Supporting Vulnerable Doctors Programme

1. Supporting Vulnerable Doctors Programme Anna Rowland Assistant Director – Fitness to Practise Policy, Business Transformation and Safeguarding Medical Advisory Board 10 September 2018

2. Today’s objectives

3. Where it began 2014 2015 Sarndrah Horsfall Chief Executive National Patient Safety Agency (NPSA) The Horsfall Report - December 2014 Professor Louis Appleby Professor of Psychiatry The University of Manchester The Appleby Proposals – December 2015

4. Key aims of the Appleby proposals

5. Appleby’s 10 Key Aims

6. What changes did we make?

7. Changes we have implemented Swifter more sensitive and consensual process 1) A process to moving to consensual undertakings more quickly 2) Experts share reports where opinions differ Only carry out formal investigations where necessary Amended guidance for decision makers on when to investigate health concerns A more sensitive process for health Reducing direct contact with GMC staff Piloting an enhanced role for medical supervisors in monitoring restrictions Signposting MPTS staff signpost doctors to available support services if unwell during hearings A specialist approach to health Specialist GMC communication team Only carry out formal investigations where necessary More early enquiries – including a pilot for those with health concerns 1) Tone of voice review for health correspondence 2) Staff have access to advice about unwell doctors 3) Pausing an investigation when a doctor is very unwell Investigations MPTS Hearing M Monitoring Triage Greater clarity about what the GMC can investigate Pages leading up to the online complaint form improved Local procedures Continued engagement with responsible officers (through our Employer Liaison Service) Guidance For medical supervisors who believe a doctor being monitored isn’t receiving appropriate medical treatment General support MPTS staff promote Doctor Support Service and legal advice line Coordinated approach Single point of contact Faster investigations 1) New process to identify allegations at triage 2) Reduced the time it takes for a doctor to be informed of their investigation outcome More support during investigation Investigation staff actively promote Doctor Support Service and legal advice line Hearing support The MPTS have established a doctor contact service to support any doctor who is alone at the hearing centre Only carry out formal investigations where necessary Pilot of Provisional Enquiries in single clinical incident cases New proportionate publication and disclosure introduced- including separate arrangements for health Further changes implemented across the process Mental health training for all staff Myth busting – communications campaign to raise awareness of our approach to fitness to practise and tackle misconceptions Compulsory training programme for staff on how to interact with vulnerable doctors (including those at risk of suicide) Continuing to promote the need for a national support service Improved access to information about the cause of doctor deaths during investigation and monitoring KEY Approach to cases involving adverse mental health Approach to all cases

8. Humane/compassionate handling

9. Humane/compassionate handling

10. Humane/compassionate handling Doctors with health concerns

11. Humane/compassionate handling Doctors with health concerns

12. Feedback from doctors with health cases so far ‘Many thanks for your continuing kindness, because this has come over in our few telephone conversations’. ‘I really appreciate your help and support along this process’. ‘I think it is rather a thank you from me for your support during the process, I am glad that it is now complete’. ‘I also would like to thank you for your ongoing support and availability throughout the investigation’. ‘Thank you for your kindness in how you spoke to me yesterday, I imagine your job can be quite difficult at times’.

13. Feedback from stakeholders about our Tone of Voice review ‘I feel that the general approach is helpful, appropriate and supportive’ ‘ I felt the documents, as far as they could be, were user friendly and sensitive to the effect that the GMC process can have on doctors’

14. Managing Risks

15. Risks and Opportunities

16. What about patients?

17. What about patients? • Clear Guidance for Staff • Respond robustly to serious conduct/performance concerns even where health a factor

18. Cultural Change

19. Maintaining the change TheMedicalAdvisoryBoard

20. Communicating our Progress

21. Blog by Professor Appleby ‘Some of the processes have seen real improvements that I feel confident will make a difference’. ‘Doctors should feel reassured to find they are speaking to someone who is trying to make balanced decisions, who understands it is stressful and undermining’.

22. Interviews ‘ [Doctors]…appreciate the fact that they can speak to an individual, that the individual is compassionate and understanding, listens to their concerns and provides information directly to them.' ‘We now have a dedicated team who work with doctors with health concerns.’

23. Interviews ‘what I’ve seen and what I’ve observed is a real culture change within the organisation when it comes to recognising the effect that the investigation process has on doctors.'

24. Social media response Tweets from stakeholders/organisations ‘This is welcome‘ @gmcuk & I’m sure I’m not the only doctor to be grateful for @ProfAppleby’s contribution to your review.’ Ruth Bromley ‘Maybe @nmcnews should take a look‘ JustMe Tweets from doctors and other individuals ‘Absolutely, it should be a supportive process’ Anil Jain

25. Assessing the impact

26. Further questions?