Blog

By Amanda Feeny, Consultant Solicitor at BMA Law, Healthcare and Regulatory.

Not always: Five situations where doctors may be over-reporting themselves 

Doctors rightly take their reporting obligations to the GMC seriously, however, sometimes more seriously than the rules actually require. In our experience, it is not under-reporting that causes problems nearly as often as the opposite: doctors assuming that any complaint, adverse finding or difficult situation at work has to be reported, when in fact it does not. Unnecessary or erroneous self-referrals can prompt avoidable provisional inquiries being made by the GMC, as well as the resulting administrative and emotional stress that comes with it for the doctor.

It is worth being clear about what the GMC actually requires. Paragraph 99 of Good Medical Practice 2024 sets out specific thresholds that trigger mandatory reporting, including certain criminal matters, criticism by an official inquiry including coroners’ inquests, and relevant fitness-to-practise findings by another regulator. There are also separate obligations concerning a doctor’s health where it creates a risk to patients. The GMC’s guidance sets out the circumstances in more detail.

A practitioner does not need to make a self-referral to the GMC where there is no risk to patient care, no misconduct, and no adverse impact on their fitness to practise.

Furthermore, the guidance does not indicate that a doctor must self-refer simply because someone has alleged that they did something wrong, or they made a mistake in their clinical practice. That distinction is important, because a patient complaint, an employment investigation or an internal disciplinary finding can be genuinely concerning for the doctor, without automatically creating a duty to notify the GMC.

The circumstances warranting self-referral are not always clear-cut. Here are five situations where doctors sometimes get the distinction wrong:

1. A patient complains about you

A patient claims you were rude, did not listen to them, or provided substandard care. Depending on the specific circumstances, this does not necessarily need to be reported to the GMC. The fact that a complaint has been made does not, in itself, create a reporting obligation. Clearly you should deal with these matters appropriately, bearing in mind the duty of candour, and in accordance with paragraph 98 of GMP, cooperate honestly and openly with any investigation that follows. However, it is important to remember that a complaint is an allegation, not an adverse finding against you.

Where it gets more complicated is if the substance of the complaint reveals a genuine, ongoing patient safety risk. That is a different question which is worth seeking advice on. The complaint itself, however, does not trigger a self-referral.

2. Your employer opens disciplinary proceedings

Your Trust investigates an allegation of misconduct and calls you to a disciplinary hearing. The process feels formal, emotionally demanding and stressful. It may be natural to assume that the GMC should be informed. However, an employer’s disciplinary process is a separate entity from a GMC investigation, and being investigated by your employer does not, in itself, trigger the reporting duty as set out in paragraph 99 of GMP.

The underlying conduct, though, might sometimes be serious enough to create an obligation to inform the GMC, and your employer may decide to make a referral. In practice, employers routinely notify the GMC of internal proceedings at an early stage. The Trust’s Responsible Officer has a separate legal duty to refer a doctor if patient safety concerns or impaired fitness to practise are established during or after the process. In general, the GMC waits for the local process to conclude, as many cases resolve without any need for further GMC involvement.

The obligation to notify the GMC is created by the seriousness of the conduct and whether it meets the paragraph 99 threshold, not the fact that a disciplinary process exists. This distinction is worth bearing in mind, and in these circumstances the doctor should seek legal advice before self-referring to the GMC.

3. You are suspended by your employer

We know how stressful suspensions can be for doctors, and it is common for suspended doctors to assume they must tell the GMC immediately. However, that is not always the case. Paragraph 100 of GMP contains a separate notification requirement: if you are suspended from a healthcare role, or any post requiring professional registration, or you have restrictions placed on your practice, you must inform any organisations you work for and any patients you see independently of those organisations without delay.

That is a duty owed to your other workplaces and patients, not a duty to self-refer to the GMC, however, the two often get conflated. The reason behind the suspension still matters, of course. If it stems from a criminal charge or something else that falls within paragraph 99, a separate reporting obligation can arise from that underlying fact, not from the suspension itself.

4. You have been criticised by a professional membership organisation

Doctors who sit on committees or hold representative roles within professional bodies can find themselves subject to an internal complaints or disciplinary process. However, where a panel finds that a doctor breached the organisation’s code of conduct, that finding does not automatically have to be referred to the GMC.

Paragraph 99 of GMP is concerned with findings made by another professional body against the doctor’s registration, as the result of a fitness-to-practise process. This would include overseas regulators who regulate doctors practising abroad. However, an internal finding by a membership organisation is not necessarily classified in the same way, even though an adverse finding can feel just as serious. That said, the conduct behind the finding can still matter in its own right; circumstances surrounding dishonesty, a criminal offence, or a risk to patient safety would each need to be considered separately. The internal finding on its own, however, does not create the duty to self-refer.

5. You have been diagnosed with a health condition

This is one of the categories doctors worry about most, and reassurance here is important. Developing depression, anxiety or a serious physical illness, while receiving appropriate treatment and remaining able to practise safely, does not require you to notify the GMC. The GMC’s own health guidance puts it plainly: “We only need to be made aware of your health condition if it poses a risk to patients.”

That position changes if a condition is affecting your ability to practise safely and the necessary treatment, professional advice or safeguards are not being followed. So the real question to be asked is not whether you have a health condition, but whether that health condition creates a risk to patients, and whether any risk is being appropriately managed. This is a different test from assuming a diagnosis has to be reported as a matter of course.

Before you self-refer, ask yourself

A few questions are worth sitting with before you decide to notify the GMC:

• What has actually happened? An allegation, a complaint, an internal investigation, a disciplinary finding, a criminal matter and a regulatory finding are all distinct from one another and not all of these need to be reported.
• Does a specific reporting obligation apply? Check paragraph 99 of GMP and the GMC’s detailed guidance on reporting criminal, health and regulatory matters, rather than relying on instinct. Sometimes seemingly trivial matters may need to be reported, while seemingly serious ones do not.
• Is there an actual patient safety concern? If there is, managing that risk is an immediate priority, separate from the reporting question.
• Are you treating an allegation as though it were a finding? Someone alleging misconduct does not mean misconduct has been established.
• Are you conflating an employment or membership process with a regulatory one? They are not the same thing, even when they feel equally serious.

It is of course important to recognise that, where there is a duty to self-refer to the GMC and this is not done in a timely fashion, GMC sanctions guidance and case law consistently treat concealment or delayed disclosure as a dishonesty issue in its own right, which is often treated more seriously than the underlying matter would have been on its own.

It is also worth bearing in mind that most medical defence organisations require members to notify them of any circumstances that could give rise to a claim, separately from any duty to notify the GMC.

Reassuringly, recent GMC data shows that there is an upward trend of cases being closed at triage stage without further action, that is to say that relatively very few cases actually proceed to full investigation by the GMC.

If you are unsure, do seek advice from your medical defence organisation or obtain specialist legal advice before you act. A self-referral is a significant step, and once information has been passed to the GMC, it cannot simply be taken back. Understanding reporting requirements is important for all practitioners, as is seeking advice when the position is unclear. Sometimes, having taken that advice, the answer may be that you do not need to self-refer.

How we can help