Serious Untoward Incidents The role of the GMC - Dr Colin Pollock

1. Serious Untoward Incidents • The role of the GMC - • Dr Colin Pollock • GMC Employer Liaison Adviser (Y&H) • Y&H Deanery School of Surgery Conference 26th April 2013

2. Our functions Registration Education & Training Fitness to Practise Standards and Ethics Our statutory duty is to “protect, promote and maintain the health and safety of the public”

3. Trends - fitness to practise?

4. Trends - fitness to practise?

5. Initial handling of complaints / referrals • Initial triage assessment - • Are there issues for the GMC to investigate? • Possible outcomes • Closed at the initial triage assessment stage (56% of cases) • Stream 2 – usually refer to local procedures (18%) • Stream 1 – GMC open investigation (27%)

6. Outcome of referrals / complaints (2011 data)

7. Opening a case based on an SUI “An adverse outcome (in particular the death of a patient or serious harm) will undoubtedly be a factor in assessing the possible seriousness of an alleged failure or breach. However, such an outcome needs to be considered in the context of the case as a whole. An adverse outcome does not, in itself, indicate any error on the part of the doctor. Often the outcome will simply be the unfortunate consequences of the particular condition or an inherent risk of the particular treatment. Similarly, ‘errors’ in diagnosing or treatment are an inevitable fact of medicine and will not necessarily raise questions about a doctor’s fitness to practise. There will be many cases, therefore, where notwithstanding an adverse outcome, it is still more appropriate for the matters to be considered initially under local procedures.”

8. Opening a case based on an SUI • Referral from Trust / Deanery • Complaint from patient / family • Press cutting • Coroner’s inquest • Police investigation • Ombudsman referral • CQC • A colleague • Which doctors are involved?

9. Principles of Investigation Process • The doctor has every opportunity to respond to the allegation at any time • Employers involved (and Deanery for trainees) throughout • Take appropriate interim action to minimise any risk to patient safety • Explain clearly our process and decision making • Transparency • Acting as quickly as is possible whilst maintaining fairness to all parties.

10. Overview of Investigation Process • Initial ‘disclosure’ to the doctor • Employer ‘disclosure’ (includes Deanery) • Collecting information: • witness statements • medical records • expert reports • health assessments • performance assessment • [Interim Orders Panel – no order made / suspension / conditions?]

11. Overview of Investigation Process • Final ‘disclosure’ to doctor for their response • The doctor’s response (tone and content) is critical • Two Case Examiners (medical / lay) decision • Four options • close (+/- advice) • warning • undertakings • FTP Panel

12. Factors taken into account during an investigation • …..it is important that the outcome of the incident should not be considered in isolation.... • ….consider the circumstances in which the incident occurred. • ….the doctor’s actions fell below what could reasonably be expected of a doctor at his or her grade and level of experience • ….a death will have a bearing on the consideration of the case.... (but)…. needs to be considered along with all the other factors. • ….ensure that any local inquiry has been sufficiently rigorous before relying on this when concluding a GMC investigation. • ….some cases which do not result in the death of a patient, but which, nonetheless, raise questions about the standard of the doctor’s practice. • ….a serious failure to meet the standards in Good Medical Practice.

13. Outcome of referrals / complaints (2011 data)

14. Further information Dr Colin Pollock GMC Employer Liaison Advisor (Yorks & Humber) cpollock@gmc-uk.org Any Questions?