Any doctors help me with this gmc query? At wits end

[user0644933]

I have a very rocky relationship with ex DH and he is not transparent about finances, leaves me to manage our kids etc and I get by on our settlement from the divorce as well as maintenance. We were married for 7 years and we have 2 kids. He was recently in trouble with the gmc for drink driving and they have restricted his practice. He is consultant level. He was working on a temporary contract at the time of the issue with the gmc, hoping it would go permanent. The team really liked him (never heard the end of how much he was valued etc, according to him..). Anyway, since these restrictions have been imposed he’s now announced that the hospital he works for are not only not going to offer the permanent position but he may actually have to move hospitals as his job is no longer secure and he doesn’t know what’s happening. Is this a normal thing to happen if restrictions are on your practice? I am very suspicious that he’s using this to spin me a line and reduce his maintenance. Obviously I know I can go down the route of CMS and could loom up online where he’s moving to etc but I am extremely stressed right now with not knowing what’s happening. I am struggling so much to work and take care of two toddlers alone. I looked on the Gmc site and he’s been given an undertaking or something? But not a warning? Yet lots of drinking incidents means warnings so I don’t understand it. I’m not coping well as he is very difficult to deal with and I essentially gave up my career to have his children, which I am now trying to get back into. I feel quite panicked this morning and haven’t slept.

@Gottasecretcanyoukeepit an issue yes but he’s been there two years so I assumed (as I think he did) that they would keep him. Also he’s at a big hospital so how would another one accommodate him if this huge one won’t? I don’t trust him so I guess I’m always going to be sceptical

Firstly, locum doctors in hospitals would never just be handed a permanent contract (although it happens quite often in GP), the role would have to go to open advert and someone else might interview better - I've known this happen even with someone who was a very well-liked and competent doctor.

Secondly, if there's another appointable applicant (and sometimes even if there isn't), no hospital is going to take someone on a new permanent contract who has significant restrictions on their license to practice (which is what this implies).

Thirdly, 'undertakings' for a drink or drug related issue would usually be along the lines of breathalysing/ regular drug testing in the workplace, and evidence of engagement with addiction services. Having to breathalyse a consultant every morning before work, or even randomly at frequent intervals, takes a significant amount of time and resource. Hospitals would likely do it for permanent staff where they have contractual obligations, but I can't imagine anyone do it for a locum - they'd just be let go.

Your ex-H is likely to find it much more difficult to get regular work over the next few years/ until the undertakings are lifted, and this may well affect his income. Having worked with someone with a similar issue (undertakings due to prescription drug addiction issues), it was a complete nightmare and not something I would willingly do again.

Sorry, I know that's not reassuring when there are school fees to pay.💐

@ClematisWren thank you, that’s not what I wanted to hear but makes sense. What I don’t understand is why a one off drink driving has led to undertakings. So many seem to have eating everything for this on the gmc site. Will be basically have to go where is desperate for staff then? And a permanent contract is off the cards most likely? The undertakings only came on in June so I don’t know how long they are imposed.

@ClematisWren *so many seem to have a warning

It may not be a single drink-driving incident (which will have triggered an investigation that may have revealed a more severe underlying alcohol issue) but, even if it was, it would potentially depend on things like blood-alcohol levels, whether he got stopped on the way home from the pub and was slightly over the limit, or got stopped on his way into work and was well over the limit etc.

The GMC takes substance problems (of any sort) very seriously indeed, doctors who develop problems need to engage willingly and seek help. It also takes a while for proceedings to be heard by the GMC, so it may be that he has failed to engage with the Fitness to Practice process that would have perhaps resulted in a warning - eg if he could already show that he'd got sober and was accessing support.

Bear in mind that this is just me extrapolating from the information provided. I'm a doctor with a role in Fitness to Practice of junior docs at Trust level, but I've not been involved with any proceedings at Consultant level, and only tangentially in GMC investigations.

I’m not sure a warning is any better given that it appears on public record for two years and would be disclosed to a potential employer. Undertakings suggest there is an issue which needs to be monitored in the interests of the doctor and patient safety. My guess is that this goes beyond a one off drink driving incident and there may be some health concern around alcohol use. You won’t see much of the detail of any investigations involving health as this is very much a private matter.

Yes, I would assume a permanent contract is off the cards for the time being. Why was he working as a locum if he's a fully qualified consultant? If it's because he's in a competitive speciality then he may find it hard to get work even as a locum. If he's in a hard-to-recruit speciality then he might be able to go somewhere where they're desperate and explain the circumstances up front.

In your shoes, if school fees are the major stressor here, I would be looking at state schools and seeing if there's anywhere you have move the DC. You may well have a lot of uncertainty in his income over the next few years.

I'm afraid I don't know how long the undertakings are likely to last - my colleague who had them was reviewed regularly for about 4 years in total I think. Sadly, he then had a relapse and had to stop practising, as there were significant probity issues. He relinquished his registration voluntarily before he was struck off.

@ClematisWren sorry I meant he was on a year I year long contract that had been renewed twice and he was hoping it would be permanent. Once the restrictions are lifted is that the end of it or are employers still wary? I read they stay on record for 10 years but presumably that’s separate to how long they are actually in place. I really don’t want to move the boys from their school and I can’t believe he has done this. Heartbroken it will impact them.

@Gottasecretcanyoukeepit well i dread to think what else has been going on then. He assured me it was a one off.

One thing to bear in mind is that if it was very serious undertakings wouldn’t be on the table and he would be looking at a tribunal. Try and take some positives from the fact that whatever the issue is, it’s something that can be monitored and he isn’t being prevented from working full stop. It may not even be substance abuse - it’s not uncommon for mental health concerns to have some impact on fitness to practice.

I'm sorry OP, I don't really know what the long term implications are, as most doctors would keep it very quiet if they'd been subject to undertakings previously - there's a lot of stigma in the profession about this.

Of the two people I know personally, one (as I've described above) had a relapse after coming off undertakings and left the profession. The other has a life-long severe mental health condition that is usually well-controlled. That person does limited clinical work and will have ongoing clinical supervision for their whole career.

@ClematisWren thanks. He does have some mental health issues, I assume that’s being monitored then now at least? Will he be forced to have some sort of therapy 9or is it optional? If there’s one good thing that would come from it it would be that!!

There are different levels of conditions that can be applied. If his GMC Adviser says he has to go to therapy/ AA etc then he has to go and also provide evidence of this, but they might not depending what the issue has been. Most of the conditions relating to health/addiction issues are confidential, so there's no way of finding out what they are unless he tells you.

I'm sorry, this is a hard thing to go through even when you have a solid relationship and good communication - GMC processes are extremely stressful for doctors, there's a lot of uncertainty. This must be even worse when you're not getting the full story and can't rely on his account of it.

@ClematisWren thanks. This has really made things clearer for me! UW it likely the restrictions will be at least a couple of years? Once they’re gone is that it, he might be able to get a permanent role? Are you saying it’s almost impossible to get permanent while they’re in place? Whilst I feel crap about what’s been said here, I do feel a little calmer now I at least understand it better.

There's no particular end date for undertakings as far as I'm aware. His GMC Adviser will be the person who decides if/when they feel he has reached a point where he is safe to practice unrestricted, and he can then apply to have the conditions lifted. It will entirely depend on his level of insight and co-operation in dealing with his alcohol/health issues that have resulted in the undertaking.

From your OP, it sounds as though his current Trust may have decided they want rid, in which case he's not realistically going to get a permanent consultant contract until the conditions are lifted. Thereafter, it remains on his GMC record for 10 years, and the conviction for drink driving with appear on his enhanced DBS check forever, which means that any applications for posts will take longer and need awkward explanations and Occ Health appointments. He will need to show humility, openness and insight, but plenty of doctors who've had previous convictions/ GMC processes continue to practice (all doctors with a conviction other than a fixed-penalty notice are automatically referred to the GMC).

My worry would be that, if his current Trust let him go and he doesn't have recent good relationships with other Trusts, he might struggle to get work due to people not wanting to provide the level of supervision needed. This is impossible to know without knowing exactly which conditions have been applied, but a Consultant who can't work independently is not much use, so he may have to take locum work at a lower grade, where supervision is given as part of the post. It may indeed become more difficult to get him to pay child support, given that you're already having issues with this, if his income becomes more erratic/ drops significantly.

@ClematisWren thanks. Gosh this is depressing!! He does have a good relationship with another Trust, but it’s another larger hospital and very competitive to get into as the team itself is small. I’m assuming that one is probably out based on what you’ve said? One thing I don’t understand is that he’s been saying for ages that work is very very busy (so much so he can’t help with the boys!) so I assumed the job was secure, but it seems that maybe it’s the case that it’s so busy they can’t and don’t want to have to supervise him? I know one of the conditions was that he couldn’t hold clinics alone and this was something he was stressed about. He wouldn’t tell me anything else.

Although good relations between us are long gone, I do actually feel a bit sorry for him based on some of the posts here. Our divorce happened just before the drink driving and I was so disgusted I wasn’t any support to him whatsoever. I didn’t realise the extent of the impact this may have had on him. I still can’t believe he’s put his children in this position.

Please keep in mind that I'm extrapolating based on the information you're providing, so don't take this as gospel, but if he's not able to do clinics independently then he's unlikely to be able to work at consultant level until the conditions are lifted. Consultants are supposed to be the supervising doctor in any clinic/ward/theatre, if they need ongoing supervision they're not really working as a consultant. It sounds as though he is required to be at least 'closely supervised' (click on the link for 'glossary for undertakings and conditions' in the document below - look at page 38 of the glossary).

The vast majority of clinical medical jobs are very busy, but that doesn't mean they aren't competitive - if he's in a major hospital, doing a competitive speciality, there will be others ready and willing to step into his role.

This is the GMC list of possible conditions that can be applied - you can see which ones might be applied to someone with an alcohol problem and mental health issues:
https://www.mpts-uk.org/-/media/mpts-documents/DC4326_MPT_Conditions_Bank_25415696.pdf

'Undertakings' are essentially 'conditions' that have been agreed between the doctor and the GMC Adviser, rather than being imposed by a tribunal.

I have to go out now, but I hope this has been helpful at least in providing information, if not reassurance. Wishing you all the best OP.

@ClematisWren thank you very very much for taking the time to talk it over. I will take a look at that link. All the best.

unfortunately because the NHS is very very busy and short of money and people, all hospitals are going to be reluctant to employ someone who needs supervision or who is generally a risk to their reputation.

You should try to get a hold of the decision, they are made public, and see what it says. If he has a drinking problem you need to brace yourself for the impact this is going to have in more ways than money. He is unlikely to be a reliable source of money and parenting support for your children.

@LemonTT as undertakings were agreed there will be no ‘public decision’. Even in cases which proceed to tribunal health elements are not published and any underlying diagnoses are confidential. Potential employers may be privy to some information but not the public at large.

Why was he working as a locum if he's a fully qualified consultant?

There are lots of reasons a fully qualified consultant might choose to work as a locum. NHS Consultant recruitment takes many many months (sometimes years) so there are a lot of gaps waiting for recruitment.

If you are just starting out it is a good way to earn more money than the starting salary, try out different units and see if you like it.

If you are experienced it can be a lot more enjoyable to be a locum as you get to focus on seeing patients, usually the bit of the job people like, and don't get asked to be on committees or do management which is great if you hate that.

It also means you avoid the recruitment process which can be a nightmare. And if you don't like the job you only need to give 2 weeks notice.

In a shortage specialty you can be in locum posts for years, effectively being a permanent staff member.