Fairness in fitness to practise: An update from the General Medical Council

Written by Andrew Hoyle, Assistant Director – Decisions

Doctors occupy a special and highly trusted position in our society. Our fitness to practise processes exist to maintain patient safety and the trust patients and the public hold in doctors. That trust is a cornerstone of medical practice, enabling doctors to care for patients with confidence and credibility.

When doctors trust the fitness to practise process, that supports their confidence and sense of security in the workplace – foundations that are essential for safe, effective patient care. But it’s not uncommon for early career doctors to feel the exact opposite, to be apprehensive about our processes, and even to be nervous about coming into contact with the GMC at all.

We’d like to change that. There’s much more to what we do at the GMC than fitness to practise, and if doctors are fearful of that specific regulatory function, they may be less inclined to engage with services that could benefit them – such as our Outreach team and our supportive resources.

We are keen to share as much information as possible about our fitness to practise processes in order to ‘de-mystify’ how we deal with complaints. If you would like to find out more, our YouTube channel is a good place to start.

Below, I’ve shared some information about recent changes we’ve made to ensure fairness in our regulatory processes.

Fairness in regulatory processes

We published a review into our regulatory processes – Reviewing how we approach fairness and bias – in 2022. It made recommendations for how we could improve our processes, and we implemented many of those recommendations in 2023.

We’ve made a number of changes to further embed fairness and ensure our decisions are free of bias. This year we’ve published a set of decision making principles, which was something the review asked for, and identified ‘high impact regulatory decisions’.  Of course, every decision we make matters, but we are aware that some have a greater impact than others. If they are mishandled, these could have a devastating impact on those involved, or they could negatively impact confidence in the regulatory system.

We are now working on detailed plans to ensure we are proactively applying best practice around these decisions, in line with our principles.

All of our high impact decision makers have  undertaken anti-bias training.

A fundamental principle of our approach is to accept and acknowledge that a degree of bias is inherent in human nature – there are many types of bias that everybody is susceptible to, consciously and unconsciously.  Individual decision makers know they must remain alert to the influence of bias, and never drop their guard or become complacent. We are committed to continuously reviewing the checks and balances we have in place to make sure our decisions remain fair, consistent, and worthy of the trust placed in us.

We want doctors to know that if a referral is made to us, our decision making processes are both rigorous and impartial and they have no reason to fear the process.

Fairer employer referrals

However, we also know that some groups of doctors – ethnic minority doctors and those who have qualified overseas – are more likely to be referred to the GMC by their employer than others.  We commissioned the Fair to Refer? report in 2019, and it revealed that at the time, both groups were at least twice as likely to be referred as their white, UK-trained peers.

Unlike bias in our own processes, employer referrals aren’t directly within our control, as the law says we must consider every concern about a doctor we receive. However, we believe we can positively influence them, and we’ve been determined to identify areas of improvement and implement changes where they are within our power.

In 2021, we set ourselves the target of eliminating disproportionate employer referral by 2026. We established the Fairer Employer Referrals programme, which people from all across the GMC are involved in. We have tightened the referral processes and paperwork that responsible officers (ROs) use to add more safeguards at the point of referral, we are providing training for RO networks, and we’re working with ROs and employers to help them build more inclusive, supportive workplaces.

We’ve now completed the first three phases of the work. Since the programme began, we’ve seen year on year improvements in the data, and believe we are on track to meet the elimination target next year. 

It’s important that everyone who comes into contact with regulatory processes is treated fairly. That principle should also apply to how doctors are treated by ROs, and by their employers, who have the power to shape a culture grounded in fairness. That foundation of fairness supports doctors and is also critical for the delivery of safe patient care.

How to find out more

If you feel like you’d like to read more about the fitness to practise process, including the support we provide to doctors going through the process, you can find that here.

There are also a couple of things to look out for from us.

Later this year we will publish our fitness to practise statistics. These provide helpful context – they show how many concerns we received in the previous year, where they have come from, and many we went on to investigate, and how many sanctions resulted. They provide transparency about what happens at each stage of our processes. The report will show that we are closing more concerns earlier, and fewer investigations are ending without action. That shows that we are only progressing cases where there is a risk to patient safety and where we can act. The report will also document outcomes by protected characteristic, data that we are analysing to understand any patterns and what may be driving them.​ We will share news of the publication in GMC news – so keep an eye on your inbox.

Also, later this year, we will publish our annual report on our progress against our ED&I targets, including disproportionate employer referral. Again, we’ll let you know via GMC news when this is available.

Fitness to practise is ultimately about protecting patients and upholding trust. It’s not something doctors should fear, but rather see as part of a shared commitment to safe, ethical practice. When concerns are raised, our focus is on handling them fairly, proportionately and with care, so that patients are protected, and doctors can have confidence in the process and continue to provide safe, effective care.