Place of medical qualification and outcomes of UK General Medical Council “fitness to practise” process: cohort studyBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1817 (Published 05 April 2011) Cite this as: BMJ 2011;342:d1817
- Charlotte Humphrey, professor of health care evaluation1,
- Shaista Hickman, research associate1,
- Martin C Gulliford, professor of public health2
- 1Florence Nightingale School of Nursing and Midwifery, King’s College London, London SE1 8WA, UK
- 2Department of Primary Care and Public Health Sciences, King’s College London, London SE1 3QD
- Correspondence to: C Humphrey
- Accepted 1 February 2011
Objectives To evaluate whether country of medical qualification is associated with “higher impact” decisions at different stages of the UK General Medical Council’s (GMC’s) “fitness to practise” process after allowing for other characteristics of doctors and inquiries.
Design Retrospective cohort study.
Setting Medical practice in the United Kingdom.
Participants 7526 inquiries to the GMC concerning 6954 doctors.
Main outcome measures Proportion of inquiries referred for further investigation at initial triage by the GMC, proportion of inquiries investigated that were subsequently referred for adjudication, and proportion of inquiries resulting in doctors being erased or suspended from the medical register; relative odds of higher impact decisions, by country of qualification, adjusted for doctors’ sex, years since primary medical qualification, medical specialty, source and type of inquiry, and nature of allegations.
Results Of 7526 inquiries, 4702 concerned doctors who qualified in the UK, 624 concerned doctors who qualified elsewhere in the European Union (EU), and 2190 concerned doctors who qualified outside the EU. At the initial triage, 30% (n=1398) of inquiries concerning doctors who qualified in the UK had a high impact decision, compared with 43% (267) for doctors who qualified elsewhere in the EU and 46% (998) for those who qualified outside the EU. The adjusted relative odds of an inquiry being referred for further investigation were 1.67 (95% confidence interval 1.28 to 2.17) for doctors who qualified elsewhere in the EU and 1.61 (1.38 to 1.88) for those who qualified outside the EU, compared with doctors who qualified in the UK. At the investigation stage, 5% (228) of inquiries received concerning UK qualified doctors were referred for adjudication, compared with 10% for EU (63) or non-EU (221) qualified doctors. The adjusted relative odds of referral for adjudication were 2.14 (1.46 to 3.16) for doctors who qualified elsewhere in the EU and 1.68 (1.31 to 2.16) for those who qualified outside the EU. At the adjudication stage, 1% (69) of inquiries received concerning UK qualified doctors led to erasure or suspension, compared with 4% (24) for doctors who qualified elsewhere in the EU and 3% (71) for non-EU qualified doctors. The adjusted relative odds of erasure or suspension were 2.16 (1.22 to 3.80) for doctors who qualified elsewhere in the EU and 1.48 (1.00 to 2.19) for those who qualified outside the EU.
Conclusions Inquiries to the GMC concerning doctors qualified outside the UK are more likely to be associated with higher impact decisions at each stage of the fitness to practice process. These associations were not explained by measured inquiry related and doctor related characteristics, but residual confounding cannot be excluded.
We thank Aneez Esmail, Debbie Cohen, James Nazroo, Celia Davies, and Celia Roberts for their valuable comments and feedback during oral presentations of the data. We are grateful to staff at the GMC who assisted our access to the fitness to practise data.
Contributors: CH and MCG were responsible for the conception and design of the study. SH and MCG did the statistical analysis of data. All authors had full access to all of the data and can take responsibility for its integrity and the accuracy of the analysis. CH, MCG, and SH drafted the manuscript and completed critical revisions. All authors approved the final manuscript. CH and MCG are the guarantors.
Funding: The study was funded by the Economic and Social Research Council (RES-153-25-0101) through the ESRC Public Services Programme Third Call. The ESRC was not involved in data collection, analysis, or interpretation or in writing this manuscript.
Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that they have no non-financial interests that may be relevant to the submitted work.
Ethical approval: Ethical approval for the study was granted by the King’s College London Research Ethics Committee on 31 July 2008.
Data sharing: No additional data available.
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