The GMC has introduced a new approach to investigating concerns relating to doctors (Registered Medical Practitioners). Rather than move immediately to a full investigation, on receiving a complaint, the GMC will instead now open ‘Provisional Enquiries‘.
The GMC receives a number of complaints each year that do not meet the threshold of impaired fitness to practise. On occasions, a complaint can be closed on receipt, as it would come nowhere close to establishing that a doctor’s fitness to practise may be currently impaired. However, in some complaints, it is not immediately obvious whether a doctor’s fitness to practise is impaired, in which case a basic enquiry will be made at the provisional enquiry stage.
In contrast to a full fitness to practise investigation, a Provisional Enquiry should be speedy (around 63 days) and not require a great deal of information or evidence to formulate a view about a doctor’s fitness to practise.
A doctor can submit a reply at the Provisional Enquiry stage, but they should do so with the utmost care. Saying too much or too little, or something that, when read, appears ill-considered at this early juncture, could lead to the GMC becoming concerned that the doctor is not competent or lacks insight.
In some instances, the GMC will obtain a short statement from a potential witness or instruct an expert to opine, in order to explore the concerns that have been raised, in slightly more detail. A doctor can provide evidence and an expert report, but it should be borne in mind that the Provisional Enquiry is just that. It is not a full investigation. On occasions, less is more when responding. It is a difficult balance, but tactically, it is not always to a doctor’s advantage to comment.
The GMC might be assisted by receiving the following at the provisional enquiries stage:
- A short, accurate and up-to-date CV, including a list of relevant CPD
- Appraisals from previous years
- Evidence of Competence – both general and specific
- A short reply – but bear in mind that there are some cases where no reply at all should be made at the early provisional enquiry stage
- A written reflection, demonstrating insight (this must deal with a number of factors)
- Testimonials that go to the heart of the matter (these must be obtained in a specific format, and certain information must be brought to the attention of certain character witnesses)
- Relevant evidence of Remediation (the taking of steps to evidence learning, and competence. This needs to be considered in the context of the allegation made and must be carefully considered).
- Evidence of discussion with other clinicians about best practice and learning
- Evidence that undermines the allegation (again this should be disclosed at the right juncture, and there are certain cases where the information should be disclosed at a later stage, rather than the provisional enquiry stage, so as to protect the doctor from false allegations being formulated by a complainant who intends, in bad faith, to tailor their evidence to damage the doctor’s interests.)
- A short report from a clinical or other expert or, in some instances, a report from a reputable colleague
- Any evidence of system failings within the working environment, to include under under-resourcing evidence, evidence of poor working relationships, human factors, and deficient clinical governance protocols
- Evidence of ill-health that may have had an impact on a doctor’s practice, and steps taken to become well
- Evidence of steps taken to safeguard patients and colleagues from the risk of repetition, or the risk of harm
- Witness Statements and Investigation Reports
- Patient’s Notes (properly obtained)
- Any other information or evidence that may show that the doctor’s fitness to practise is not currently impaired.
A GMC case officer is tasked with obtaining the evidence on which the GMC will base its decision as to whether to move to a full investigation. If a full GMC Investigation is opened, it is often still possible to make further submissions that lead to the closure of the case on paper, at the GMC’s Rule 4 or Rule 7 stages (stages set out in the legislation governing the GMC’s process).
The case officer might obtain evidence from a number of sources, including reports from coroners, employers, and officers.
By way of example, see the GMC’s Single Incident Provisional Enquiries Guidance
A doctor might need to request that the case officer obtain certain documentation, such as medical notes or hospital documents, for the doctor to reply to the concerns raised. Documents that may be needed should be identified early on, so that there is a reasonable chance of the GMC obtaining them within the provisional enquiry time frame.
A doctor must not overload the GMC at an early stage with material that is not compiled properly. A doctor’s documents should be placed in a bundle that is paginated and indexed. A summary of the contents can often be of assistance to the Assistant Registrar tasked with reviewing the information.
In our experience, doctors can damage their case by submitting documents or phoning the GMC and making comments that are ill-considered. Taking legal advice early on is very important. The above list of steps that a doctor might take is for guidance only. Each case will turn on its own facts, and in some cases, many of the above-listed items might be otiose.
If you would like advice on how to respond to the GMC at the Provisional Enquiries stage, contact Doctors Defence Service on: 0800 10 88 739