Background
Dr C is an experienced GP of over 23 years’ experience. She is a GP Partner at a GP practice in a small community in England (“the Practice”).
The Practice is well known within the local community, not just for the quality of clinical care provided, but also for the friendly and caring team who provide that care.
Community is very important to Dr C and, over the years, she has made concerted efforts to ‘give back’ to the community as much as possible through holding educational events at the Practice, raising funds for local charities and sponsoring opportunities for young people.
Patient Complaint and GMC Referral
Until 2024, Dr C had an unblemished career and had never been the subject of a GMC referral. Despite Dr C’s good work and close community ties, quite out of the blue she found herself the subject of a serious patient complaint. The concerns were raised by a long-standing patient of the practice (Patient Z), who alleged that she had received poor treatment from Dr C at a consultation in March 2024. Patient Z said that she had been prescribed medication that was not clinically indicated, that Dr C had not listened to her and that she had been rude and dismissive.
Dr C’s Practice Manager initially responded to Patient Z’s complaint with an apology on behalf of Dr C. However, Patient Z was unhappy with this and so decided to report Dr C to the GMC.
In due course, the GMC contacted Dr C to notify her of the complaint that had been made and to advise that a ‘provisional enquiry’ had been commenced.
The provisional enquiry process is used by the GMC as an initial, limited stage in the fitness to practise process, which helps the GMC to decide if a full investigation is necessary, or if the case can be closed with no further action. As part of the provisional enquiry process, the GMC asked Dr C to provide a copy of Patient Z’s relevant medical records.
Unfortunately for Dr C, the record of her consultation with Patient Z was brief, lacking in detail and incomplete. The record was littered with typos and included Dr C’s own personal shorthand and acronyms, which meant that large parts of the record was undecipherable to third parties.
Having not been reassured by the patient record that had been disclosed by Dr C, the GMC decided to progress the complaint to its ‘Rule 4’ stage.
Rule 4 stage of a GMC case is the stage where the GMC will send the doctor an initial letter which outlines the complaint or concerns raised. The doctor will then have an opportunity to respond with their comments on the complaint.
Upon reading the patient’s complaint, Dr C felt that the concerns could be easily addressed, especially as the Practice Manager had provided a detailed response to the complaint the first time around. Dr C therefore decided she did not need to contact her medical defence organisation and, instead, wrote to the GMC herself to tell them that Patient Z was a long-standing patient of the Practice, that Patent Z had been given excellent care, and that she would smooth things over with her the next time she came into the Practice, in keeping with her usual friendly and informal approach.
In light of Dr C’s limited response, and noting Patient Z’s allegation about being prescribed incorrect medication, the GMC progressed the case to the next stage of its process – full investigation and formal allegations known as Rule 7 allegations.
In due course, an email from the GMC informed Dr C that the case was progressing to Rule 7 stage and that a number of allegations required a response within 28 days. To her horror, Dr C saw that, in addition to the concerns raised by Patient Z, the GMC had included an allegation that she had failed to maintain an adequate standard of record keeping in relation to her consultation with Patient Z.
Dr C was extremely distressed to learn that the GMC had progressed her case to Rule 7 stage and realised that, before she did anything else, she needed proper support from her medical defence organisation. Within a short time of speaking to Dr C, Medical Defense Society arranged legal representation and Dr C immediately felt reassured.
Assisting Dr C
As soon as we were instructed to assist Dr C, we contacted her and arranged a face to face meeting the next day, so that we could discuss the case with her and provide a detailed explanation of the GMC process and what would happen next. We reassured Dr C and gave her the opportunity to ask any questions she had. Dr C reported feeling extremely comforted by this, stating that she felt sure we would do everything we could to help and support her throughout the process.
We also explained to Dr C what needed to be done in order to achieve the best outcome in her case. We informed her that, whilst it would be important to respond to the allegations that had been raised by Patient Z in detail, we would also need to address the legitimate record keeping concerns that the GMC had identified. Dr C explained that this had only arisen due to a very busy week at the Practice. She said that her records were usually of a high standard and that she did not routinely use her own personal shorthand. Dr C also explained that the Practice carried out regular 360 degree peer reviews for all of its GPs, so she had quarterly record keeping audits that would demonstrate her usual high standards. Following our advice, Dr C also enrolled on a number of record keeping courses and provided us with a copy of her recent CPD, which helpfully included a number of BMA accredited courses which had all been completed in the last 12 months.
Turning to the complaint from Patient Z, we listened carefully to Dr C’s response to this, which was that the patient had misunderstood the position and had not, in fact, been prescribed medication which was not clinically indicated. Dr C explained that, although Patient Z had attended the Practice to discuss cold and flu like symptoms, during the course of the consultation, it transpired that Patient Z also required a prescription for her Corticosteroid Inhaler. Patient Z, who was not regularly compliant with her asthma medication, had therefore misunderstood that she had been incorrectly prescribed asthma medication for a cold, which was not the case. However, due to the poor standard of the clinical record from this encounter, this was not immediately clear to the GMC.
In assisting Dr C with her response to the GMC, we also obtained more than 10 patient and colleague testimonials in support of Dr C, as well as copies of Trustpilot reviews for the Practice that specifically mentioned Dr C. Evidence of Dr C’s contribution to the wider community was also obtained.
Having collated this material, we prepared a detailed response to the GMC Rule 7 allegations on behalf of Dr C, which was submitted to the GMC within the 28 day deadline.
Outcome
Dr C received notification from the GMC that the Case Examiners had reviewed her case and decided to close it with words of advice. The GMC’s Case Examiners were reassured by the explanation provided regarding the patient encounter, and the information Dr C was able to produce in support of her usual standard of record keeping, including the audit data accompanying her response. The Case Examiners therefore concluded that there was no realistic prospect of establishing that Dr C posed a current and ongoing risk to public protection, or that her fitness to practise was currently impaired. The advice provided by the Case Examiners related to the principles in Good Medical Practice surrounding record keeping, and a reminder to ensure her records were complete and accurate at all times.
Learning points
- This is a matter which might not have progressed to Rule 7 stage if a fuller response had been provided to the GMC at provisional enquiry stage. Always contact Medical Defense Society as soon as you receive any correspondence from the GMC. The sooner you get in touch, the sooner you can access the support you need.
- Keeping good quality records for each patient consultant is extremely important. Always try to create entries in real time or as soon as possible after the patient interaction. Check your medical record entries before you complete them and move on to the next patient. The GMC says that you “must make sure that formal records of your work (including patients’ records) are clear, accurate, contemporaneous and legible”.
- Your notes should be an understandable record of interactions with, and actions/decisions relating to, the patient. Ask yourself, “if someone else needed to read these records, would they be able to understand the patient encounter?”
- Do not become complacent with record keeping, even experienced practitioners can fall into bad habits, especially amid the pressures of a busy workload.
- Carry out regular CPD and consider putting in place peer review / audit processes, including in relation to record keeping, to maintain standards and identify areas for improvement.
Author: Anne Marie Rugeris, Partner – Keystone Law
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