Swansea University academic asks ‘Are Doctors’ Fitness to Practise Panels serving the public interest ?ʼ

The question of how best to legislate to protect the public in the UK from the ethically dubious, incompetent, and criminal actions of doctors has long been of fundamental significance and interest to lawyers and beyond.

However, over the last two decades in particular there has been heightened political, legal, and public attention paid to the field of doctors’ fitness to practise as a result of a series of medical regulatory failings in prominent medical malpractice cases, such as the respective Bristol and Alder Hey cases, as well as medical acts of criminality, including multiple homicide in the case of the general practitioner Harold Shipman. 

Against this background, Associate Professor Marty Chamberlain, College of Law and Criminology, Swansea University decided to examine the trends over time in panel outcomes in order to identify their effectiveness in ensuring public protection.

His findings were:

  • there has been a notable increase in the last two decades in the number of complaints being made against doctors.
  • the majority of complaints received by the GMC are not taken forward for investigation or are concluded at the investigatory stage without action being taken against a doctor;
  • complaints from colleagues and employers were more likely to be investigated and lead to a tribunal, than complaints from patients, 
  • when action is taken, that the GMC is providing more informal guidance and advice to doctors and their employers, as well as issuing warnings, rather than referring a case to a tribunal; and
  • that the lowering of the level of evidence required at a tribunal hearing to remove a doctor from the medical register, from the criminal to civil standard, has not resulted in more doctors being struck off the medical register and so being stopped from practising medicine in the UK.

Professor Chamberlain’s research paper, recently published in Medical Law Review*, discusses how in spite of a decade of reform these findings reinforce that due process and procedural issues persist in how medical tribunals operate in the UK.

Speaking about his findings Professor Chamberlain said: “ My overwhelming concern is that any future legal reforms instigated to maintain public trust in doctors must ensure that they do not sacrifice public safety and notions of due process. After all, maintaining a fair, open and accountable medical complaint and tribunal system is very much in both the public and professional interest. “

Background

The General Medical Council (GMC) represents the principal formal legal mechanism for medical regulation within the UK and is the statutory body responsible for responding to complaints about the fitness to practise of doctors. Only the GMC has the authority to remove doctors from the register of approved practitioners by instigating disciplinary proceedings via what, since the end of December 2015, have been called medical practitioners tribunals (MPT).

As a result, growing public and political concern with the regulation of doctors in light of a series of high-profile medical malpractice and negligence cases has focussed on the need to reform the organisational structure and operational culture of the GMC. In particular, attention has been paid to addressing the contention that the medical regulatory system in the UK has frequently served to mask medical mistakes rather than first and foremost protect the public interest.

Inquiries of high-profile scandals at Bristol Royal Infirmary, Mid-Staffordshire NHS Trust and Morecombe Bay NHS Foundation Trust very publicly brought to the foreground questions about the willingness of a practitioner to report a colleague’s underperformance. They also reinforced to medical elites and NHS leaders the importance of, in principle, supporting reforms to medical regulatory and complaint processes.

As a result of these developments, the GMC and medical leaders from the Royal Colleges and British Medical Association, have collectively acknowledged that although (as they see it) some form of professionally led regulatory process is necessary, given the specialist nature of medical expertise, a more open and accountable system needs to be promoted within the GMC and its day-to-day operation.

  • Associate Professor Marty Chamberlain, College of Law and Criminology, Swansea University specialises in medical regulation, professional decision-making, medical malpractice, criminality and clinical negligence, fitness to practise and medical tribunals, bioethics, neuroscience and neurointerventions in the field of crime and justice, and medical law and bioethics more generally.

  • *Chamberlain, J.M. (2016) ‘Malpractice, Criminality and Medical Regulation: Reforming the Role of the GMC in Fitness to Practice Panels’ Medical Law Review Published online first 26th December 2016.  http://medlaw.oxfordjournals.org/content/early/2016/12/24/medlaw.fww025.abstract

  • Dr Chamberlain has also written another paper and a book on this topic - 
  1. Chamberlain, J.M. (2016). ‘Reforming Fitness to Practise Tribunals in the United Kingdom:  Serving the Public Interest?’. Health Risk and Society. 6: 318-334 http://dx.doi.org/10.1080/13698575.2016.1232374
  2. Chamberlain, J.M. (2015) Medical Regulation, Fitness to Practise and Medical Revalidation: A Critical Introduction Bristol: Policy Press & Chicago: University of Chicago Press https://policypress.co.uk/medical-regulation- fitness-to-practice-and-revalidation