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GMC will consider ‘sustained fatigue’ in FTP decisions

by Caitlin Tilley
19 January 2022

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The GMC will take into account ‘sustained fatigue’ experienced by GPs during the pandemic when assessing fitness-to-practise complaints.

The GMC has updated its temporary pandemic guidance to include fatigue, as well as workforce shortages and instances where patients may have delayed seeking medical care due to the pandemic, among factors that should be considered mitigating.

The GMC told Pulse the new guidance stresses ‘the importance of considering concerns fairly and proportionately to the circumstances, while protecting patient safety and maintaining standards’.

Updated pandemic guidance says: ‘Where there has been a substantial resurgence of Covid cases over time due to new variants, these have created exceptional pressures for healthcare professionals.’

It said that these pressures ‘have resulted in a combined and enhanced level of the impacts outlined in this guidance including but not limited to’ things such as ongoing tiredness and the need to do other clinical work.

The updated document said the GMC may have allegations which seem to suggest a GP may be unfit to practise, but ‘we receive further information or clarification that suggest that the circumstances which have arisen as a result of the sustained nature of the pandemic indicate the allegation does not’. 

The GMC said examples of these allegations include:

  • A GP’s action put patients at risk when clear guidance about aspects of treatment were ‘unavailable, not easily accessible, or there were conflicting guidelines’;
  • A GP’s actions caused harm or risk of harm to a patients but the GP had to work ‘outside their usual area of practice with limited or no support to do so safely’;
  • A GP did not ‘escalate an issue or failed to respond to an escalating situation’ in the pandemic when doing so was not ‘reasonable’ given the circumstances;
  • A GP chose to deny access to treatment but this was ‘reasonable’ in the context of Covid;
  • A GP did not take ‘reasonable steps in planning for a change in a patient’s capacity to make decisions about their care’ but the GP’s behaviour was ‘appropriate in the circumstances’;
  • A GP did not care for a patient because of a lack of PPE, when the doctor was at ‘higher risk of infection and had raised concerns with their employer or tried to make alternative arrangements for the patient where treatment services were available’;
  • A GP did not wear available PPE when consulting with a patient but this was ‘reasonable in the circumstances’. For instance, if care was urgent and necessary, they were the only one available to provide care, they did not know PPE was accessible.

When allegations such as these are raised about a doctor’s fitness to practise, the effects of fatigue will need to be taken into account, it said.

GMC chief executive Charlie Massey said: ‘Our health services continue to face extreme pressures as we enter a new year and we’re doing all we can to support doctors and the health system during the pandemic.

‘One of the changes we’ve recently made is to update the guidance our decision makers use when they are assessing individual fitness to practise cases.

‘This means the prolonged nature of the pandemic is taken into account and decisions are fair and proportionate to the circumstances.’

The GMC had previously said it would consider ‘unpredictable’ Covid ‘circumstances’ in complaints against GPs.

It comes as the MDU unveiled a survey this week, which showed that one in four doctors (26%) said tiredness had affected their ability to safely care for patients.

Head of advisory services at the indemnity provider, Dr Caroline Fryar, said: ‘It is very welcome news that today the GMC has updated its guidance for decision makers recognising the challenging circumstances in which doctors are currently working and the extreme fatigue they are experiencing due to sustained nature of the pandemic.

‘As memories inevitably begin to fade of the pressures healthcare professionals are under, those holding the profession to account – regulators like the GMC, the courts and indeed employers – must properly take the Covid-19 context into account.’

MDDUS chief medical officer Dr John Holden said: ‘It is clear the unique experiences of the last two years have been taken into account, with this revision including more specific guidance regarding the type of issue that GMC decision makers should take into account.

‘It is especially important that this includes the access and availability of personal protective equipment (PPE) and staff shortages due to Covid-19 infection or self-isolation requirements.’

He went on to warn that ‘many years may pass following an incident that may subsequently be reported to the GMC’, adding that the revised guidance ‘will help ensure that an investigation is conducted with an awareness of all the prevailing circumstances at the time of the event’.

MPS medical director Dr Rob Hendry said: ‘GPs remain under severe pressure and continue to face difficult decisions on how limited resources are allocated, which may increase the prospect of a poor outcome for some patients and leave doctors vulnerable to medicolegal disputes relating to situations out of their control.’

He added: ‘We will continue to monitor this closely to see how the guidance is being implemented.’

Pandemic pressures that GMC will consider in fitness-to-practise decisions

  • Sustained fatigue  
  • Ongoing requirements to work outside normal areas of practice  
  • Availability of resources, including absences and workforce shortages in wider healthcare teams and managing prolonged or more pronounced rota gaps  
  • Nature of presenting conditions where patients have had delayed care due to the cumulative impact on elective treatment and the potential for non-covid related illnesses to present very late. For example patients whose routine surgery was postponed as a result of the pandemic, sometimes repeatedly and whose conditions deteriorated and became urgent. 

This story first appeared on our sister title, Pulse.