As researchers we believe (of course) in the value of independent research. Actions you take and policies you adopt may have clear objectives and intended consequences, but do you always know what the true impact is on your audiences? Internal data may not be sufficient to give you the answer and the following recent example of our work shows how wider and unintended impacts can be uncovered through careful and sensitive research.
We recently conducted a research study with doctors and employers of doctors. All the doctors who took part had been given a warning or had restrictions placed on their practice by their professional regulator, the GMC (our client), following an investigation. The research examined these doctors’ experiences following the issue of a warning or a restriction on their practice and concentrated particularly on how well these actions meet their objectives.
The intended consequence of the GMC taking these actions is very clear. Warnings are meant to be a deterrent. They are also intended to remind the doctor that their conduct or behaviour fell significantly below the standard expected, but they do not imply impaired fitness to practise. The restrictions in question (undertakings or conditions), on the other hand, are intended to be the minimum action necessary to protect patients and the public. They are designed, where possible with the appropriate support, to provide time and space for doctors, who have been found to have impaired fitness to practise, to remediate and return to full practice once it is safe for them to do so.
Our research uncovered a good deal of evidence that the impact of warnings and restrictions can go well beyond these intended objectives. The study, for example, suggests severe and long-term impacts are occurring for some doctors receiving warnings from the GMC. A number of doctors reported that their current and ongoing employment had been adversely affected. Some had been unable to work again at all.
Likewise, when it comes to restrictions on practice, whilst some of the stories uncovered in this research do describe a process of very successful remediation, in other cases where the restrictions were more constraining employers did not feel able to provide the support needed and for many of the doctors interviewed, the undertakings and conditions proved unworkable, leading to the faltering or even the end of a doctor’s practice and career.
The findings in the research are similar to the views that have been shared with the GMC through other channels; which it is considering and, where possible, seeking to address. The detailed stories they have heard will allow them to further refine what they do and communicate the findings with doctors’ employers and other key partners. The ultimate aim will be to ensure that such actions by the regulator achieve their objectives, effectively protecting patients, with fewer wider unintended impacts on the doctors in question.
The results of this fascinating research project were used to inform chapter 6 of the State of Medical Education and Practice in the UK 2015 report.