What is a provisional enquiry?
Before looking at how doctors should respond, what is General Medical Council (GMC) provisional enquiries?
Simply put, when the GMC receives an initial complaint or allegation, it will look at the information and evidence against a set of criteria to determine whether the concern appears to raise a question whether the doctor’s fitness to practise is impaired. This is known as the triage test.
Where the information and evidence meets the criteria, the GMC will move to provisional enquiries.
During the provisional enquiries stage, the GMC will identify and assess the information and evidence. The GMC will write to the doctor to inform them of the complaint or allegation and giving them a right to reply if they so wish. At the provisional enquiry stage, the GMC may also seek information and evidence elsewhere.
During provisional enquiries, the GMC will consider the nature and seriousness of the allegations, the evidence obtained through our provisional enquiries and the risk of the conduct being repeated and placing patients at risk and decide to either:
- close the enquiry with no further action
- close the enquiry but, in addition, notify the Responsible Officer (RO) or notify Employers process
- promote the enquiry to a full investigation.
Provisional enquiries are normally concluded within 2-3 months.
Triage threshold test
The GMC will determine whether the concern appears to raise a question whether the doctor’s fitness to practise is impaired, also known as the triage test.
The test applied to determine whether the triage test has been met involved the GMC asking itself, during the provisional enquiries stage:
“Whether the allegation appears to raise a question as to whether the doctor’s fitness to practise is impaired.”
In other words, the triage test focuses on whether the issues are such that they require investigation by the GMC. Although this test applies universally, the factors to be considered by decision makers will vary depending on the nature of the concerns and the information we have gathered through different provisional enquiry streams.
What to do if you receive a provisional enquiry letter from the GMC
It is universally accepted and understood that GMC investigations cause stress and anxiety in doctors. When doctors received correspondence from the GMC advising them that they are the target of a fitness to practise complaint or allegation, it is human nature to react and respond in panic and stress. However, doctors must proceed with great care and take time to consider their response.
It is always advisable to seek legal advice at the earliest possible opportunity. Legal advice will assist doctors in deciding whether to response to at the provisional enquiry stage (this is discretionary), and where they do, assist with the contents, tone and evidence.
The wrong approach, tone, information or evidence might, for example, lead the GMC to conclude there is a lack of insight and which could lead to a full fitness to practise investigation.
Doctors should also be aware that, they will be required to inform their employer and/or appropriate body (under Performers List regulations) if you are subject to a regulator’s investigation.
Insight and Remediation
Insight and evidence of remediation can make a difference at the provisional enquiry stage. GMC guidance indicated that during provisional enquiries, consideration as to the nature and seriousness of the allegations, the evidence obtained through our provisional enquiries and the risk of the conduct being repeated and placing patients at risk should be given.
This means that doctors can submit information and evidence of insight and remediation. Here again, legal advice should be sought at the earliest possible opportunity.
Doctors should however note the GMC guidance when considering insight and remediation:
“Even where we have obtained evidence of remediation, promotion to an investigation will be appropriate if a reasonable, well-informed member of the public would consider the doctor’s actions to be shockingly bad and therefore irremediable.”
Generally speaking therefore, if during the provisional enquiry stage, the GMC is satisfied that there is no patient safety concern and, if appropriate, the doctor has taken steps to remediate, a full fitness to practise investigation is unlikely to be the outcome.