SPEAKER_01 0:23

Entrepreneurs or interviews and month building something that matters in the technical profession. Hello and welcome to Conference Took Live. My name is Jody Rainsford and I'll be talking today with Christopher Cloak Brown, Director of Alicity. On this podcast episode, we're talking about what a GMC complaint actually looks like, how to navigate one, and make sure you do it without destroying your practice. Welcome, Christopher.

SPEAKER_00 0:50

Thanks, Jodie. Thanks for having me.

SPEAKER_01 0:52

So we're going to be talking about what is potentially the worst case scenario for many a practitioner, for many a doctor, GMC complaints. Hey, what is a GMC complaint? What does that look like?

SPEAKER_00 1:03

So the GMC, the General Medical Council and for doctors and the General Dental Council for dentists are the industry regulators. So you have to have a license from the GMC GDC to practice medicine dentistry. The role of the GMC and the GGC is patient safety. So a complaint to the GMC GDC is should be, or is technically about unsafe practice. And if your regulator determines that you are too unsafe to practice, they have the power to remove your license to practice, and that can be temporarily or permanently. But temporarily is fairly bad, and permanently is career ending. What you've trained for to do for seven years, you can't do anymore. For us, it is the most stressful thing for any practitioner to face. And you know, unfortunately, practitioners in those slightly more leading-edge areas of medicine are more at risk because they are what they're doing is less understood and less accepted and all these things.

SPEAKER_01 2:12

And so, how does this start? What's the reality of a uh GMC complaint? How is it initiated? What are the processes that are typical in a complaint?

SPEAKER_00 2:21

So a GMC complaint is literally as uh sort of what it says on the tin. Somebody writes into the GMC or the regulator and says, I am dissatisfied about XYZ Dr. XYZ's practice, and here's why.

SPEAKER_01 2:35

And can can they complain directly? Do they not have to go through a complaints process at the like literally can complain straight to the GMC?

SPEAKER_00 2:45

It's direct, it's anonymous, and it can be done by a third party. So the person who is a patient doesn't have to be the person who puts in the complaint.

SPEAKER_01 2:56

And what does that mean? Does that mean that there at any one time there are a whole number of people dealing with complaints against them that they are unaware of where they've originated until it gets to later in the process?

SPEAKER_00 3:12

Yes. I mean it's I think people generally do find out or at least get an inkling after a while. But as a practitioner, the first you'll know about it is is the your regulator, GMC GDC, will send you a letter saying we've received a complaint about you.

SPEAKER_01 3:28

And that must be frightening for most practitioners.

SPEAKER_00 3:32

Yes. Yeah, no, that's you know, that is the single most terrifying thing for for pretty much any practitioner.

SPEAKER_01 3:39

And the uncertainty as well, because you don't know where it's originated from or what it's about, just that it exists. And so what happens after that point then?

SPEAKER_00 3:47

So you do at that point you do get some information about the complaint and uh and what it's about. You you're not told where it's originated and it is anonymous. I think most people generally work it out in the end as well for the evidence again. It's not quite as bad as you don't get to see the evidence of it against you, it's not quite that medieval. It is a bad process. But yeah, it is not necessarily the patient, and then a lot of what we see is it quite often isn't the patient. So that's a very interesting aspect about it. The first thing you get is there's sort of a triage person process. There's like a sort of pre-committee. So you do get some information about the complaint, and you are, I'm not even sure if you're invited to. I mean, Roger deals with this, so he knows much better. But certainly there is no compulsion to respond to that. So that is something that very much differentiates our approach from most approaches, is that we will always put in our point of view or a response to the complaint in that first stage, as you can imagine with the stress potential outcomes of this entire process, ending it positively as quickly as possible has to be an absolute primary objective. And so we view that initial committee as a very fertile ground. And actually, in contrast to the patient complaints and litigation, the existence of a single negligent event is not proof that you are unfit to practice. The regulators do accept that not everything goes perfectly every time. It's where the patient's safety is at risk. So it is your attitude to that, it is your learning from that event, it's how you will change your processes and so on to deal with that kind of issue. It's all these things. So it is very worthwhile trying to understand the key nature of the complaint, understand that the backdrop to all of this is whether you are safe to practice with patients, and put in a response to that initial committee setting out your stall as to how you are safe and your safety will be improved, and patient safety wasn't at risk, and and all these targets. It's a very targeted piece of work.

SPEAKER_01 6:12

And do the majority of people put a submission in at that early stage, or is does that normally go past without any kind of submission to the next stage?

SPEAKER_00 6:23

A lot of people won't respond to that.

SPEAKER_01 6:24

There's why why is that? Why will not most people not respond?

SPEAKER_00 6:28

I think again, part of it is a lack of knowledge. I don't think, as I say, that you're invited to respond. So you might not even know that you're able to respond. Part of it is if you if you're, as most practitioners are, decent, caring, sensible people. Uh a lot of them are are almost frozen in fear, so they're just waiting to see what happens next. And not necessarily thinking. So again, having that objective support. We clearly care about what's happening to you, but it's not happening to us, so we can be more objective about the whole situation. It's really providing that support to understand that you can respond and uh and probably having experience to know how to respond. You can imagine that even if people did respond, it might just be some sort of you know, I'm a decent doctor, it'll be a bit of a bit of a download and a rant where it it needs to be targeted and nuanced to really, and your objective is to persuade that initial committee that there really isn't a problem here, and they can move on to the next one.

SPEAKER_01 7:28

So experience and understanding the process itself is the biggest advantage that you've got to to dismissing that quickly. So is there a gap between uh receiving the initial complaint and then then getting that further information from the committee as to exactly what the nature of the complaint is?

SPEAKER_00 7:44

Roger's the expert on this, so I'm basing it on talking to Roger about oh, this has come in, oh now we've had now we know what it's about, and so on. But as far as I can tell, yes, it's it comes out. And under a sort of normal complaint process, it's actually, I think, quite quite a slow process. You do, in some ways, get time to think, time to respond. Uh, what we have seen is again the regulators are a law into themselves, they can almost do as they like. And so we have one situation where it was in this functional medicine, this sort of new whole-body medicine that uses off-license medications and all these sort of really quite quite controversial things medically, to be honest. So one patient who was a minor, a child, had been treated, was being treated, and then they decided to discontinue the functional medicine treatment, went back into the NHS, where they saw a pediatric consultant. Pediatric consultant took one look at the notes as to the what had been happening in the previous treatment and said, What has this person been doing? This person's only trained as a GP. They shouldn't know anything about any of this stuff that I myself as a pediatric consultant don't even understand. This is absolutely insane. And so I think there was a bit of a delay in the process, but we ended up in a situation where they were pulled into a full tribunal. So the full tribunal is where they can, or or an interim orders joined. There's an interim orders tribunal and a full tribunal. So they can only strike you off at the full tribunal, but they can certainly restrict your practice or suspend you at the interim orders tribunal. And he had, I think, a week or ten days to prepare for that interim orders tribunal. So he's got he gets a note basically saying, let's call it ten days. In ten days' time, you will be pulled into a hearing, and the result of that hearing could be that we will suspend your licence to practice.

SPEAKER_01 9:49

And that's what potentially comes after that triage point. You could frequently get pulled into that.

SPEAKER_00 9:54

Yeah, so after the triage point, if you remain in the process, the next piece is this interim orders tribunal. So that's sort of uh, if you like, a first go at the whole thing. And uh again, they they have the ability to organise those quite quickly if they really think that there is patient safety concerns, uh, and so they can sort of at least suspend your license. And then after that interim orders tribunal, if they really think it's so bad, they can go to the full tribunal, which uh has the the power to end your license. Again, that's my understanding of it.

SPEAKER_01 10:30

So the timeline is potentially collapsed by the fact that depending on the severity of the complaint that's brought against and the potential for patient safety, because it all comes back to patient safety.

SPEAKER_00 10:40

Yeah, or at least the the tribunal says perceived risk, you know, in our view, though, you know, in this particular case, there wasn't an awful lot of risk, and actually the guy is one of the top practitioners and what he was doing in probably in the world. And so there was an awful lot of it was actually putting the information together and presenting that and getting that accepted, and and that all worked, and he kept his license and all the rest. There were there was some issue that was ultimately indefensible that that cropped up, but it wasn't a massive issue to be honest.

SPEAKER_01 11:11

But that ultimately speaks to the fact that when you are working at the leading edge or you were working in things, all it takes is a single complaint from someone who isn't working in those areas, who doesn't maybe have the experience or the expertise, but it can trigger something that essentially within a very short period of time could have resulted in a suspended license. Yes. And so who's on who are on these tribunals? So when you're the triage, then you come to the the ones after it, who sits on these, who is doing the assessment at this stage?

SPEAKER_00 11:40

So the triage is all the case managers who work for the regulator, so that's their job to assess these things and triage them. Um these interim orders and full tribunals, there's basically a panel of three, and one's a lawyer, so they're not a doctor. One is a doctor, but doesn't have to be from your specialty or anything. So again, might have no understanding of you and your practice, and the third person's a layperson, a member of the public. So again, not a doctor. When you think about the whole process and the medical nuances of it, you've got a fairly unskilled uh panel that you're presenting to.

SPEAKER_01 12:20

And that's the major challenge then, as someone operating in in these areas, is the fact that you are, if you do get to that stage, you have a higher burden of proof or explanation and really trying to explain the context of what you're doing in a way that they potentially don't understand because they don't have the expertise, specific expertise or specific experience in that part of the industry.

SPEAKER_00 12:44

We often use the phrase misunderstood with our more avant-garde practitioners, and yeah, standing in front of that tribunal is probably the absolute epitome of that misunderstood. So you have to uh you have to be very prepared as to what points you're making and how you're going to make them.

SPEAKER_01 13:07

And is that is that something that if you are what will you say avant-garde, if you are operating that, to start thinking about that now in terms of if something like this does because you say the getting a GMC complaint is potentially career ending. So when you are working in those areas, having a view to that potential risk of having to stand in front of a tribunal and explain it, is that something that you would recommend thinking about early on, regardless of whether there's a complaint launched against you or not?

SPEAKER_00 13:42

Absolutely, and part of our mission in life is we almost regard our client base as a mutually supportive community. We have clients who have amazing expertise in in all sorts of things, but it's really about being able to tap into that where you need that support, where you need somebody with the skills, the qualifications, the expertise, the track record, the credibility to stand up and say, no, this is perfectly normal, this is how it works, this is what you do. So we like to try and identify our practitioners ahead of time because again, having that support is great. Also, another way of dealing with these tribunals to not get suspended is to get oversight from somebody who, you know, a trusted second pair of buyers. Again, you can imagine patient safety is assisted by having a second practitioner who has the relative skills, knowledge, and experience to oversee what somebody's doing. So it's having another person who clearly has the expertise to support your practice is it can be enormously valuable in those situations.

SPEAKER_01 14:55

The final stage is being struck off. How often does that happen? How likely is that uh that to happen?

SPEAKER_00 15:02

Is it is that a regular current or is that a very I think it's uh it it's pretty rare, to be honest. So yeah, um that that that is fairly extreme. Yeah, is you know, there's a certain amount of it's all down to how you handle the process and the situation. The outcome is you know, you as a doctor have to show some kind of contrition and learning from the problem, I think is a a huge factor. It's it's the attitude of the doctor coupled with the extent of the problem that will determine the outcome.

SPEAKER_01 15:40

So in normal circumstances then, say in in a situation where maybe the that level of patient risk isn't high in the example you used, how long can this process take? Like how long can someone potentially be tied up in the first stage, second stage, third stage?

SPEAKER_00 15:57

I mean, you know, is it for some years? I mean, it's literally, I think I've I've heard about these processes going on for two or three years. So, yes, yeah. And uh really, as you can imagine, it's uh the the emotional drain of that is horrific.

SPEAKER_01 16:12

And so ensuring that it is tackled at that earliest possible opportunity is the best way of dealing with this as as quickly and effectively as possible.

SPEAKER_00 16:23

Yeah, we got one client who had a GMC complaint and six months later a NHS England when that existed complaint. We got both of those, we got her exited at the first stage from both of those processes in five weeks each time.

SPEAKER_01 16:39

And that was simply because you had the experience to know that though those things could be done. Was there anything else that you you put in place beforehand or you suggested people would do in order to make sure that they if they ever found themselves in a situation that increases the chances that you're gonna get it dismissed early?

SPEAKER_00 16:58

So with her in particular, I mean it was all fairly spurious stuff. So it was actually just understanding the process and how it worked and being able to demonstrate that there certainly in the GMC complaint that patient safety was not at risk, and that wasn't a problem, therefore it was nothing to whatever happened was nothing to do with the GMC. And I think similar in the NHS England, so that that one was in some ways fairly straightforward, and she is actually a very, very skilled practitioner, so she can produce very good evidence as to what she was doing and why she was doing it, and so on. In that one which went more quickly. I think the thing that we regretted was not having pre-lined up some people with the appropriate expertise to support and defend. The issue there was it was a child, you had a pediatric consultant who uh raised the complaint. And the complaint was this guy's a GP, which is what his qualification is, doesn't know what he's doing. So having having somebody to with the right skills, background, qualifications to step in and say, well, no, actually, whilst he did qualify as a GP, he's done all these other things since, and so have we, and we know this works, and this is all the data and so on, would have been helpful. Fortunately, it wasn't turned out that it wasn't critical, but certainly that is in when we look at how that process went, extremely grateful with the result, but we would have felt a lot more comfortable going into that process had we had that person.

SPEAKER_01 18:36

And that's something you can draw on because you have that client base, and that's especially absolutely you can quite easily draw on other practitioners who can you can attest to the fact that that is a reasonable thing to do in that area.

SPEAKER_00 18:47

We've done, and also in the complaints, claims, negligence. I mean, just to put it that into context, we had in in the days when there was weight loss surgery before the GLP one drugs, but a lot of our clients are weight loss businesses, and there was a claim against one weight loss surgeon, uh, and a few of the leading weight loss surgeons in the country are our clients. So one of them very kindly produced a breach of duty report, a very supportive breach of duty report. And so that's uh the situation which we talked about before. All of a sudden, the lawyers have on their desk one of the top weight loss surgeons in the country has said, Well, what happened here looks all right to me. So all of a sudden he's now faced with the issue of, well, I've got to get somebody at least as important as this guy to say it was terrible, and then even then we've got to fight it in court. So no thanks, I'm not gonna do that.

SPEAKER_01 19:41

Is professional indemnity is this relevant in any way at this point? Because will most people think that, oh, I'm covered with my professional indemnity insurance, therefore any issues going to come as a result of it is going to be covered. Is that something that's worth discussing or is that not relevant?

SPEAKER_00 19:58

Uh well, the medical indemnity is a specialist form of professional indemnity. Uh and the difference is most professional negligence is loss of money. So silly fact, but I find interesting. You remember the walkie-talkie building that the focused the sun and zapped the car? Yeah. So that was the claim on that was about a thousand pounds to replace a bit of plastic inside the car and twelve million to improve the building so it didn't happen again. So, yes, so most professional indemnity is just financial loss. Can be big financial loss, but financial loss. What separates the medical indemnity is it uh is bodily injury. So it's that injury to patients, and that's what makes that piece unique, or the medical indemnity piece. That would not cover you for your regulatory complaints. So some policies have that cover built in, others don't, and you need to buy it separately as an add-on. But that sort of regulatory cover ultimately is a legal expense cover. It is insurance for the cost of defending yourself through that process.

SPEAKER_01 21:06

And do most practitioners know that they would need that, or is that automatically offered when they are taking policies? Is it or is it something that they have to very specifically ask for in in case of that situation happening?

SPEAKER_00 21:23

Yeah, so you need to ask for it and check it. I think it's fairly well known because it's all part of the support. So the the sort of classic indemnity for the medical profession is is these medical mutuals and medical defence organizations. Um, and that's that's a core part of their service.

SPEAKER_01 21:43

I think we can conclude there. I think we've covered in a lot of detail what a GMC complaint looks like and how to navigate it, and also shine the light on the importance of ensuring you get that first submission in and making sure that you are it. If anyone here listening is uh potentially facing a GMC complaint, what should be what should be their first step?

SPEAKER_00 22:13

As we've discussed, if you are uh just in those first stages, then do take the opportunity forward to you to put your response into the the first committee uh that sort of first triage stage and do think very clearly that they are their concern is was patient safety at risk? So gear your response to that. Again, on the basis that we do think that most doctors are fairly honourable people, and if you're an honourable first person facing a complaint, we're we'll again we're more than happy to support you. Society is not served by doctors being forced out of the profession for the wrong reasons. If it's a more spurious complaint, uh we are more than happy to help people.

SPEAKER_01 22:56

Excellent. Thank you, Christopher. I think that's been informative around the whole GMC complaints process. Thank you for listening to Confidence to Thrive. Before you go, please rate, review, and subscribe to Confidence to Thrive on your preferred podcast platform and help us spread our message to others who are making a difference in private healthcare. This podcast was brought to you by Our Litity, insurance advisors who support your business ambitions. Our litity advises practitioners, owners, and entrepreneurs of healthcare practices on mitigating risks so your business can thrive. Learn more about how OurLitity can support you by finding the link in the show notes or visiting ourlitity.co.uk