The number of complaints against doctors in the UK is on the rise, according to widespread media coverage. The Daily Telegraph has reported that complaints have reached a “record high”, while the Daily Mail says that GPs are “rude, dishonest and hard to understand”.
The headlines are based on a new report by the General Medical Council (GMC), the organisation that oversees, registers, and licenses doctors practicing medicine in the UK.
The three most commonly reported types of complaint were related to:
In total, the GMC received 8,781 complaints in 2011, of which 2,330 resulted in a full investigation (due to the severity of the allegation or the strength of the evidence).
However, the most serious sanction available to the GMC, removing a doctor’s licence to practice medicine (being ‘struck off’), was only used 65 times.
It is important to put these figures into context. It is estimated that there are over 100 million patient-doctor interactions each year in the NHS. So a ‘complaint-rate’ of less than 0.001% per interaction is something that most industries would kill for.
Also, as the GMC points out, the rise in complaints may not be due to worsening services, but could be the result of rising patient expectations and an increased willingness to complain.
Still, we can never afford to be complacent about patient safety and this report offers some useful suggestions about how it can be improved.
The report was produced by the General Medical Council (GMC) which registers and licenses doctors to practice medicine in the UK and has four main functions:
The report, called ‘The state of medical education and practice in the UK’ presents a profile of the medical profession in the UK, and is the second if its kind produced by the GMC .
Where possible the report compared data from this 2011 report with the 2010 report to highlight changes or trends. Four main areas were included in the report:
The report used data that the GMC routinely collects on registering doctors, quality assuring medical education and assessing doctors’ fitness to practice.
Registration data was obtained from three registers, although the report notes that this data has some limitations, including that the specialty recorded for a doctor is the specialty they qualified in, and may not reflect the doctor’s current area of practice. Some doctors often move from one related field into another as their training and experience progresses throughout their career.
For comparing differences in patterns of complaints at different points in doctors’ careers, fitness to practice data was used and this included complaints reported to the GMC between January 1 2007 and December 31 2011. It also included complaints that were considered concluded during this time. The report notes that characteristics of doctors such as age group and time since primary qualification were considered in isolation, with no adjustments made to account for the influences of other factors, which means that the results present broad observations, but do not draw conclusions about causality (for example, whether age or experience itself is an important cause of more complaints).
Various pieces of external evidence were also included in the report, including data on patient experience surveys and data from NHS written complaints, as well as data from international and European regulators and other UK health professional regulators.
The key findings from this report were:
It is worth noting that according to the report, the number of doctors falling seriously below the standards expected of them remains very small and that a rise in the number of complaints does not mean that medical standards are falling. As the report points out, ‘Several factors may have contributed to this increase (such as)… rising patient expectations and better informed patients who have access to a greater range of information (particularly online). Other factors such as greater equality in modern society have also influenced people’s relationships with professionals, including the patient-doctor relationship and what patients expect from it.’
In 2011, 65 doctors were permanently removed from the register (struck off), removing their right to practise medicine in the UK, this compares to 73 in 2010.
The GMC is introducing a series of measures to deal with the rise in complaints, including:
Out of the 8,781 complaints received by the GMC:
Almost 3 out of 4 complaints involved male doctors, although it is important to note that 57% of all registered doctors were men.
The three most complained about issues were:
Out of the 8,781 complaints, the GMC:
While the actual statistics provided in the report were reported accurately, there was some degree of ‘editorialising’ where various papers put forth their own theories to explain the rise in complaints.
For example, the Daily Mail implied that that foreign-trained doctors were more likely to be the subject of complaints, when this was not actually the case, as stated by the report (though in cases when foreign-trained doctors were the subject of complaints, there was a trend of the complaints being more serious).
The report identified four areas where there is a need for ‘further debate’ and action to address the identified barriers to good medical practice:
In discussing the report’s findings, GMC chief executive Niall Dickson said 'we are committed to enhancing patient safety and improving the quality of medical care across the UK. Critical to this is the new system of regular checks for all doctors – known as revalidation – which we plan to introduce from the end of this year. We also need to respond to the rising number of complaints about doctors – a pattern seen across healthcare. We are investing more in this area and we are rolling out a package of measures both to protect patients and provide greater support for doctors during the course of their careers.’