Who’s keeping doctors safe?  The rise in bullying, blame and suspension

Good evening and welcome to the Society for Healthcare Reform.  Tonight’s Webinar will be a focused discussion on the rise in bullying, blame and suspensions facing doctors, and I can also add investigations to that list. Who’s Keeping Doctors Safe?

We are lucky to have several experts to discuss and debate these issues.  So, in alphabetical order, I would like to introduce our expert panel:

Anne Ball is a Senior Partner in the law firm, Hempsons.

Roger Kline is a Research Fellow in the Business School at Middlesex University and has published widely on the blame culture facing doctors.

Professor Colin Melville is the Medical Director of the General Medical Council and Director of Education and Standards

Daniel Poulter is the Member of Parliament for Central Suffolk and North Ipswich.  He is a psychiatrist and served as Parliamentary under-Secretary of State in the Department of Health between 2012 and 2015.

Professor Peter Sagar is the President of the Association of Coloproctology and on Council for the Royal College of Surgeons of England.  He has raced back this evening to join us having just travelled from Central London to Leeds.

Jenny Vaughan is the Chair of the Doctors’ Association UK.

Ben White is a GP who works for the Medical Protection Society.

Jeeves Wijesuriyas is the Deputy Chair for the Professional Regulatory Committee of the British Medical Association.

…….. 

Good evening everyone and I’m happy to say that we have a large number in our audience.  

I’d like to start by just setting the discussion.  Becoming a medical student is no easy task.  It takes a considerable amount of drive, success at exams and luck to get through from the large number of school students who want to be doctors.  For those who manage to enter medical school, it takes 5-6 years of studying at medical school, long sleepless nights of studying, and passing all the exams to become a doctor.  From those who want to continue their journey into this profession, there are many years ahead, not only of long hours working, on-calls, but also postgraduate exams and travelling from one hospital to another trying to move upwards from one grade of doctor to the next.  

It takes a special person, not only to become a doctor, but to continue as a doctor, with the same amount of drive, passion and motivation.  Doctors are leaving the profession for many differing reasons, but one of the most important reasons is that they feel that they are not valued.  There is no profession that is so highly regulated as Medicine.  There is no other profession which has so much individual accountability as Medicine.  In recent years, doctors have found themselves increasingly undervalued and targets of bullying, investigations, blame and suspension.  Institutions have created this culture within healthcare and have placed doctors high up on a tightrope without an effective safety net.  Doctors have become easy targets within the NHS and also in the private sector both from private healthcare companies and private medical insurers.  Although the vast majority of doctors are working extremely hard and provide the best care that they can, these institutions are regularly citing the tiny numbers of doctors whose care or behaviour falls below an acceptable level, and using their powers to provide the threat of blame, suspension and referral to the General Medical Council without any accountability.  This fear of having their livelihood and profession taken away from them is something which has allowed the balance of power to remain strongly with these institutions.  

In a recent article published in the Morning Post, there was a warning from the Doctors’ Association UK which came after a report from the General Medical Council found that between 2018 and 2020 29 doctors died during its probes into their conduct.  Twenty died of natural causes, but five took their own lives.

So, that is why this Webinar asks:  Who’s keeping Doctors Safe?

It is clear that there is no single process whereby the NHS and the medical private sector investigates doctors.  There is an NHS procedure:  MHPS (Maintaining High Professional Standards) which is prepared by the Department of Health and which NHS Trusts adapt and adopt.  However, too often, processes are not followed, there is so much variability between hospitals as to how they investigate and treat doctors, and there is insufficient training for those who are designated as investigators of doctors or who claim to be medical experts.  The problem is that doctors are individuals and find themselves overwhelmed by the power of the big institution.  As we can see from the recent P&O dismissal of 800 employees, big institutions feel that they can do whatever they deem to be in their best interests, whether due process has been followed or not.  

We are going to divide the Webinar into two parts.  The first will deal with what happens when doctors are reported or investigated and how doctors can best be supported through any process of blame, bullying or suspension.  We will then answer a small number of audience questions, so please pose your questions to the panel on the Chat.

The second part of the Webinar will try and formulate a plan whereby there is a recognised universal process for any institution which chooses to investigate a doctor, but also a process which provides an equal accountability for doctors and for those healthcare institutions.  It is this process which needs to be robust and enforceable. 

My first question is to Jenny Vaughan.  Are we over-reacting?  Is there really a problem for doctors?

Colin Melville, could you please tell us how many doctors are reported to the GMC each year, what percentage of cases are investigated by the GMC and how many cases are found to be without merit?

Could you also run us through the process whereby doctors  are first reported to the GMC?

Ben, how do you try and support doctors?  Please run us through the MPS process of supporting a doctor when they first contact your society saying that they are being investigated or have been suspended?

Pete, you are on Council of the Royal College of Surgeons.  Do you feel that the Colleges could do more to support doctors?

What is your experience of colleagues who have been investigated or suspended?

Anne, you represent doctors when things go wrong.  Please tell me how you see the system facing doctors.

Jeeves, What is the BMA’s opinion about what is happening to doctors and how can your organisation provide support?

Roger, you have worked with several organisations in Healthcare.  How can Institutions provide fairness to doctors and what can be done to improve the processes?

Daniel, is government and the Department of Health aware of this problem facing doctors?

Second Half

(Questions to all panellists)

1. What should be the reason for suspending a doctor pending an investigation?

The only reason to suspend the doctor pending an investigation is in the following event:

when there is immediate danger to patients and/or staff.  

However, this is a rare event and the organisation will be fully accountable if it chooses to immediately suspend the doctor without meeting the definition of the above event.  The accountability for the organisation will be discussed further in this document.

1. What does the panel think of the qualifications and training that investigators have ?  The reason for asking this is that the doctor, who is highly qualified, is being investigated by someone who will making decisions about the future of this doctor.

2. Should there be a clearly defined process with timelines for investigating or suspending a doctor and should this process be enforceable and universal?

3. Should a healthcare institution be as accountable as the doctor?  Private healthcare institutions try and get round accountability by claiming that the doctor does not have a contract of employment with them.  Should any contract between a doctor and an institution which has conditions of work practices be considered within the same employment category as an NHS institution?

4. What does the panel feel about a Doctors’ Charter.  The Patients’ Charter was originally introduced in 1991 by the Conservative Party.  It enlists patients’ rights and responsibility along with a code of practice.  It’s now part of the NHS Constitution for England.  Although the BMA published the SAS charter, do we need a Doctors’ Charter that provides minimum conditions of employment, rights to fairness in work, accountability of the healthcare institution where they conduct work. 

I’m afraid that I have to bring this fascinating Webinar to a close.  We have been so lucky to listen to so many expert opinions tonight.  I believe that we may have agreement on how best to move forward and I hope that some of us can meet outside of this forum as a focus group to see if these ideas can come to fruition.

We have to improve on what we have now.  Doctors do need to feel safer in their places of work and not to feel like easy targets.  If we can agree a Doctors’ charter, similar to the Patients’ Charter that was introduced so many years ago, we will be able to value our doctors more, we will reduce the amount of suspensions and referrals to the GMC, we can reduce medical litigation and finally, we can provide a safer environment in which doctors can work.