Meaning To Do Something About It

It’s a matter of conjecture whether Stilton wants more complaints to the GMC. Last year, he was all for it. The GMC’s State of the Profession report for 2014, published on 8th October 2014, noted ‘regulators…are seeing a rise in complaints…much easier to raise a complaint. This is all to be welcomed…’. The ellipses cover many words but the meaning is unaltered. By 11th February 2015, only four months later, writing in BMJ Careers, he said ‘We do not “welcome” the huge increase in complaints’. It is not clear why “welcome” is in quotes but that aside the two positions seem rather at odds with each other. Perhaps they have the heating at GMC Towers set rather high, and Stilton is starting to overheat. Or maybe it’s complaint blowback, be careful what you ask for. Welcoming complaints, the GMC got more than it bargained for.

Three days ago, Dr No got an email, Subject: ‘Email from the GMC Chair’. Putting aside the Churchillian comedy of the vocative – should Dr No start any reply ‘O Chair’? – the unexpected arrival of what appeared to be a personal email from The Colonel (Afghan Division) had Dr No intrigued and alarmed in equal measure. God forbid he should be about to be offered a place on the GMC’c council! Perhaps it would be hostile, a warning shot to Dr No, maybe along ‘we know where you live’ lines. In the event, it turned out to be a Round Robin. The Colonel (OC, Resilience Training) wanted to introduce himself, and reassure us all that, while his aims were high, his feet were firmly on the ground. He outlined ambitious work programmes, but his feet stayed on the ground. We’re all in this together. There was even a bit about hard-working doctors who paid their GMC taxes, but he wanted to reassure us that he was no political puppet, no, he was the Colonel, and he too had been under fire. His fervent hope, he declared at the end, was that, when asked what does the GMC do for us, all doctors will chant in unison, with Orwellian convolution, ‘the GMC helps me keep my patients safe’. Dr No is still trying to work out what that means in the real world.

The very last bit is the rail the now rather desperate GMC clings to: it’s all about patient safety. It is patient safety that puts the lead in GMC pencils; but it is also the hot air that inflates its lead balloons. It’s all very well, meaning to do something about things, but there is now a lead elephant in the room, the rising toll of morbidity and mortality associated with GMC fitness to practise investigations. Being a doctor-patient under GMC investigation, far from being safer, is now more dangerous than ever. And that is without even taking in the wider chilling effect on intelligent practise caused not just by the threat of a complaint and investigation, but also by the heavy burden of GMC guidance imposed on doctors. Deposed from the sunny uplands, doctors now find themselves practising in cramped lead caissons, where the heavy roofs and walls press in, the air is foetid, and the will suffocated. This is a world of dystopian irony, a world where practise becomes so safe, so defensive, that it starts to become unsafe.

For a few weeks, after the GMC published at the end of last year mortality figures on deaths while under FtP investigation, there was a brief flurry of articles and a blizzard of comments. Stilton’s meaning to do something about it article in BMJ Careers – link above – appears to be the last. Since then, silence, and the world could be excused for not knowing the deaths ever happened. The Colonel’s email doesn’t even mention them; all we have is an aspiration to speed up FtP investigations. But while delays are bad, and actions – not aspirations – to speed investigations up are welcome, deaths are truly terrible. When a healthcare regulator fails to keep its own charges safe, what hope is there for patients?