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GMC investigators get training to include system issues in fitness to practise decisions

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4295 (Published 11 October 2018) Cite this as: BMJ 2018;363:k4295
  1. Clare Dyer
  1. The BMJ

General Medical Council (GMC) staff and clinical experts who investigate doctors’ fitness to practise will receive “human factors” training so that the context in which doctors have to work is taken into account when the regulator takes decisions.

The move follows the case of the junior doctor Hadiza Bawa-Garba, which sparked a widespread loss of confidence among doctors regarding the GMC. After she was convicted by a jury of gross negligence manslaughter in the death from sepsis of 6 year old Jack Adcock,1 a medical practitioners tribunal decided to suspend her from the medical register rather than strike her off.2

The tribunal had taken account of substantial system failures at Leicester Royal Infirmary, but the GMC appealed to the High Court, which ordered her to be struck off.3 The Court of Appeal later ruled that the court had got it wrong, and it reinstated the tribunal’s original decision.4

But the GMC’s decision to appeal against the tribunal’s ruling brought an outcry from doctors. The then secretary of state for health, Jeremy Hunt, said that he was “totally perplexed” by the decision, which he feared might set back attempts to end a culture of blame in the NHS. He later announced that the GMC would be stripped of its power to appeal against tribunal rulings.5

The decision to incorporate human factors into future investigations will be seen as a tacit acknowledgment by the GMC that it got it wrong in Bawa-Garba’s case. The regulator has teamed up with Oxford University’s Patient Safety Academy to provide the training, and it plans to introduce the same approach in local investigations of doctors’ conduct and performance before issues reach the GMC.

Peter McCulloch, co-director of the academy, said, “Integrating human factors into the fitness to practise process will involve both staff training and modification of procedures and documentation, to ensure that the knowledge acquired is embedded into the investigative process. Our aim in this work is to ensure that context and systems issues are always fully taken into account when evaluating a doctor’s performance, allowing doctors to have confidence in the fairness of GMC procedures.”

In announcing the move the GMC defined human factors as “a social science which studies and attempts to optimise the interactions of humans, technology and the environment at work.” It added, “It is a standard tool of safety investigation and improvement in several industries such as civil aviation, nuclear power and military planning which seek to balance high risk and high reliability.”

Charlie Massey, GMC chief executive, said, “This collaboration will make sure that human factors are hardwired into our investigations so that the role that systems and workplaces play in events is fully and evenly evaluated in assessing context following serious failings.

“That will guarantee consistency in how we investigate after things have gone wrong and give doctors the assurance that their actions will be seen clearly against the backdrop of any system failings.”

Caroline Fryar, head of advisory services at the Medical Defence Union, which represents doctors in GMC investigations, welcomed the decision. She said, “We are glad that the GMC is recognising and taking into account the fact that doctors are often put in a position where they are unable to control their environment and circumstances but must carry on and treat patients as best as they can.”

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