Medical Council trying to lay a ‘more empathetic’ path

The Medical Council has commissioned an independent wellbeing support service for doctors, medical students, and the public interacting with any of its regulatory processes. Catherine Reilly reports

Compassion as a medical regulator “is possible” and “not contradictory”, the Medical Council’s President has said.

Dr Suzanne Crowe was speaking at the launch of “CAREhub”. It is an external mental health support service for doctors, medical students, and members of the public who are engaged with the Council’s regulatory functions.

In addition, CAREhub is available to family members of doctors who are going through the complaints and investigation processes.

The free and confidential service, delivered by Lyra Health International, is available 24/7 all year-round. It can be accessed through self-referral or via a Medical Council representative who can make a referral with consent.

“We want to acknowledge what we’ve been told by doctors and patients who interact with the Council and we want to give something back in support of those who have raised those concerns,” stated Dr Crowe at the launch on 5 November.

She said the Council was “very mindful” of the fact its processes “are quite heavy in legal language”.

“And in many ways, we can’t dilute the impact or the significance of the legal aspects of some of our processes, but what we can do is support those who interact with those processes.

“We recognise that the medical profession, patients, medical students, anybody who interacts with doctors, are all undergoing a whole host of challenges that we don’t know much about, and that’s always there in the background. Behind every case, behind every contact, there is a story, and often, there’s another story behind that.”

She added: “Looking after your wellbeing is incredibly important, but it’s also important to have access to empathic, impartial support that you can trust and that is there whenever you need it 24/7, in any kind of situations that you’re encountering where you feel stressed, upset or overwhelmed, and that’s really where the idea of CAREhub comes in.”

According to Dr Crowe, the initiative reflected the Medical Council’s “dedication to prioritising mental wellbeing and aligning with global best practices, ensuring that emotional support is readily available for those who need it”.

“And we genuinely hope that medical students and doctors and members of the public will utilise it if they need it.”

Speaking to the Medical Independent (MI), Dr Crowe acknowledged that there were some existing support services in place for doctors’ health (see information below). However, she believed CAREhub filled a gap as it is available 24/7.

“The other important resource that every doctor should be aware of, and should be registered with, is their own GP,” she added.

As well as counselling, CAREhub includes other supports including wellness coaching.

The package of support was also part of encouraging a mindset shift in the medical profession that investing in their mental and physical health was not “superfluous”.

“That’s actually how you will ensure your greatest longevity within the profession and ensure that you can give the most both to your family and to your patients.”

Confidentiality

Dr Crowe and other Council representatives emphasised CAREhub’s independence and confidentiality. This point was reiterated by Ms Arlene Thomas, Account Manager for Lyra UK and Ireland, who stated the Medical Council will never know who has accessed CAREhub.

The initiative is a key strand of the Medical Council’s new liaison and support services framework. Ms Niamh Dunne, the Council’s Head of Liaison and Support Services, provided background on its evolution. She said stakeholder feedback had demonstrated that the Council needed to show more compassion and empathy in its regulatory engagements.

In terms of emotional support, it was vital this provision was “trusted, empathetic, and impartial”.

“And this is how the birth of CAREhub happened,” said Ms Dunne. “This has been in the works for almost a year.”

She said some organisations that had commissioned a support service had restricted it to either doctors or patients. However, the Council considered it was needed for both groups, and should not be limited to doctors in the complaints and investigations processes. She noted, for example, that some doctors registering with the Council were coming from war-stricken countries and may require additional support.

Similarly, she said it is important that the regulator can signpost professional supports for people who raise sensitive matters with the Medical Council. In some cases, a Council staff member may be the first person to whom the patient/member of the public has disclosed this information, she said.

The CAREhub service is delivered by licensed therapists and mental health professionals. A freephone in-country telephone number, a live chat function, and email address, can be used to access immediate support. Ms Thomas encouraged those interested in the service to download the Lyra Wellbeing Hub app onto their phone. People accessing CAREhub can remain anonymous, she outlined.

Under CAREhub, Lyra offers access to six structured counselling (or coaching) sessions per primary presenting issue per year (and people can present for an unlimited number of issues).

Lyra has counsellors based in Ireland if in-person sessions are preferred.

The service will endeavour to pair the individual with a counsellor that best meets their needs and preferences (eg, gender, language, LGBTQ+ status etc).

MPS survey

While CAREhub is not solely for doctors in the complaints or fitness to practise processes, the considerable stress experienced by this cohort is an important reason for its development.

In 2023, the Council received complaints in relation to 391 doctors – which is a small proportion of overall registrants (1.3 per cent), but a significant number of individuals.

In the same year, its preliminary proceedings committee (PPC) made 286 decisions, with 61 cases referred to the fitness to practise committee. 

A survey by the Medical Protection Society (MPS), published in June, highlighted that the complaints and investigations processes can be prolonged. The toll on doctors was also clearly illustrated in the findings.

Of 114 doctors who had been investigated by the Medical Council in the last five years, more than three-quarters (77 per cent) said the investigation had a detrimental impact on their mental health, and 93 per cent said it caused stress and anxiety. Nearly a quarter (24 per cent) considered leaving medicine due to the investigation, whilst one-in-10 either left or retired early. Twelve per cent also reported experiencing suicidal thoughts during the investigation.

In the survey, 70 per cent of respondents said the length of the investigation impacted on their mental health the most, with some investigations lasting several years. The tone of the communications from the Medical Council was also raised. Doctors commenting anonymously spoke of feeling “guilty until proven innocent”, while others described Council correspondence as “cold”, “legalistic”, and “hard to understand”.

MPS issued a series of recommendations on foot of the survey. It urged the Council to review its communications with registrants and signpost doctors to 24/7 support services. It called for legislation reforming the complaints process to be commenced as a priority.

It also stated the Medical Council should consider a review of its own processes, outside of the regulatory framework, to help reduce delays.

Commenting after the launch of CAREhub, Dr James Thorpe, Deputy Medical Director at MPS, said: “Discussions with the Medical Council on our survey findings and recommendations have been positive from the outset, and the launch of CAREhub to provide independent wellbeing support to those facing this uniquely challenging process is a welcome and positive step. We hope to continue our constructive dialogue with the Medical Council and will do everything possible to help to bring about other improvements to this process.”

IMO President Dr Denis McCauley also welcomed the CAREhub initiative, but echoed the concerns expressed by the MPS.

“The current system is long and stressful for doctors and 90 per cent of complaints brought to the preliminary proceedings committee require no further action,” stated Dr McCauley.

“Recent changes to the Medical Practitioners Act will hopefully go some way to ensure that complaints are only investigated and brought to the preliminary proceedings committee where there is sufficient cause. The IMO is also of the view that all fitness to practice hearings should be held in-camera.”

According to the Council, it frequently reviews the content of its communications to doctors and members of the public. It said the information contained in the MPS survey has been reviewed and considered, with some of the issues already addressed. “We expect the MPS survey to continue to inform some of the changes we will implement as part of the new complaints framework.”

Reforms

In recent years, the Medical Council has seen a rise in serious complaints and in the number of complaints that include several doctors. These factors have led to increased complexity resulting in longer investigation timelines. According to the Council, it added resources to its complaints and investigations directorate in 2023 and 2024. It has restructured to best address “demand capacity” and to prepare for the Regulated Professions (Health and Social Care) (Amendment) Act 2020.

The Act will introduce significant changes to the complaints process, with the aim of making it more efficient.

The legislation will allow the Council CEO to receive complaints and conduct investigations with the assistance of authorised officers, before sending the complaint to the PPC. Furthermore, the PPC will be able to convene as subcommittees and to accept undertakings from doctors.

Long awaited

Dr Crowe acknowledged the new legal provisions were long awaited. One hold-up was the need to ensure the legislation met the requirements of an EU directive on proportionality.

“We are optimistic that [the new provisions are] starting in January or February of next year, and that will mean that there will be some steps that we can take that will close-off the complaints process at an earlier point,” Dr Crowe told MI.

“For example, the doctor will be able to give an undertaking to the preliminary proceedings committee to, for example, undergo further training in a particular area or not to engage in a particular part of practice….”

Some doctors will also be eligible to undergo a performance assessment instead of a fitness to practice inquiry, depending on the circumstances of the case.

“But I think there’s going to have to be a period of a couple of years for this to all bed-in, both in how the Council uses these changes, but also we need… indemnifiers and our legal colleagues to work with us around these changes as well. So it won’t be a quick fix in the first couple of months; it’s going to take a bit of time.”

Expert reports

Dr Crowe also highlighted other issues contributing to the length of investigations, which will not be impacted by the new legal provisions.

Firstly, she encouraged doctors to “engage as quickly as possible as an important first step” when they are made aware of a complaint to the regulator.

“The next delay that we encounter at that point is obtaining records from hospitals,” she continued. According to Dr Crowe, this can cause substantial delay and neither the Council nor necessarily the doctor has much control in expediting matters.

“So that can be very frustrating, both for the team here and for the doctor,” she said.

Another key issue leading to significant delays is the Council’s access to medical expert reports.

“We can be waiting many months for a report from an expert. So we would really like to encourage the medical profession to step forward and to act as medical experts, because it’s a very small pool of people who will act as an expert, and that leads to the delays in getting a report.”

An expert report can help determine whether the doctor’s action was part of accepted practice, or a deviation from what should be expected.

“An expert report can really be important in deciding as to whether a complaint should proceed or not,” said Dr Crowe. “So it has immense power, actually.”

Dr Crowe urged the profession to “really think of themselves as being eligible to be experts”, particularly female doctors who traditionally have been less inclined to come forward in this capacity. She added that some doctors at earlier career stages may unnecessarily discount themselves as potential experts.

“So those kinds of areas of delay won’t be changed by the legislation, but we will engage with the profession to try and change those things, and with the stakeholders, the hospitals, to get the medical records.”