Reports > The Fifth Report > CHAPTER TWENTY SEVEN - Proposals for Change >
The Availability of Information about Doctors
Information Available to Employers and Primary Care Organisations
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27.142 |
One of the issues discussed at some length during the Inquiry was the difficulty experienced by PCTs in verifying information about doctors who apply to join their lists. I listed the checks to be made at paragraph 5.43. One of the witnesses described the process of obtaining this information as a ‘real chase-round’. Even the process of checking registration at the GMC, the Criminal Records Bureau (CRB) and the NHS Counter Fraud and Security Management Service can take a good deal of time. Several PCT staff suggested that a more co-ordinated method of making these checks would be very welcome. |
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27.143 |
Quite apart from the information that can be gleaned from those three sources, there exists an enormous amount of other information about doctors which would be of value to PCTs and to potential employers. At the moment, there is no way in which such persons or bodies can find out all they would like to know about an applicant for a post or for admission to a list. For example, they will receive a reference from one, or maybe two, previous employers or PCTs but they will have no idea whether there are other employers by whom the doctor may have been dismissed or disciplined. They cannot find out whether a complaint has been made or even a series of complaints. In the Report of the independent investigation into how the NHS handled allegations about the conduct of Clifford Ayling (the Ayling Report), the problem of drawing together and tracking records of separate complaints about the same doctor was highlighted. A similar concern was expressed in the Report of the investigation conducted by CHI into the various complaints made about the GP, Peter Green. |
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27.144 |
During the Inquiry, the idea emerged that there should be a central database of information about every doctor working in the UK. This would not be open to the public, but would be accessible to the officers of NHS bodies and to accredited employers in the private sector, as well as to other bodies with a legitimate interest, such as the Healthcare Commission, the GMC, the NCAA and the DoH. Several different classes of information would be fed in.These would include the current records held by the GMC (including any FTP history), although it might be more convenient to create a link to the GMC website, the contents of which I will discuss below.The database would have to contain information provided by the CRB or be linked electronically to that organisation. CRB information would include details of convictions (including those resulting in an absolute or conditional discharge) and cautions; the existence of other, more sensitive, information could be ‘flagged’ so that further enquiries could be made. In addition, the database would contain information from the NHS Counter Fraud and Security Management Service, a record of any disciplinary action by employers, the details of any list management action by PCTs, any adverse reports prepared following the investigation of a complaint, any adverse findings by a Healthcare Commission panel or by the Health Service Ombudsman and any findings of negligence in clinical negligence actions and settlements of clinical negligence claims above a pre-determined level of damages. The level of damages should be set at a low threshold, say £5000, so as to catch cases involving the deaths of children, where the damages are unlikely to exceed about £11,000 on full liability and may well be settled for less than full value. In addition, an entry would be made in respect of every post taken up by a doctor in employment, thereby creating a running curriculum vitae. For self-employed doctors, an entry would have to be made for each GP practice or deputising service for which the doctor worked. The identity of the doctor’s medical defence organisation (if any) could be included. Also, if the doctor had any financial interests which should be declared, they too could be incorporated. Doctors would be able to access their own entries to check the accuracy of the information held. |
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27.145 |
I would suggest that private sector employers should be required to provide relevant information. The Healthcare Commission could require this as a condition of registration. Also, deputising services should be required to provide information to the PCT with which they are contracted and would then be entitled to access to the information on the database, again through the relevant PCT. |
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27.146 |
The NHS has already made a start on the collection of information about individual doctors working in the hospital service through the use of NHS Occupational Health Smart Cards. I would have thought that this provision could usefully be extended to doctors working in primary care and that the categories of information that the cards contain might be extended to include those that I have mentioned above. |
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27.147 |
At the seminars, there was also discussion about whether unsubstantiated allegations should be included on the central database. Not surprisingly, opinions differed. The view was expressed that it would be grossly unfair to include such material. Others thought that, in the light of cases like that of Peter Green, where a number of unsubstantiated complaints had been received but not co-ordinated, it would be in the interests of patient safety if such information were to be included on the database. During the Inquiry hearings, there was discussion about evidence being given to the Independent Inquiry arising from the Soham Murders, chaired by Sir Michael Bichard. The gist of this discussion was that, if Humberside Police had retained information about unsubstantiated complaints against Ian Huntley and had passed them to Cambridgeshire Police when they made their pre-employment enquiries, Huntley would probably not have been employed at Soham Community College and Holly Wells and Jessica Chapman might not have died. Those contributors to the debate who had previously objected to the gathering of information about unsubstantiated complaints or concerns immediately realised that such material might be of great importance to patient protection. The view was that such material should not be entered into the central database, but that the entry should be flagged to indicate that confidential material was held by a named body. Disclosure of that information would have to depend upon who was asking about it and for what purpose, and questions of access would have to be determined at a high level. |
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27.148 |
Not only would such a central database make it far simpler for an employer or PCT to conduct pre-employment or pre-admission checks, the reliability of those checks would be greatly enhanced. The great majority of doctors would have nothing to fear; their entries would contain no more than their qualifications and their curriculum vitae. However, those doctors who cause problems, and who move on from place to place causing more problems, would very soon be identified. |
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27.149 |
The question arose as to who should keep this database. To be useful it should cover the whole of the UK and should include doctors who work in the NHS, in the private sector and in both. That being so, it seems to me that it would have to be funded by Government and a suitable host would have to be found. The Healthcare Commission would seem to be a suitable candidate. It might even fit in with the Commission’s own plans for information systems. |
Further Information to Be Provided to Primary Care Organisations
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27.150 |
In Chapter 5, I described the information that GPs now have to provide when seeking admission to a PCT list. This includes information about convictions, cautions, various types of disciplinary or FTP findings and ongoing proceedings. Doctors already on a PCT list are under an obligation to inform the PCT about any new relevant information. At the Inquiry, there was some discussion about whether other categories of information should be included, in particular information about clinical negligence claims. |
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27.151 |
The debate generated some heat. On the one hand, it was said that a clinical negligence claim was just another way of making a complaint or raising a concern and was of real importance for clinical governance purposes. On the other hand, it was said that many clinical negligence claims are brought which have no merit at all and that, therefore, they should not be reported to the PCT or recorded in any way. It was said that, in many cases, a letter before action was written and then the matter did not proceed further. It was also argued that some clinical negligence claims were settled for quite large sums even though there was no merit in them; this was done for commercial reasons, to avoid costs. My long experience of personal injury litigation teaches me that that is not so. Offers of settlement are often made, it is true, to buy off the risk that the action will succeed but not where it is judged that there is no risk. |
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27.152 |
In my view, civil actions are analogous to complaints and concerns. It would be illogical to retain records of complaints and concerns because their clinical governance importance is recognised, and to ignore clinical negligence claims. The fact that the allegations made in some such claims may have little merit seems to me to be unimportant. Some complaints have little merit but that is not a reason for disregarding them; the value of investigating them is recognised. If a record were to be kept of those clinical negligence claims which resulted in a finding of negligence (of which there are very few) and those which were settled for £5000 or above, I do not think any injustice would be done and the PCT would have useful and relevant information on its file. That information should also appear on the central database, if created. |
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27.153 |
I consider also that it would be appropriate for PCTs to be given notice when an action is brought. In my view, the trigger for notifying the PCT about a civil action should be the receipt (either by the doctor or by his/her medical defence organisation, or that organisation’s legal representatives) of a letter of claim which complies with the requirements of the pre-action protocol in the Civil Procedure Rules. Such letters are sent only where there is a serious intention to proceed. In my view, doctors should be under a duty to notify any PCT to whose list they have been admitted of the fact that such a letter of claim has been received and the gist of the allegation made. They should also be required to report the outcome. |
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27.154 |
As I have said, there is an ongoing requirement under the provisions of the National Health Service (Performers List) Regulations 2004 on doctors to make relevant declarations to their PCTs. In my view, failure to do so, and to do so accurately, should amount to misconduct of sufficient gravity to warrant referral to the GMC. |
Information Available to the Public and Patients
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27.155 |
During the Inquiry, there was discussion about how much information about doctors should be made available to the public and to the doctors’ patients. This was appropriate in the context of an Inquiry into the activities of a doctor who, 24 years before it was discovered that he was a murderer, had been convicted of a series of offences of dishonesty in connection with his dependence upon a controlled drug. It is entirely natural that the relatives of Shipman’s victims should say, ‘If only we had known.’ |
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27.156 |
The information available to patients and prospective patients about an individual GP is very limited under the present system. The public may become aware of a doctor’s criminal convictions or about disciplinary matters through press coverage. However, there is no means by which comprehensive information can be obtained. At the time of the Inquiry hearings, the GMC would, in answer to a specific enquiry, provide information to members of the public about current conditions on a doctor’s registration and on any previous disciplinary findings. However, that information was not - and still is not - available on the GMC website and will be provided only in response to specific enquiries by telephone. At the seminars, Dr Lewis, representing the GMC, said that the GMC did not at that time have an established strategy on disclosure but was in the process of developing such a strategy through public and professional consultation. That has now taken place and I shall describe the new GMC policy on disclosure later in this Chapter. |
The Principle of Disclosure
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27.157 |
Respondents to the Inquiry’s Consultation Paper were asked whether patients and prospective patients should be provided with more information about their GPs to enable them to make an informed choice in deciding whether to consult a doctor and whether to submit to treatment by him/her. Respondents were asked what information should be available including, as examples, previous criminal convictions, disciplinary findings and current or past restrictions on a doctor’s licence to practise. Respondents were also asked to comment on how the information should be provided to patients. |
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27.158 |
Respondents to the Consultation Paper and participants at the seminars were divided on the principle of whether more information should be provided to patients. One of the strongest advocates for complete openness was Sir Donald Irvine. He said that the issue was one of patient autonomy; patients are entitled to have access to information which is already in the public domain. Sir Donald said that he was aware of two cases in which patients had become aware of a doctor’s history after a problem had arisen; they had been angry that information had previously been withheld from them and that they had been denied the opportunity to make a decision in the knowledge of all the facts. The patients had been left with a feeling that there had been a ‘cover up’. A number of other seminar participants agreed with that view, including Professor Halligan, Deputy Chief Medical Officer for England and Director for Clinical Governance for the NHS. He said that the need to inform patients and to allow them to make up their own minds about how and from whom they receive treatment arose out of the privileged position of doctors and the trust that patients necessarily place in a doctor. |
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27.159 |
A large number of respondents to the Consultation Paper expressed the opposing view. Their argument was that it was for the GMC, a PCT or a doctor’s employer to decide whether a doctor was fit for practice and that patients should be able to rely on those bodies to fulfil their respective roles. There was (or should be) no need for patients to receive further information about their doctors. The BMA said in its written response to the Consultation Paper that patients should be reassured that minimum standards apply, which reduce as far as possible the chances of patients coming into contact with a GP who might cause them harm. In that context, it was said that the GMC and PCTs should be more robust in their approach to their respective roles of licensing and appointing doctors. Mr Michael Summers, Chairman of the Patients Association, agreed that the responsibility to ensure fitness to practise lay with the GMC and the PCTs. He thought that providing further information might cause patients to worry, which would be particularly damaging to those patients who live in parts of the country where it is not possible to change doctors. With due respect to Mr Summers, it seems to me that the issue is not only one of choosing a doctor. If the only GP to whom a female patient has access is a male one who has been convicted of indecent assault, she might wish to be accompanied when consulting him. |
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27.160 |
A number of respondents pointed to practical problems associated with the provision of information. Dr Grenville, who represented the BMA, said that the mere knowledge of an event would be insufficient to give the patient informed choice and that the patient would need to be able to ask and get satisfactory answers to questions about a doctor’s history. He said that, in practical terms, this would be very difficult to achieve. I see the force of that argument. Some respondents thought that providing some types of information would make it impossible for a GP to continue practising, because patients would be unwilling to be treated by that doctor. My reaction is that, if the doctor’s past record is so bad, perhaps the patients might be right and s/he ought not to be practising at all. |
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27.161 |
Professor Roland said that he had been involved in research into the impact of providing information to the public. The research was aimed specifically at providing information on quality of care. It had shown that publishing the information had made more of an impact on doctors and healthcare managers than on patients. Although he acknowledged that releasing details of, for example, a doctor’s criminal convictions might cause patients to refuse to be treated by that doctor, the research suggested that this would not be the case. Ms Freedland agreed, saying that she did not think that the provision of information to patients about a GP would necessarily lead to an exodus of patients. In its written response to the Consultation Paper, CHI said that it thought there was a need for further research on the impact of sharing such information with patients. |
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27.162 |
During the course of receiving evidence, the Inquiry was told about the case of a doctor who had been convicted of the manslaughter of a patient and, as a condition of his registration, was required to undergo a period of supervised practice. A suitable supervisor was found but he and other members of the practice decided that they could not keep their patients in ignorance of the situation. A letter was sent to patients setting out the doctor’s history, describing the remediation programme he was undergoing and explaining the precautions that were being taken to protect patients. The patients’ reaction was good; it appears that they were willing to consult the doctor. |
Categories of Information to which Patients Should Have Access
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27.163 |
There are several categories of information to which patients might wish to have access, including criminal convictions and ongoing criminal matters, a doctor’s GMC FTP history and ongoing FTP matters, action taken on the doctor’s inclusion on the PCT list and findings of clinical negligence. There was broad agreement that information about existing restrictions on a doctor’s licence to practise should be available. |
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27.164 |
A number of respondents to the Consultation Paper and participants at the seminars thought that the guiding principle should be that any information that has at any time been in the public domain should be available to patients. However, that principle is less easy to apply than it is to enunciate. Criminal convictions are in the public domain at the time they occur but the public soon forgets about them. After some years, they are deemed to be ‘spent’ under the provisions of the Rehabilitation of Offenders Act 1974 (the 1974 Act). The 1974 Act is designed to allow persons convicted of offences to put the past behind them. Such persons are not in general required to disclose spent offences when applying for jobs. There are, however, certain exceptions to this general rule, one of which extends to work concerned with the provision of health services. Doctors are required to declare any convictions they may have in response to questions from a prospective employer or PCO. |
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27.165 |
Of those respondents who thought that the public should have access to information about criminal convictions, some believed that access to such information should be available throughout a doctor’s career. Others felt that the information should be available only until the conviction was spent, as defined by the 1974 Act. One respondent thought that there was a need for flexibility about past events and that information about past events should be made available only if it was ‘too material/significant not to be shared with patients’. I can see the force of that but think that such a scheme would lead to uncertainty and endless argument. There was broad support among seminar participants for the proposition that matters that were under investigation should not form part of the information available to patients until findings of fact had been made. |
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27.166 |
There was some support among respondents to the Consultation Paper for the proposition that information about the outcome of successful clinical negligence claims against a doctor should be accessible to patients. Some findings of clinical negligence against doctors enter the public domain because civil courts generally sit in public and the findings of a judge in a clinical negligence action are publicly available. However, there was some opposition to this idea. It was said that the cases of clinical negligence that go into the public domain are a minority, and that disclosure of them would therefore be unrepresentative and misleading. It is quite usual for the worst cases of negligence to be settled privately with no public hearing. Also, a claim for damages might fail, not because the doctor was not negligent but because the negligence did not have the consequences alleged. Finally, it was said that negligence on the part of a doctor is often part of a more wide-ranging failure and the contribution of the doctor is difficult to determine. |
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27.167 |
Dr Reith suggested that it would be sensible to canvass the views of patients on the sort of information they thought they ought to have. |
Methods of Making Information Available
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27.168 |
A variety of different methods of providing information to patients was suggested in the written responses to the Consultation Paper and at the seminars. One respondent argued that the information should be provided proactively so that all patients received it, not only the few who had sufficient determination to seek it out. Another respondent took the opposite view and thought that the information should be provided only to patients who made a specific application for the information. Moreover, that respondent thought that the request for information would have to be justified; in other words, reasons should be given for making the request. |
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27.169 |
At the seminars, Dr Wilson said that it would be better if the information were provided to patients on a one-to-one basis by someone at the PCT or from the GP practice, rather than by way of a letter. It seems to me that that ideal would be difficult to meet. Dame Lesley Southgate said that doctors themselves should have the responsibility for providing information about restrictions on their practice. She suggested that one method would be for a joint letter to be agreed between the Chief Executive of the PCT and the doctor, setting out the information that should be disclosed as well as the steps that were being taken to ensure that patients were not put at risk, together with any other matters that might be appropriate in an individual case. Dame Lesley agreed that such a system would be more effective in the case of a GP working at one practice than, for example, in the case of a locum doctor or a doctor working for a deputising service. |
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27.170 |
Another possibility is for the relevant information to appear on a website, to which patients and members of the public generally would have access, as is provided in a number of overseas jurisdictions. |
International Perspective
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27.171 |
As part of his presentation to the Inquiry, Dr Rocco Gerace, Registrar, College of Physicians and Surgeons of Ontario, Toronto, spoke about the website which is operated by the College. Patients can obtain from the website details of a doctor’s referral to the College Disciplinary Committee together with any findings made by the Committee. The College is currently seeking legislative change in order to permit publication of undertakings provided by doctors in cases which do not come before the Disciplinary Committee. |
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27.172 |
Dr Gerace said that various categories of information are kept in the public domain for different periods. Findings of the Disciplinary Committee relating to sexual abuse on the part of a doctor, for example, would remain on the record throughout the doctor’s career. For lesser findings, there are fixed periods during which the information will be available, and, for certain categories of activity, the Registrar has a discretion as to how long the information should remain on the website. If a doctor were to go into the equivalent of the old GMC health procedures, then the fact that s/he was in the health procedures would not go on the website, but any restrictions on his/her practice would be published and would remain on the website while the restrictions were in force. I think the practice in Ontario might be worth copying. |
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27.173 |
Dr Perry Pugno, Director, Division of Medical Education, American Academy of Family Physicians, said that, in the USA, a number of resources providing information on a doctor’s fitness to practise were available to members of the public. The State Medical Boards run websites which provide details of disciplinary action against doctors, criminal convictions and other information, such as the status of a doctor’s licence to practise. In addition, a number of websites exist which are operated on a commercial basis and contain similar material. One example mentioned by Dr Pugno was ‘Choice Trust’, which covers the whole of the USA. The website is partially funded by advertising, and the basic service of establishing a doctor’s administrative details is free, but a charge is made for information about a doctor’s disciplinary history. Dr Pugno said that the information on the commercially run websites is not wholly accurate and, for example, in his own case, some of the practice addresses listed on ‘Choice Trust’ were incorrect and more than five years out of date. |
Information Currently Made Available by the General Medical Council
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27.174 |
At the present time, the only official provider of information about a doctor is the GMC. At the time of writing, only information which is on the medical register is available to the public, although, for reasons which I will shortly explain, that may well change in the near future. Of course, anyone who is prepared to use a search facility on the internet will be able to discover a great deal more. |
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27.175 |
There are two means of access to information held on the medical register. Some information appears on the GMC website. Alternatively, an enquirer can either telephone or email the GMC. I suppose it must also be possible to write. The website contains very limited information. If the doctor is currently registered and if there are no conditions attached to registration, his/her entry will appear on the website. The entry provides basic factual information, states whether the registration is full, limited or provisional and specifies any specialist register to which the doctor has been admitted. If there are any conditions attached to the doctor’s registration, the website will indicate that it is not possible to display an entry that matches the request but that this does not mean that the doctor is not registered. A telephone number is provided as well as an email address so that further enquiries may be made. |
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27.176 |
If the enquirer telephones the number provided and asks about the doctor’s registration, s/he will be told whether or not the doctor is registered and whether the registration is full, limited or provisional. Even if the doctor has conditions attached to his/her registration, the caller might well be told that the doctor is ‘fully registered’. That means only that the registration is not provisional or limited. If a lay caller had heard that his/her doctor was or might be subject to conditions and was telephoning to check whether that was so, the statement that the doctor was ‘fully registered’ might give a misleading impression, even though it would in fact be true. Only if the enquirer asks a specific question, such as whether the doctor has been suspended or whether s/he is subject to conditions, will the enquirer be told of any such matters. The GMC does not volunteer a full account of the doctor’s registration status; it waits for the enquirer to ask. Indeed, the person who answers the telephone is able to provide only the level of information that appears on the website. If the enquirer wishes to ask any further questions, s/he is passed to someone else, apparently in another department. The experience of a member of the Inquiry staff who made a registration enquiry (on my instructions) about a doctor whose registration was subject to conditions was that she was kept waiting and that it was necessary for her to be quite persistent in order to obtain the information requested. Indeed, it appeared doubtful that she would ever have been given the information at all if she had not been able to quote the doctor’s GMC number. Initially, when she gave the doctor’s (correct) name, she was told that no doctor of that name was registered. When she volunteered the doctor’s registration number, she was advised that the doctor was registered but his name was hyphenated on the GMC database. |
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27.177 |
It seems to me that this process is unhelpful to the public. All information about a doctor’s registration is in the public domain and it should be made readily available. For those who wish to access the website, the full information including any history of erasure, suspension, conditions and warnings should be shown. For those who prefer to telephone, the full information should be volunteered, without the enquirer having to ask specific questions. I had hoped that, by now, the GMC would have recognised that this should be done. When Professor Sir Graeme Catto, President of the GMC, gave evidence to the Inquiry in December 2003, he said that, in his view, for the GMC to decline to make available anything that is already in the public domain was a ‘weakish stance from which to start’. He accepted that it was not satisfactory that an enquirer had to ask the right questions before s/he would receive full information. However, at the end of October 2004, there had been no change in the amount of information available on the website and no change to the practice of requiring enquirers to ask specific questions before they would be told the full details in respect of the doctor’s registration. I hope that that change will be made very soon. |
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27.178 |
As I have said, conditions imposed upon a doctor’s registration are matters in the public domain. In the past, if conditions were imposed by the Health Committee, only the restrictions upon the doctor’s practice were recorded on the register and any conditions of a medical nature were not. That seems appropriate, as any conditions relating to the doctor’s health (such as a condition that s/he submit to medical supervision) should, I think, be treated as confidential, at least so far as the public is concerned. For the future, under the new FTP procedures, I envisage that any conditions on registration (other than those relating to medical matters) imposed by a FTP panel will appear in the doctor’s entry in the register. However, it seems to me that conditions and restrictions entered into voluntarily ought also to appear in the register. A statement of requirements or a set of voluntary undertakings agreed following a performance assessment is, in reality, every bit as much a ‘condition on registration’ as a set of conditions imposed by a FTP committee or panel. If the doctor will not agree to the undertakings, s/he will be referred to a FTP panel. The undertakings would be proposed in the first place only if the view had been taken that the doctor could not safely practise without restriction. Similarly, if the doctor voluntarily accepts a series of undertakings on account of his/her ill health, they are, in effect, conditions on registration. It is verging on sophistry to suggest that restrictions accepted voluntarily are not conditions on registration. I note that the report of the Performance Procedures Review Group suggested that restrictions agreed following a performance assessment should be treated as conditions on registration. In my view, it should be a condition of acceptance of voluntary undertakings that they are to be treated as the equivalent of conditions imposed. |
Imminent Changes to General Medical Council Practice
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27.179 |
When Sir Graeme Catto gave evidence to the Inquiry in December 2003, he said that the GMC intended to consult publicly in 2004 on questions of public disclosure. That consultation has now taken place and the results were considered at a meeting of the GMC in July 2004. Several new principles of disclosure were established. I do not think that these changes have yet been put into operation but I think that they must be imminent. |
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27.180 |
First, it was decided that, as a general principle, all information that has been in the public domain should be disclosed to any enquirer. That would include any aspect of the FTP procedures that has been in the public domain, even including the fact that a doctor has been charged with SPM but has been acquitted. Second, as a general principle, historical information that has not been placed in the public domain should be disclosed only in limited, defined circumstances, to the police, a coroner or ‘an official inquiry’. Third, it was agreed that information that has been in the public domain but is no longer of relevance to the doctor’s registration should be disclosed for as long as the doctor remains on the register. The transcript of the meeting shows that it was agreed that this type of information should be disclosed to enquirers but that the answer should be accompanied by an explanation that the information is no longer of relevance to the doctor’s registration. |
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27.181 |
The fourth resolution was that any finding of SPM, whether or not that had been followed by the imposition of a sanction, should be disclosed to enquirers. This should continue for as long as the doctor remains on the register. The fifth decision concerned information relating to the findings of fact that had been made against the doctor but had not resulted in a finding of SPM. After some discussion, it was agreed that such information would be provided to enquirers but that it must be set in context so that it would not reflect unfairly on the doctor. It was pointed out that this would be easy in respect of recent and future findings because reasons are now given, whereas, in the past, they were not and it would be difficult to put the information into context. Sixth, it was agreed that, where there had been findings of ‘not guilty’ and no findings ‘in relation to the allegation’, the information would be disclosed to enquirers but, again, it would be put in context. |
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27.182 |
Seventh, it was agreed that, if a warning were to be issued in the future under the new FTP procedures, it should be disclosed to a prospective employer at any time during the following five years. The Council decided to postpone its decision about whether warnings should remain on the doctor’s record indefinitely for some purposes, including enquiries from potential employers. Finally, the Council decided that, during the first five-year period after the issue of a warning, it should be disclosed to any enquirer, not only to prospective employers. |
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27.183 |
It appears therefore that, in future, the GMC will give full replies to questions about a doctor’s past FTP history. However, it appears that the Council did not question the present practice of giving only the amount of information expressly requested. Mr Finlay Scott, Chief Executive and Registrar of the GMC, told the meeting that the GMC received about 1000 registration enquiries each day but that 999 of them went no further than finding out whether the doctor was currently registered. It does not appear to have occurred to the Council that this suggests that many prospective employers (or PCOs) are not finding out whether the doctor whose application they are considering has a FTP history, or even whether s/he is subject to current conditions. I find this very worrying. Evidence received by the Inquiry suggests that pre-employment checks are made by clerical staff. It would be quite possible to give such staff a list of questions that must be asked, but it appears from Mr Scott’s advice to the Council that this is not being done. It seems to me that there ought to be much more information on the website and that, in the interests of clinical governance, much more information should be volunteered to telephone enquirers whether or not they ask the right questions. |
Recommended Framework for General Medical Council Disclosure
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27.184 |
I recommend that the GMC should adopt a policy of tiered disclosure. It may already have such a policy; if so, my recommendation is that it should be modified in the following way. |
The First Tier
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27.185 |
The first tier of disclosure should relate to information which is relevant to the doctor’s current registration status together with certain limited information about his/her past FTP history. First-tier information should be posted on the GMC website and should also be volunteered to anyone who requests registration information, regardless of the questions asked. |
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27.186 |
The information to be disclosed in respect of the doctor’s current registration status should include not only those conditions imposed by a FTP panel but also those voluntarily accepted by the doctor, save those that relate to the doctor’s medical condition or supervision. It should also include the existence of any interim orders in effect. When the provisions for revalidation come into force in 2005, information about a doctor’s registration status should include the year in which the doctor is due to be revalidated and, when s/he has been revalidated, the term for which the revalidation will be effective. Thus, it should be possible to see from the register whether the doctor has been revalidated in the year in which revalidation was due. |
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27.187 |
The preparation of a list of additional items of information that should be disclosed at the first tier will require public consultation. I shall not attempt to provide a definitive list. However, in my view there are some essentials, which I shall enumerate. |
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27.188 |
If a doctor has been erased from the medical register and restored, those facts and the circumstances behind them must be included. If the erasure was voluntary, that can be stated. If it was ordered by a FTP panel, that must appear, together with the underlying reason, in summary form. For example, the doctor was erased following his/her conviction for an offence of manslaughter at the XXX Crown Court. The date of erasure should be given. The date of the restoration should be given. In a case of erasure following a finding of SPM, the nature of the misconduct should be explained, for example, ‘irresponsible prescribing of controlled drugs’ or ‘indecency with patients’. In my view, such information should be available for as long as the doctor remains on the register. |
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27.189 |
The fact that a doctor has been erased from the register and the reasons for it should be accessible to the public at the first-tier level for a limited period after erasure even if the doctor has not applied and may never apply for restoration. Now that the minimum period that must elapse before an application for restoration can be made is five years, I would suggest that such information should be available for seven years after erasure. |
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27.190 |
The fact that a doctor has been suspended from the register should be disclosed at the first tier, not only during the period of suspension, but for a period afterwards. I would suggest that a period of, say, seven years might be appropriate. The fact that conditions have been imposed should also be disclosed. The period of time for which these should remain on the register ought, in my view, to depend upon whether the condition related to some requirement for retraining (in which case a fairly short period would suffice) or whether it entailed some restriction on the circumstances in which the doctor was permitted to practise, in which case a longer period would be appropriate. |
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27.191 |
The fact that a warning has been given should be disclosed at the first tier. I would suggest that an appropriate period for disclosure would be five years. A brief explanation for the reason should be given: for example, a warning was given after an assessment of performance, or a warning was given following the receipt of a report of a conviction for stealing goods to the value of £20 from a shop. |
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27.192 |
Past convictions should, in my view, be disclosed at the first-tier regardless of the sanction, if any, imposed by the GMC. The period for which this information should stay at first-tier level should, I suggest, follow the periods laid down in the Rehabilitation of Offenders Act 1974. |
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27.193 |
In respect of any past FTP history or convictions, when the period of first tier disclosure has expired, a note should appear on the doctor’s website entry to the effect that there is further information about the doctor which can be obtained (in effect at the second tier) by telephoning the GMC number. Any person seeking first-tier disclosure by telephone should be told if there is any further information which may be disclosed at the second tier. |
The Second Tier
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27.194 |
Disclosure at the second tier should be to people who make a specific request for information about a doctor’s past FTP history. They should not be asked to identify themselves; nor should they be required to justify their request. The information should be imparted without more ado to anyone seeking either further or full information about the doctor’s FTP history. I do hope that the GMC will instruct its staff to be forthcoming with information rather than waiting for specific questions to be asked. This must not be a game of ‘Twenty Questions’. |
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27.195 |
At its meeting in July 2004, the GMC accepted as a general principle that it must provide all information about a doctor that has at any time been in the public domain. It has not yet decided what to do about warnings after the expiry of five years. I think that the GMC’s decisions were sensible. I quite understand the concerns of Council members that some items of past information should, for reasons of fairness, be put into context. This applies particularly to cases in which the doctor has been found not guilty of an allegation of misconduct but the fact that s/he was charged is in the public domain. It seems to me obvious that information that has been in the public domain should be provided by the GMC for as long as the doctor remains on the register. |
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27.196 |
The effect of the second tier would be that any person who was contemplating joining the list of a particular GP or who knew that s/he was about to be referred to a particular consultant would be able to find out what s/he needed to know to make an informed choice, at least so far as any history with the GMC was concerned. For example, if this system had been in operation when Shipman was in practice, anybody thinking of joining his list who had looked him up on the website would have seen that his current registration status was full and unrestricted and that he had no recent disciplinary history. However, they would have been alerted to the fact that there was something more to be known about him and would, by telephoning the GMC, have been able to find out about his convictions in 1976. I think that this arrangement provides a reasonable balance between the interests of the doctor in being able to put the past behind him/her (which would be difficult if full information remained on the website indefinitely) and the right of the public and patients to find out, if they are prepared to make a telephone call, everything that has at one time been in the public domain. |
The Third Tier
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27.197 |
The GMC has identified a number of types of information that should be disclosed only to a limited class of persons who have a need to know about it in the public interest. These classes of information must, I think, be matters that have never been in the public domain. I think that this approach is entirely reasonable. I would call disclosure of this confidential information to a limited class of persons third-tier disclosure. If my recommendations for a central database were accepted, it would be appropriate for the GMC to ‘flag’ the names of doctors about whom confidential information was held. |
Information That Ought to Be Given to Patients of a Practice
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27.198 |
So far, I have discussed only information that should be made available to any member of the public who wishes to obtain it. However, there are some situations in which, in my view, a positive duty to impart information arises. I mentioned above the action taken by a GP practice which had taken on, for supervision and remediation, a doctor previously convicted of manslaughter. The action taken was, in my view, exemplary. The circumstances were rather unusual and it might be said that it would obviously have been wrong to allow the doctor into the practice without informing the patients. However, in my view, the good practice adopted in that case should apply to all cases in which a doctor is subject to conditions on his/her practice. It should also, I think, apply when a doctor has resumed practice following a period of suspension or erasure. In my view, the practice should send a letter of explanation to all patients. The draft should be approved by the PCT. Patients should have the opportunity to refuse to be treated by a doctor who is subject to conditions or has previously been suspended or erased. However, the experience of the practice to which I have referred suggests that they will not necessarily do so. |
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27.199 |
It is not part of my remit to make recommendations in respect of doctors working in hospitals. However, having read of the circumstances that arose in the case of Sadler v General Medical Council, to which I referred in Chapter 24, I will permit myself to observe that any patient who is to be operated on by a doctor who is subject to conditions should, in my view, be told about them and should be told what arrangements are proposed for the supervision of the operation. This information should not be imparted at a late stage when the patient is asked to sign the consent form. It should be given at a time when the patient can, without throwing all his/her personal arrangements into chaos, exercise a choice not to consent to that doctor carrying out the operation. |
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Proposals for Change Affecting NHS Arrangements for Primary Care
