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Report on doctors facing GMC action published

General Medical Council (GMC) decisions about doctors who qualify outside the UK are more likely to have far reaching consequences (high impact decisions), finds research led by King’s College London, published in the British Medical Journal today.

The authors, Charlotte Humphrey, Professor of Health Care Evaluation from the Florence Nightingale School of Nursing & Midwifery, and Martin C Gulliford, Professor of Public Health, from the Department of Primary Care and Public Health Sciences, from King’s, say there is no clear answer why overseas doctors do worse in GMC fitness to practise processes than their UK-trained peers.  

Humphrey and Gulliford argue that perhaps 'real differences exist in fitness to practise between groups of doctors who are referred to the GMC' or 'that the GMC processes tend to discriminate against certain groups of doctors.'    

However, the authors stress that their research makes it 'difficult to reach a conclusion that clearly supports either of these potential explanations and both might be valid.'

The researchers reviewed the background to 7,526 inquiries to the GMC concerning 6,954 doctors. They assessed how many inquiries were referred for further investigation, how many were investigated and then referred for adjudication, and the number that resulted in doctors being erased or suspended from the medical register.

The results show that among the 7,526 inquiries, 4,702 were related to doctors who had qualified in the UK, 624 in the European Union (EU) and 2,190 who had qualified outside the EU. At the initial GMC stage (triage) 29% of enquiries concerning UK qualified doctors had a high impact decision compared with 43% for EU doctors and 46% for non-EU doctors.

At the adjudication stage 1% of UK qualified doctors were erased or suspended from the medical register compared to 4% of EU doctors and 3% of non-EU doctors.

The authors conclude that their research raises questions about the GMC fitness to practise processes. They speculate that perhaps inquiries involving UK-qualified doctors are being assessed less seriously than those involving non-UK qualified doctors.  

Humphrey and Gulliford also question whether some non-UK qualified doctors may not be well placed to defend themselves or challenge decisions compared to their UK-trained colleagues.

In an accompanying editorial, Marcella Nunez-Smith, Assistant Professor at Yale University School of Medicine, says that given the rise in the dependence on foreign-trained doctors in countries like the UK and US, it essential to determine 'whether international medical graduates offer the same quality of care as doctors who train and practise in destination countries.'

Nunez-Smith argues that the research by Humphrey and Gulliford is a critical contribution to the debate but that 'additional research on the association between other doctor related characteristics, such as ethnicity, and the fitness to practise process is needed.'

Niall Dickson, Chief Executive of the General Medical Council, in response to the study said: 'Patients all over the UK rely on doctors who qualified overseas – they make an invaluable contribution to healthcare in this country, and we need to know if there are factors that either lead to the poor performance of a small minority or if there is any unfairness in how they are treated.

'This study, commissioned by the GMC, throws a little more light on a complex issue. It reveals more about what is happening, although we also need to understand better why it is happening.'

To view the full paper, place of medical qualification and outcomes of UK General Medical Council 'fitness to practise' process: cohort study, click here:

http://www.bmj.com/content/342/bmj.d1817

To view editorial, Migration of doctors and the 'fitness to practise' process, click here:

http://www.bmj.com/cgi/doi/10.1136/bmj.d1641

Notes to editors

Florence Nightingale School of Nursing & Midwifery – celebrating 150 years

The Florence Nightingale School of Nursing & Midwifery at King’s College London is the world’s first professional School of nursing established by Florence Nightingale in 1860 and in 2010 celebrated its 150th anniversary. Visit our commemorative anniversary website:

www.kcl.ac.uk/schools/nursing/anniversary/

The number one Nursing and Midwifery School in London and highly regarded by leading London NHS Trusts with links to industry, health services and policy makers, the School develops leading-edge nurses and midwives of tomorrow – practitioners, partners, and leaders in their field.

The School has over 1,000 full-time students training to be nurses and midwives plus an extensive portfolio of undergraduate and postgraduate activities to meet the needs of a wide range of healthcare professionals seeking continuing professional development.  The School is at the forefront of health services, policy and evaluation research and home to the influential National Nursing Research Unit (NNRU). For further information visit

www.kcl.ac.uk/schools/nursing/

King's College London

King's College London is one of the top 25 universities in the world (2010 QS international world rankings), The Sunday Times 'University of the Year 2010/11' and the fourth oldest in England. A research-led university based in the heart of London, King's has nearly 23,000 students (of whom nearly 9,000 are graduate students) from nearly 140 countries, and approximately 6,000 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.

King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly £450 million.

King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar. It is the largest centre for the education of healthcare professionals in Europe; no university has more Medical Research Council Centres.

King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org

For more information please contact Frances Dodd, Communications Officer at King's College London on  +44 020 7848 3062 or email: frances.dodd@kcl.ac.uk