May 2, 2019

Single clinical incidents: no longer a concern for the GMC?

The GMC have announced procedural changes in a bid to reduce the number of investigations into single clinical incidents. After a two-year pilot study, the GMC are implementing changes to their processes to lower the number of full investigations into one-off mistakes. Will this change have any tangible benefit for patients or doctors?

The GMC's pilot study saw 202 single clinical incident cases closed without further action from a sample of 309. The changes are designed to fast-track the investigation and ingathering of records and reports following a complaint or referral. An assessment is made as to whether a full investigation is required. If not, the case is closed.

At first sight the changes seem little more than fast-tracking processes that would take place in any event. However there seems to be a real desire by the GMC to expedite (and close where possible) investigations in cases of one-off mistakes.

Single clinical incidents involve one patient and one treatment. It has been held by the High Court that negligence does not constitute misconduct and that a single negligent act is less likely to cross the threshold for a finding of professional misconduct to be made (Calhaem v GMC [2007] EWHC 2601). It is therefore understandable why the GMC are keen to prevent wasted time, effort and worry on cases which do not reach the requisite threshold.

The fitness to practise process is focused on a doctor's fitness to practise at the present date and time. It is forward-looking and considers whether there are any ongoing risks to patients or the public. All professionals are fallible and make mistakes. Where they are a one-off and the doctor has made appropriate reflections and changes, there is little prospect of showing continuing concerns over their fitness to practise.

This is not to say that all single clinical incident cases will be closed or do not amount to misconduct. There will remain cases that are of a serious enough nature that patient safety and public confidence require a full investigation.  It must also be highlighted that, under the current regulations, the GMC are legally obligated to investigate any allegation that a doctor's fitness to practise is impaired. Until there is a revamp of the legislative framework, the change represents a half-way house.

The public can remain assured that all complaints are considered and, where appropriate, sent for further investigations. Doctors can take comfort in the fact that, if they are subject to a complaint relating to a single clinical incident, they are more likely to have the matter dealt with quickly. In what is undoubtedly a stressful process for registrants, it is positive to see a regulator implementing procedural changes to speed up their own processes.