Dan Kremer: Time limits on published sanctions are needed but we must tailor them to doctors’ circumstances

dan_kremerWe are pleased that the General Medical Council (GMC) has changed its policy on how long it publishes sanctions imposed on doctors, but do not believe it sufficiently considers individual doctors’ circumstances.

Currently all sanctions on a doctor’s registration, imposed by either a fitness to practise panel or an interim orders panel, remain on the medical register indefinitely, even after the sanction no longer applies.

However, following the GMC’s consultation around the information published and disclosed about a doctor’s fitness to practise (FTP), changes will be introduced in 2017. [1] The aim is to strike the right balance between transparency and proportionality, and reflect human rights and data protection law, while ensuring public protection.

The changes include a time limit on information published about doctors regarding sanctions placed on their practice. For those who have had conditions on their registration, or a suspension of up to three months, it is a limit of ten years and for those who have been suspended for more than three months, a limit of 15 years.

Although Medical Protection supports a number of the proposed changes, it is disappointing to see that the GMC is not making a distinction between the nature of an undertaking/sanction, and the time limits given, something we recommended in our response to the consultation. Nor have they fully addressed the need for a proportional balance between transparency and openness in the public interest and being fair to individual doctors, which we look at in further detail below.

• Under the proposed changes the GMC does not clearly differentiate between restrictions imposed after an FTP hearing where there have been findings of fact made, and other restrictions where there have been no findings of fact, such as mutually agreed undertakings or interim orders. For example, a doctor who has been suspended whilst being investigated, and then found to have the allegations unproven at an FTP hearing would still have this information publically listed for 15 years. In those circumstances it would be entirely wrong for the interim suspension to be published for 15 years, while the exoneration would not be. This requires proper consideration and clarification. *

• The GMC currently makes no distinction between two scenarios. The first; a newly qualified doctor who is found to require some clinical remediation, and is given undertakings which they have entirely satisfied, will have this information on public record for ten years. The second; a more senior doctor who, with a much more serious issue, is subject to prolonged conditions or undertakings of a more onerous nature, will have the same time limit given. Ten years will have a significantly bigger impact on a junior doctor at the start of their career in comparison to a senior clinician with the same infringement towards the end of theirs. We believe the impact this could have on the junior doctor is disproportionate to the public interest. The time limits placed on a junior doctor in this case, may have an excessively adverse impact on the doctor’s career, when compared to their more senior colleague.

• Niall Dickson, Chief Executive of the General Medical Council, said: “Patients have a right to know if there have been any serious concerns about a doctor…” Whilst patients have a right to know that practising doctors are safe, and that the regulator is doing its job, we do not believe a patient needs to know about minor infringements remediated 15 years ago.

The GMC consultation stated that it will continue to use its discretionary powers on a case-by-case basis, in line with their legislative framework. We believe there should be scope for discretion according to the severity and seriousness of the matter. A junior doctor involved in a relatively minor matter and subject to a short period of condition or undertakings, and who has entirely satisfied these on review, could have a publication time limit of 10 to 15 years if the guidelines are applied without careful thought.

More consideration needs to be given to individual doctors’ circumstances. We are keen to share our extensive knowledge and expertise in this area with the GMC to assist in working towards a policy which is transparent and fair.

1. The GMC consulted on its publication and disclosure policies which, under the Medical Act, allow the GMC to:

• Publish decisions made about a doctor by a fitness to practise panel
• Withhold information about a person’s health where it is considered to be confidential
• Publish or disclose information about a doctor to any person where it is considered to be in the public interest

The consultation covered information published about fitness to practise decisions on the GMC’s website and on the decisions page of the Medical Practitioners Tribunal Service (MPTS).The consultation took place between 1 July 2015 and 23 September 2015.

*Note added on 14 June 2016: The GMC has clarified that where an interim order has been placed on a doctor’s registration but their case is subsequently closed without any finding of impairment or warning, the information about the interim order is removed from the doctor’s online record [Publication and disclosure policy, para 8]. We are pleased that this is the case. The GMC understood that their List of publication time limits may have been unclear and will edit it to clarify it relates to substantive sanctions only.

Daniel Kremer is a medicolegal adviser at Medical Protection and previously practised as a general practitioner.