Understanding employers' referrals of doctors to the General Medical Council

What were the key findings?

• Within trusts concerns about doctors came to light in a number of ways. This included performance data, serious incident reviews, patient complaints and colleagues raising concerns.

• Local resolution of concerns was favoured wherever possible. Only the most serious of concerns were escalated to the GMC.

• The majority of trusts had a core decision making group who raised, debated and monitored concerns. The make-up of this group and frequency with which it met varied across trusts.

• Dealing with complex or borderline cases, balancing confidentiality with an open and transparent culture, feeling responsible for the outcome of decisions and feelings of isolation within decision makers were difficult aspects of dealing with concerns.

• Trusts followed the department of health’s maintaining high professional standards in the modern NHS (MHPS) process for dealing with serious concerns. Difficulties with this process included maintaining a pool of trained case investigators, accessing credible expert witnesses and the generation of counter complaints.

• Some participants suggested the likelihood of issues coming to light was not the same for all groups of doctors. For example, some felt that concerns were more likely to be raised against locums, doctors who qualified overseas, doctors approaching retirement and doctors that worked in specialisms that are easy to benchmark. Conversely, some felt that concerns were less likely to be raised (or more carefully considered) against trainee doctors, popular doctors and doctors from non-white backgrounds.

• Promising approaches (that enabled trusts to deal with concerns more effectively) included clear organisational values, targeted appraisals, having a wide pool of case investigators, reviewing previous cases, having two case investigators per case and providing unconscious bias training.

• Ideas for the future (individuals’ thoughts on dealing with concerns more effectively) included developing an integrated professional support unit, a forum for case investigators, sharing of legal/HR expertise (for smaller trusts), having a ‘faculty’ of case managers, sharing case investigators at a regional level, establishing an expert witness database, developing terms of reference for expert witnesses and reverting to a single employer for trainees.

Why did we commission this research?

In examining the data held at the GMC it became apparent that concerns raised by responsible officers, employers and other doctors are more likely to merit full investigation by us and lead to warnings and sanctions, compared to other sources. We wanted to understand further the process by which this occurred, that is, the process by which responsible officers and employers identify appropriate concerns for referral to the GMC. The aim of this research was to identify any promising approaches for effectively escalating concerns to the GMC that could be shared with others.

What did the research involve?

A random sample of 11 acute trusts in England were chosen as case studies for this research. The sample included:

• large and small trusts
• foundation and non-foundation trusts
• rural and urban trusts
• teaching hospitals
• trusts from ethnically diverse areas of England
• trusts from different regions of England
• trusts with varying numbers of referrals to the GMC over recent years.

Qualitative interviews were conducted with 4–7 staff at each case study site. These included:

• responsible officers
• chief clinicians
• senior clinicians
• human resource directors and staff
• administrators and others.

Read the full report

Understanding employer’s referrals of doctors

We are reviewing the report to develop our next steps in understanding referrals to us.