Complaints about doctors at 'record high'

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:

concerns with investigations and treatment, such as failure to diagnose or prescribing inappropriate medications
problems with communication – such as not providing appropriate information or not responding to people’s concerns
perceived lack of respect for the patient – such as being rude or dishonest

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.

Who produced the report?

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:

keeping an up-to-date register of qualified doctors in the UK – you are not legally entitled to practice medicine as a doctor in the UK if you are not registered with the GMC
fostering good medical practice
promoting high standards of medical education and training
dealing firmly, yet fairly, with doctors whose fitness to practice is in doubt

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:

changes in the medical profession in the last year, such as the number of doctors working part-time, or the number of registered doctors who received their training in another country
medical practice at different stages of a doctor’s career, including how types of complaints vary over a doctor’s professional life, and the importance of tailoring support for them
whether medical practices differed in different environments (for example, the difference between a busy inner-city hospital and a hospital that served a rural community) and whether these factors impacted on both the level and types of complaints received
possible methods that could be used to overcome barriers to good medical practice, including changes that may be required to ensure the profession can meet existing and future challenges and healthcare needs

What data is the report based on and how reliable is it?

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.

What were the key findings of the report?

The key findings from this report were:

the number of doctors on the register has grown, and for the first time women doctors on the register exceed 100,000
the number of complaints made to the GMC increased by 23% from 7,153 in 2010 to 8,781 in 2011 which the report notes appears to be part of a wider trend experienced internationally and in other health professions across the UK
the likelihood that the GMC will investigate a doctor has increased from 1 in 68 in 2010 to 1 in 64 in 2011
the GMC received more complaints about men, older doctors and GPs, which is consistent with the pattern of complaints in 2010
among the complaints, concerns about how doctors interacted with patients have increased most, with allegations tending to involve issues about doctors’ communication skills and how they interact with patients (allegations about communication increased by 69% and lack of respect rose by 45%)
there is evidence that patient outcomes are worse during the evenings and weekends, which are times when fewer senior doctors work
a small, but worryingly significant, minority of doctors developed health problems related to alcohol and /or substance abuse

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:

a helpline for doctors to raise issues they may have with the GMC in confidence
major reforms of the fitness to practice procedures
launching a new version of ‘Good Medical Practice’ guidance later this year

Who complained, and what did they complain about?

Out of the 8,781 complaints received by the GMC:

5,665 (64.5%) came from the general public
1,481 (16.85%) came from people working for public bodies, such as the police or the coroners’ service
1,635 (18.6%) came from what was described as the ‘other’ category – this included other doctors and healthcare professionals

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:

complaints relating to treatment and /or investigation (2,643 or 30.1%)
complaints about a lack of effective communication between doctor and patient (789 or 9%)
complaints about a lack of respect for patients (679 or 7.75%)

What action did the GMC take?

Out of the 8,781 complaints, the GMC:

closed down 4,914 complaints after an initial assessment as it was felt that they did not raise an issue about the doctor involved being fit to practice
carried out a preliminary enquiry into 1,537 complaints to check for wider concerns
carried out a full investigation in 2,330 complaints
temporarily suspended 93 doctors from the register
permanently removed 65 doctors from the register

How did the media report the story?

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).

What recommendations did the report make?

The report identified four areas where there is a need for ‘further debate’ and action to address the identified barriers to good medical practice:

the size and shape of the medical workforce – including an ongoing discussion about what is expected of doctors and what support is required for them
the rising tide of complaints – understanding what might lead to a complaint, what the complaint is about, and the environments from which complaints are made
tailored support for doctors across their career including supporting doctors who may have unhealthy levels of stress
gaining a better understanding of how organisational factors can affect 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.’