practising part-time as a Consultant Anaesthetist. I have been a College Tutor. I have also been a patient a few times, and have a son with a learning disability.
"The good is the enemy of the great" - how can we improve care and reduce complaints? No room for back-slapping!
1. By having stricter systems in place to "weed out" medical students who will always struggle. Admission to medical school is not an exact science!
2. One of the commonest causes of patient complaints is conflicting information from various members of staff, which lead to unrealistic or inaccurate expectations by the patient.
A simple question "What have you already been told/understood about this?"before answering their question can be a first step.
3. Active listening to patients, especially those who are slow to communicate.
4. More thorough testing of doctors qualified from ALL other countries; after all, the U.S.A. has done this for years.
5. More compassion!