Doctor’s Support Group – DSG – Next meeting

Sunday 18th June 2017

at 12.30 hours to 16.00 hours

The Priory Hospital, Priory Lane, Roehampton, London SW15 5JJ – (Map – below)

On 18th June, Mr Phillip Dayle – Barrister will be addressing the group.

He will be pleased to answer legal question of a general nature but not on a case specific basis.

Our Room

There are a few steps from the entrance to the reception area:

We are through the first door on the right at the top of the steps.

DSG Meetings

Our meetings are held with strict adherence to the principles of professional confidentiality.

We aim to assist doctors and dentists cope with the enormous stresses and difficulties they may face.

Attendees come from all areas of the UK.

There are no fees.

Our prime objective is to enable those facing these bewildering and confusing situations to cope and eventually emerge with the minimum of professional and/or personal damage.

Benefits of Attending DSG Meetings:

Doctors facing suspension, exclusion, investigation of complaints and/or allegations of professional misconduct are under extreme stress. They find it difficult to know how to respond or to know which professional body or people to work with for support. Members of the DSG have been through these challenging times and offer recommendations based on their individual and collective experiences.

Members attending our meetings have been able to include them in their CME credits.

Introductions

Attendees introduce themselves – no more than 30 seconds each.

e.g. Name | Status – eg Consultant, General Practioner, Junior Doctor | Specialty | Duration of Problem

New Cases

New members are in turn invited to summarise their story within 10 minutes – about 2 pages of A4.

Several members of the DSG have extensive personal experience of suspension, exclusion,  NHS Trust, NCAS and GMC investigations and will offer recommendations.

Most new members learn at their first meeting that there are common threads of management actions between cases. This means that suggestions made to one member might be applicable to others.

Accompanying visitors. At most meetings one or two new members come with a close member of the family or a friend: They are welcome but must accept our principles of professional confidentiality.

Members of the Doctor’s Support Group have an opportunity to network at meetings. We also try to link up members with similar experiences so that they can learn from one another.

If you have never attended one of our meetings, it would be helpful if you let us know in advance – please see contact us. You will be welcome even if you have not let us know before the meeting.

Dates for your diary – Booked meeting

Sunday 18th June 2017

Sunday 6th August, 2017

Sunday 24th September 2017

Sunday 29th October 2017

Sunday 3rd December 2017

(The Priory Hospital, Priory Lane, Roehampton, London SW15 5JJ)

Membership:-

The Doctors Support Group (DSG) aims to provide support and assistance to any medical professional or dentist facing suspension, exclusion, investigation of complaints and/or allegations of professional misconduct:-

  • Where the Group feels that major management decisions adversely affecting the doctor’s career have been inappropriate, disproportionate or unreasonable.
  • Or where the doctor is suffering from severe psychological problems that could be life threatening – whatever the causation.

Every member of the Group has experience of facing such problems. High on the agenda of every meeting is an opportunity for new members to outline their story – usually no more than 10 minutes. Members of the group will offer suggestions from their experiences on sensible options that the joining member might consider.

Testimonials 2016

DSG is both therapeutic and educational; the fellowship and food add a wider dimension to medicine..

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When trust management started questioning my functioning, I immediately became very isolated. I did not accept the accusations. I was not in a position to talk to colleagues about it and felt very isolated. Luckily I found the doctorssupportgroup on the internet and during meetings it became obvious that I was not the only one.

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 I’m a junior doctor who went in front of the GMC following an incident in 201x, just saw an e-mail about a support group meeting and realised I hadn’t sent you an update as to what happened to me.

I was given a 28 day suspension by the GMC and unfortunately the Deanery advised me that I would no longer be allowed to continue my training. I am under the impression that I will now be allowed to apply for speciality registrar posts but am still trying to clarify this

I was obviously quite cut up at the time but have got my life back on track largely and I know that when I get a training number sorted it’ll be a huge weight off my mind. I just wanted to say a huge thanks – your guidance and rapid responses were exactly what I needed at the time and especially given that you’d never met me before to have your advice and sympathy meant a huge amount to me and your service really is invaluable. Maybe in a few years when things have blown over a bit more I could also get a bit more involved and help out –

Anyway, thanks again for all your helpDSG Success

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I would like to inform everyone in DSG …

… the good news that the GMC has considered the allegation of (mis)conduct made against me and decided that I have “no case to answer” !

I think my previous Trust Board has now used up their “last bullet” against me.

Unless of course they decide to expose themselves by sending their employment solicitors after me … and try a desperate ‘last stand’ !

I have survived it all the ‘conflict’ from 9 years ago ! I have now come to the top of the “whistleblowing process” pyramid.

This played out like a game of chess !

I am now re-employed as you know in XXX Hospital which is a Trust very supportive of me and the expertise I deliver.

I am very grateful to DSG.

Recent Events – News Items

GMC Conference – Medical Professionalism Matters – 6th December 2016

The DSG was represented by its president.

The GMC had held a series of events over the preceding 18 months to discuss some of the challenges facing the medical profession. Discussions from the events can be read on gooddoctors.org.uk

A number of concerns had been recognised:

  • Lack of time and support for reflective practice.
  • Professional isolation.
  • Poor communication.
  • GMC and Medical Schools Council should focus on understanding medical professionalism.
  • Medical Royal Colleges and GMC should work to reinvigerate continuing professional development.
  • GMC and employers should support a greater emphaisis on reflection, personal development and quality improvement.
  • Increase patient involvement.
  • GMC and other regulators should intensify their efforts to promote a culture openness, learning and candour – a supportive culture.
  • Intense pressure on the profession needs recognition and it should be more acceptable for those struggling to ask for help.

Some thoughts from the recent meetings;

Managers becoming accountable. Doctors who have had their careers shattered by NHS managers seemingly inappropriately have felt that managers do not seem to be accountable to anyone. The situation is beginning to change ……

Hit squads of patients to inspect hospitals in radical shake-up of monitoring.

 

Bernard Palmer v Lister Hospital

Injury Benefit for NHS Employees who are not able to work due to work related stress.

Dr Michalak £4.5 million award – Read more…

NCAS Conference 3rd February 2011 – Summary of Papers –

Medical Act 1983Essential reading if you are preparing for a GMC Hearing – 18th October 2010

GMC Reprimands increase – 2010

Post-Shipman fitness-to-practise overhaul falls victim to cuts

The Government is set to scrap plans for a massive shake-up of GP fitness-to-practice hearings, in a move it claims will save the NHS more than £60 million by avoiding an unnecessary new layer of bureaucracy. Read More….

Revalidation deferred

Shirine Boardman – Exhonerated by GMC

Employment Tribunals – 16th November 2009

Human Rights and Other Acts

Race and Racism in the NHS

The Suspensions Scandal

NCAS Update – Report 22nd September 2009

  1. NCAS referrals come from all parts of the UK and across all sectors, whether in hospital or in general practice;
  2. Two referrals in three are about clinical skills but behavioural concerns are also common, seen in more than half the cases analysed;
  3. The average duration of exclusions of doctors in the hospital and community sector has fallen by over a third since 2003, which directly addresses concerns raised over the past two decades about prolonged exclusion from work;
  4. Amongst 144 of our cases where the most serious concerns have been raised, two thirds were back in work after remediation – rather than being lost to the service;
  5. Certain groups of practitioners are more likely than others to be referred to NCAS, for example men and older practitioners. The same groups are also more likely to experience exclusion or suspension from work;
  6. The report also examines the part played by ethnicity and place of qualification in the likelihood of referral of practitioners in hospital and community services. It shows that non-white practitioners qualifying outside the UK are more likely to be referred to NCAS, but that neither referral nor suspension or exclusion from practice is any higher among non-white practitioners qualifying within the UK.”

Recommended Related Websites:

A better NHS

The Doctor’s Support Group is a sub-group of the Society of Clinical Psychiatrists.

Two books from the Society are presented here…

Doctor’s Support Group and the Society of Clinical Psychiatrists

Doctor’s Support – Society of Clinical Psychiatry.

Article from Doctor’s Support Group on the Suspensions Scandal

First Aid -

First Aid Kit for Doctors

First Aid Advice For those medical professionals or dentists facing suspension, exclusion, investigation of complaints and/or allegations of professional misconduct.

Almost inevitably, you will experience the typical emotional turmoil of a bereavement if you have recently learned that you:-

  • have received a major complaint.
  • have been placed on suspension or an exclusion.
  • will be facing disciplinary action.

You may feel that your predicament is totally unjustifiable – and the chances are that you are correct. – see Suspensions Scandal – page 225

Clinical depression requiring specialist advice is not uncommon. Recognise it in yourself and seek advice early. The DoctorsSupportGroup may be able to assist.

Prolonged clinical depression, even reactive depression, can result in long-term brain damage – (Rao and Alderson 2014). You may need clinical expertise to treat depression but there are steps you can do to help:

Computer - Closing Dollarphotoclub_37447605 - 500

Close your computer early evening and have well deserived quality time with your loved-ones and friends.

Learn to close your computer early each evening. Most of us keep all our documents, current and historical on our computers. Close the computer and have some quality time with your friends and loved-ones.

  1. You will sleep better, deal with your issues better and get through your problems more effectively.
  2. Your career is extremely precious. Your loved ones should be even more precious.

Fallacy Accusations – Red Herrings

Many members of the Doctor’s Support Group have belatedly realised that the initial dispute related to a nonesence accusation such as:-

  • An event that could not have been prevented by anyone.
  • The employer falsely claiming that the employee is ill.

There may be benefit in documenting your concerns in a carefully drafted letter or email to the employer – after checking the content with your legal adviser.

Arson Dollarphotoclub_85454939 - Arson - 400

Arson – Destroying a Doctor’s Career

Sadly, when doctors experience allegations from their employers and the doctor believes that the allegations are fallacious others including friends, family, patients and colleagues assume that where there is smoke there is fire.
It is for the doctor to demonstrate that the fire is due to arson – and that is not easy:-
It is part of British law that a man is innocent until proven guilty (unless, it would seem, if you are a doctor where you are assumed to be guilty unless you can prove you are innocent)

– but you are not allowed to argue your case in public as this would contravene your contract with your employer.

The Innocence Project and Cognitive Dissonance

Black Box ThinkingIn his book ‘Black Box Thinking‘, Mathew Syed discusses cases documented by the Innocence Project. In Chapter 4, cases are discussed where prosecutors could not accept overwhelming DNA evidence that some men had been incorrectly found guilty. The prosecutors put forward rediculous arguments rather than accept that the prosecution had been wrong. Syed suggests that these prosecutors preferred to maintain the false prosecution rather than accept they had been wrong probably to maintain their self-esteem and risk to their own professional career. In one example, an 8 year old girl had been raped and murdered. When DNA testing proved that the semen was from another man, the prosecution argued that the girl had consensual sex with one man but the convict had subsequently used a condom when he raped and then murdered her. Syed makes the point that the prosecutors were behaving according to the theory of cognitive dissonance.

Cognitive Dissonance Theory (Festinger, 1957)

This is based on two factors: –

  1. Humans are sensitive to inconsistencies between actions and beliefs.
  2. Recognition of this inconsistency will cause dissonance, and will motivate an individual to resolve the dissonance.

Cognitive Dissonance and Medical Director / Doctor Dispute

Members of the Doctors Support Group frequently observe that Medical Directors hold that the member is guilty of bad practice even when bodies such as the GMC or NCAS conclude that the doctor is innocent.


Remember that at all times, the employee should react professionally.

Be cautions in the way you respond to your employers.

Hospital Directors and managers are skilled and experienced with employment issues and the chances are that you will have none of these skills. Furthermore, they have the support of employment solicitors and barristers paid for by the public purse.

Employers will often write legalistic jargon such as “we are committed to” as this may help their case if there should be litigation at a future date. At times you may consider it prudent to challenge such statements. A recent example from one group member was as follows:

You suggest that the Trust has sought to support me at all times but all I can remember is an endless and pointless series of delays since the Trust began to arrange xxx from 200x. Please remind me how the Trust has supported me over the last x difficult years?

You may have concerns that your employers are building a dosier of documents against you: Incident forms may be produced more frequently than seems reasonable for example.

  1. If your employer seems to be making inappropriate conclusions, question them in writing in a professional way.
  2. At all times, keep your cool and react in a professional manner.
  3. It may seem that your employers are trying to provoke you.
    • By responding in a professional manner, you will counter such objectives.
    • Seek professional advice early.
  4. If the problem persists, it is likely that advantages will come your way:-
    1. You will be focused on one case only – your case. Your employers are trying to keep on top of many cases.
    2. Over time the managers come and go and the incoming ones will not have the same recall of events as you.

Be cautions in the way you respond to lawyers or a court.

Members of our group have observed that lawyers and the courts are only assessing you.
They do not assess your employers or other doctors.

Depression, Despair and even Suicide resulting from Employer Disproportionate Pressure still occur.

The Doctor’s Support Group is aware of a couple of suicides in its early days but mercifully none for more than 20 years..

We are here to provide general support and where needed we can provide confidential professional psychiatric care for doctors and allied medical professionals who may be at risk.

Sadly we still read of occasional suicides related to NHS employer pressure.

Read more about coping with employer pressure….

Understanding British Justice

A series of videos explain how British Justice works explained by the Supreme Justices – Watch them here……

This section also includes advice on

  • Avoiding playing into the hands of your employers.
  • Keeping a file of all correspondence.
  • Legal Advisers.
  • Pro Bono (No cost) legal advice.
  • Medical Indemnification. – In 2016, the DSG received an email from wai.chan@jameshallam.co.uk stating that “I work for James Hallam Insurance Brokers within our Specialist Healthcare division. We provide a range of insurances to the healthcare industry in the UK. We have seen an increased number of enquiries for doctors and dentists rejected by the defence union because of their previous claims history or previous suspension / condition to their registration.I was wondering whether this is a common issue for your member, we have access to insurers that can assist individuals that are struggling to obtain insurance cover from the defence union.If this is something which is of interest then please do not hesitate to contact me on 0207 9777 858.

You are in overall command of your side of the dispute.

In the early stages, you are likely to be weakened mentally by your situation.

Take care not to play into the hands of your employers.

  • If you demonstrate insubordination, this can lead to termination of your contract.
  • If you put your case in the public arena, this may be seen as disclosing employer confidentiality and can also lead to termination of your contract.

Read more…. about how the system works and how you can begin to contend with it to defend your career.

Legal Advisers

You may believe that all you have to do is to place your details in the capable hands of your legal advisors and they will skilfully sort it all out for you.

However:-

  • Most legal advisors, even those in the medical area of legal practice, have very little if any medical knowledge and if they do, it is almost certainly not in your area of expertise.
  • None of them will recall the facts of your case in the same detail as you.

Pro Bono Advice (No Cost)

In the event that you have inadequate legal support, there are some organisations that may be able to help you on a Pro Bono basis.

Some solicitors may work on a “No Win – No Fee basis” but there could only be a ‘Fee’ if litigation is likely. These can be found with a Search for example – “Employment Law Solicitors – No win no fee”.

Legal Advice Free -Dollarphotoclub_55640590-e1438234110780 - 450

Free (Pro Bono) Legal Advice

Pro-Bono Legal Advice for the Public

A local legal academic unit near you may offer pro bono legal advice.

Read more about free (pro bono) legal advice in your area.

Some solicitors and barristers may consider providing advice on a Pro Bono basis:

 The Bar Pro Bono Unit is a charity which helps to find pro bono (free) legal assistance from volunteer barristers.

– See more at: http://www.barprobono.org.uk

GMC – Self-regulation and complaints handling

Due to its nature the GMC is placed in between the medical occupation and the general public, and has drawn criticism from both sides – from experts for being unduly harsh in its decisions on fitness to practice and from the general public for being too lax.
Issue has also resulted from numerous research studies which have revealed that GMC handling of complaints appear to vary depending upon race or “overseas qualification”, but it has been recommended that this might be due to indirect aspects.
The death and morbidity among doctors going through these treatments has attracted attention. In 2003/4 between 4 and 5% of physicians undergoing fitness to practice examination passed away. In reaction to a request for details in accordance with the Freedom of Details Act 2000, the GMC revealed that 68 medical professionals had actually passed away recently whilst going through a fitness to practice investigation, sustaining doubts about the hearings and sanctions being proportionate and fair.
In an internal report ‘Medical professionals who dedicate suicide while under GMC physical fitness to practise examination’, the GMC identified 114 doctors, with a mean age of 45, who had died during the past 8 years and had an open and revealed GMC case at the time of death, and where 28 had actually dedicated suicide and suggested ’em otional durability’ training for doctors.

Further requests for public document disclosure under the Flexibility of Information Act have been made pending the case being lodged within the European Court of Human Rights.
The Health and wellness Executive’s (HSE) provisional figure for the number of employees fatally injured in 2013/14 is 133, and corresponds to a rate of deadly injury of 0.44 deaths per 100 000 employees. According to the recent Horsfall review the size of the deaths of medical professionals under the GMC procedures in the 8 years in between 2005 and 2013 accounts for over 10% of the USA’s death rate at work of the entire UK workforce, every year and consistently.
According to the HSE’s timeline, no other organisation, besides the GMC, has come anywhere near this occupational death rate.

In a warning on ‘over-regulation’, the Royal College of General Practitioners former chair Dr Clare Gerada commented:
“    We already spend up to £1bn regulating doctors. We are one of the most over-regulated professions around and there will always be people who fall through. If we pile on more and more regulation we will never win.     ”
Following the suicide of Professor John E Davies from Guy’s Hospital, London, the HM Senior Coroner for the area wrote to Niall Dickson with her Regulation 28: Report to Prevent Future Deaths:
“    This is the second death of a doctor that has come before me over the last 2 years where a GMC investigation into the doctor’s practice has been found to play a part    ”

Read more about the General Medical Council…

Civitas, the Doctors’ Policy Research Group has published an interesting document entitled “The General Medical Council: Fit to Practice”. This questions the fitness of the GMC. Read more………….

Politics and the DSG

Our group is a support group.

We follow the politics and news items relating to the injustices associated with complaints against doctors but our group is a support group and does not actively participate in politics.

Freedom To Speak Up

Francis 2

Sir Robert Francis QC undertook a second NHS related review for the Secretary of State for Health. All those with ideas on how to create and maintain a culture of openness and honesty in the NHS could offer them to the review.
The closing date for submissions was 10th September 2014

The report was published on 11th February 2015 and can be read here……..

Videos relating to the publication of the Sir Robert Francis Report – Freedom to speak up:-

The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: across-sectional survey. BMJ January 2015

Some points made in this paper:-

The primary aim was to investigate the impact of complaints on doctors’ psychological welfare and health. The secondary aim was to assess whether doctors report exposure to a complaints process is associated with defensive medical practise.
Results: 16.9% of doctors with current/recent complaints reported moderate/severe depression (relative risk (RR) 1.77 (95% CI 1.48 to 2.13) comparedto doctors with no complaints (9.5%)).
When asked how the complaints process could be improved, doctors indicated that what mattered to them was that the process should be transparent and that staff responsible for investigating complaints should be up-to-date and competent. There was also a clear feeling that in the event of a complaint being shown to be vexatious, there should be disciplinary consequences if this related to colleagues, or the option for financial redress in the event it related to patients. Concerns about the lack of redress associated with vexatious complaints have been raised in the BMJ before.
This highlights the inherent tension in the system whereby an apparent ‘whistleblower’ may be perceived as a vexatious complainant by a colleague. We have shown that doctors who responded to our questionnaire and experience or observe complaints processes exhibit high levels of psychological morbidity including severe depression and suicidal ideation. These effects are greatest when the process involves the GMC.
In addition, the majority of these doctors exhibit hedging and avoidance; both these behaviours may be damaging to patient care and be contrary to the professed aims of these processes.

Read More…

MHPS, NCAS and assessments – an important development

1st September 2014

Judgement in a case brought by Dr Chakrabarty v Ipswich Hospital has been a welcome development for NHS employers according to Hempsons.

The Judgement has been summarised as follows:

 

  • The employer has an obligation to refer cases to NCAS for them to consider assessment but NCAS has no obligation to conduct an assessment
  • If NCAS do not carry out an assessment there is no impediment to the employer proceeding to a capability hearing
  • In cases where NCAS do conduct an assessment and recommend remediation there is no obligation upon the employer to agree to it, particularly in cases where the plan is not practical
  • There is no obligation upon an employer to delay a capability hearing where the GMC are conducting fitness to practice proceedings.

Read more:-

 

dr-raj-mattu

Read More about Dr Raj Mattu here …………………

BBC – Investigation Great Ormond Street Hospital – April 2012

If this video does not run smoothly, please pause it for a minute or two.

High Court quashes GMC’s findings that psychiatrist abused his position Read More  March 2012

Individual managers are liable for record discrimination (£4.5Million) award as well as trust

 

(BMJ January 2012   344: 2)

 Read more..

Read more…… Shoot the Messenger – Private Eye July 2011Read More:

 

Secret doctors’ courts move a ‘disaster’ for patients Press Gazette 20 April 2011

Read More

 

BBC Inside Out 25th October 2010

Video:- Exclusion from clinical practice. Baby P, Whistleblowing.Wrongly Suspended Dr Kim Holt Great Ormond Street Hospital | Ramon Niekrash | GMC Guidelines | BBC Inside Out | Gagging Clauses | Employment Tribunals | Doctors Support Group

Quoting from the above video:-

Ramon Niekrash – Consultant Urologist:- “It is a bizarre feeling because when you do end up leaving the hospital you feel rather empty of course and there isn’t anyone you can turn to. It is not as if a crime has been committed and you can go to the police.””… This sounds like the Stasi of former Eastern Germany.”
Lawyers claim there is a patternArpita Dutt – Employment Lawyer:-  …. The focus being on the quality of the disclosure becomes a focus on the character of the individual. The reputation of the individual and then often becomes “how do we destroy that characer? How do we destroy that reputation?

Political Progress?

Peter Tomlin, president of the group, has analyzed the process by which senior hospital doctors are disciplined within the NHS and published on “The Suspensions Scandal” in The Journal of Obstetrics and Gynaecology.  A number of faults were identified and he found that many of these give an unfair advantage to management and are contrary to the rules of “Natural Justice”. Read more….

Google must delete search results on request, rules EU court.

Search resuolts google

Removing Adverse Publicity from Search Engines such as Google

European lawmakers have told Google to forget about it. The top European Court has ruled that citizens have a “right to be forgotten” and can ask the Big G to delete search results about them.

In what could turn out to be one of the biggest shake-ups to online privacy legislation, the European Union Court of Justice decided Tuesday (PDF) that people can ask Google and other online entities to edit or erase online search results if those results contain information that might infringe the privacy of the person in question.

“If, following a search made on the basis of a person’s name, the list of results displays a link to a web page which contains information on the person in question, that data subject may approach the operator directly,” the judges ruled. If the search operator refuses to change the search results, the person in question can “bring the matter before the competent authorities in order to obtain, under certain conditions, the removal of that link from the list of results.”

Read more….