Doctors and Remediation in GMC Cases
The GMC requires doctors who get into difficulties to take active steps to overcome any perceived or actual shortcomings in their practice. Competence and suitability to practise may be in issue as a consequence of identified failings. Concerns may have been exaggerated in certain cases, and on occasions malicious complaints may have been made against a doctor. While in other cases the doctor may have no insight into the level of the problem and the complaints may well be the tip of the iceberg.
The GMC assessment process of doctors, to identify weaknesses, can take some considerable time and will often turn on expert evidence. It is not always easy for a doctor to remedy their failings. In some instances the doctor may choose to refute the allegations made against them.
The cost of remediation can also be prohibitive, financially and in terms of time-commitment. Some doctors end up funding their own package of remediation. While other doctors may be lucky enough to be offered a package of remediation by their employer, this is becoming less common due to the finite resources that employers have access to.
What is remediation?
In short, it is taking steps to overcome one’s shortcomings or sub-optimal conduct, so as to ensure full insight and a lack of risk of repetition.
Examples of Remediation
Some examples of how doctors have taken steps to remediate their shortcomings may be useful to explain the process:
A doctor who has been dishonest might go on a probity and ethics course (both online and face to face), then write a reflective account of what led to their dishonesty and what they have learned.
A doctor who has been found to have acted sub-optimally in their clinical sphere might have to be supervised for a while during clinical procedures, and be signed off as competent, also going on courses that evidence updating.
A doctor who has behaved badly might see a behavioural psychologist and a counsellor to understand their triggers and overcome their misunderstandings and impulsivity through a course of CBT or other therapies.
A doctor who has an alcohol or drug dependency might seek help from AA, and see a drugs and alochol specialist.
A doctor who has beaten their spouse will need to demonstrate that they understand about the impact on their partner or ex-partner, and any children they have, as well as the impact in wider society of domestic violence of undermining confidence in the doctor and the medical profession.
A doctor who has inappropriately touched a colleague or patient, or had an inappropriate emotional or sexual relationship will need to demonstrate their understanding of boundaries, and understand how they crossed the line, and the impact of their conduct on others.
A doctor who has acted out of character due to burn-out, fatigue or mental ill-health would need to work at resilience, and ensure that they had a stay well plan, and an understanding of the warning signs of getting into difficulties.
Risk of Repetition
Doctors will need to be able to demonstrate that the risk of repetition of the same conduct is negligible if not nil. This is not an easy task, and a mere assurance will be unlikely to be enough. respectable and detailed work on remediation therefore needs to be evidenced in a variety of ways.
A doctor who has been suspended may find it difficult to remediate their shortcomings because they are excluded from their clinical job. Some doctors therefore undertake a period of clinical attachment, so as to keep up to date and observe current clinical practice. Doctors who have conditions of practice may also struggle to find work, and so undertake a clinical attachment. The GMC has written guidance to doctors undertaking clinical attachments who are the subject of conditions or a suspension. Doctors must ensure that they comply with their conditions, or the restrictions that a suspension imposes. Read the GMC document: GMC Guidance on Clinical Attachments
The GMC and others organisations have also commissioned research on remediation and the ability of doctors to achieve it, which is worth reading:
GMC: (this link is currently unobtainable): GMC Remediation Analysis
The Royal Colleges: Remediation and Revalidation – Report and Recommendations (2016).
Wide reading about remediation is helpful to any doctor seeking to achieve remediation. It is useful to discuss remediation with specialists and peers, to ensure that one is adopting the right approach.
Doctors Defence Service can advise doctors on remediation. For more information, call us on 0800 10 88 739