Facing the GOC

In your professional career, possibly the worst thing that can happen is a patient complaint, which escalates to an official GOC investigation. That said, a complaint, and subsequent investigation, can happen to anyone: the AOP legal department handled over 1,500 cases in 2012 alone. 
 
Some of you might be scoffing that the people involved in these cases probably did something wrong. No smoke without fire, right? Wrong – two years ago, this happened to me. 
 
One day in June 2011 I breezed into the practice and proceeded to sift through my mail – an A4 brown envelope had been left out for me which had been sent by recorded delivery the day before. Paying little attention, I opened the envelope to find it was from the GOC – I was the subject of a complaint and the GOC was investigating.   
 
In that first morning, I walked around the practice in a daze. Indeed, during the whole process you get hit with a variety of emotions. My first was fear – I was scared about the proceedings. Swiftly this was followed by panic – how would I cope? Not only could I lose the practice, but my house and everything I had built. Working with the AOP legal department, I had knowledge of how this process could affect a practitioner. Then the worst feeling – shame. What would I say to my colleagues – those that held me in high regard? I was an AOP councilor; I worked with the AOP legal department of all things. Who would take me seriously when I had an allegation against me?
 
I allowed myself a couple of hours of moping, then the next emotion hit – anger. This was useful; it shook me into action, and I read the letter again. I am not able to go into the details of the case, but as I re-read the letter I became more baffled and, if I’m honest, annoyed. The complaint stemmed from 2001, more than 10 years previously, and I was working for someone else at the time. 
 
Now, I realise that I am more fortunate than many, and have maintained good relationships with previous employers. I knew I would be able to obtain the copies of my clinical records to start my defence. Plus, I knew that my AOP insurance would cover me. However, telling that first person about the investigation was unbelievably difficult.

FIRST STEPS 

When you receive any type of complaint, the first thing I would advise you to do is to contact the AOP legal department. This is for two reasons: it stops you from doing anything stupid; and it logs the complaint and starts your support.
 
In my case, that was the second thing I did. First, I rang my previous employer and got the full story. I arranged for all copies of my record cards which related to the complaint to be sent to me. 
 
This done, it calmed me down enough so I could contact the AOP legal department with a clearer head. Speaking to a lawyer there, I was advised to send everything to them, and that I needed to inform the GOC in writing that I’d asked the AOP to represent me so they could get copies of the papers they would need. I also had to notify the PCT, as it could have a bearing on my GOS contract.
 
Thirdly, I rang my husband: “Hi honey, I’m being sued and we might lose the business. How is your day?” By that stage I needed a heap of sympathy and to listen to someone else berate the system. 
 
Fourthly, I contacted Trevor Warburton and Lyndon Taylor of the AOP: friends and colleagues, I knew I would get sensible advice on the validity of the case. Any case that goes through the legal department will get a professional, unbiased opinion from one of them. It was, however, a difficult email to write. These were optometrists and I felt that they were more likely to shun me for my potential stupidity. 
 
Lastly, I had to do something even harder – carry on working and seeing patients. A case can cause a crisis of confidence. Did I actually miss something? Should I still be seeing patients? I couldn’t walk out, but it is hard to carry on as if nothing is different.
 

THE WAITING GAME

Whether you are allowed to carry on working depends on the severity of the complaint – the more serious cases are prioritised and can become the subject of an interim decision. The GOC can impose conditions on your working practice or suspend you while they investigate, and it does not matter if that has a negative financial impact on you. 
 
I was allowed to carry on in my practice with no restrictions, so that is what I did. I also spoke to the other people involved with the case. We knew it would take a long time, although I didn’t realise how long, or that there would be long periods of inactivity. 
 
The process feels too slow – and you live with the emotional turmoil for far too long. I was unprepared for the legal ‘jargon’ letters that you get, including from the AOP, which are cold and accusatory in tone. Reading these can make you feel worthless, but you learn to understand ‘solicitor speak’ and go back to waiting.
 
At some point, you will be asked to write a statement of your version of the events, comment on the reply letters that the legal team make on your behalf, or write a final response. 
 
This is incredibly difficult to do. I felt sorry that complainant felt ‘wronged’ – in the same position I would want answers. But your future lies in an A4 piece of paper that must be correct. Again, advice from the solicitors, who are used to legal language, is invaluable. 
 
Faced with an allegation, the two overriding emotions I felt were anger and shame. No matter how sensible you are or how well you cope, these emotions will affect you – it’s not letting them take over which is the key.
 
Eventually, after nearly a year – short by all accounts – the complaint was finally closed with no case to answer. I received a letter from the GOC informing me that they could find no merit in taking it further and that my record keeping was adequate. The wording of the letter gave the impression that the GOC was disappointed to be dropping the case, and I still felt I’d had my knuckles rapped, even though I had done nothing wrong.
 
Although relived, I felt drained and unsure whether I wanted to carry on. I love my job as an optometrist, and I get very enthusiastic, so for someone like me to consider throwing in the towel highlights how stressful the situation can be.   
 
Every practitioner has a day when we are distracted from giving the best to our patients and I defy anyone to produce 10 years of perfect practise – no matter how good you are. Yes, you may be the ‘go to person’ for the local GPs, be a local representative or have reams of anecdotes from your local consultants that you are the best in the business. But you’re only as good as your last test. By writing this article, I wanted to show that anyone could end up in front of the GOC. I would like it to become less of a taboo subject and that, yes, occasionally, your practices will have to change to cope with a changing society.
 
BOXOUT: 

<Crosshead> ANDREA’S TAKE-AWAY ADVICE
1 Contact the AOP legal team before you do anything else. Do not reply to a patient before you have taken advice. A poorly worded letter often inflames a situation. The AOP legal department is brilliant. The team become your friend, confidante, support and sounding board
2 Talk. Tell your family and friends first, but also speak to colleagues. As professionals in a modern society, we are likely to get complaints, and some cases are valid – for example, missed pathology – but many arise because a badly handled complaint about a product has resulted in an escalation to the GOC. Instead of judging our colleagues and assuming they must have done wrong, give them the benefit of the doubt. Some of the cases which end up in front of the Fitness to Practise panel arise out of a ridiculous patient statement, which leads to a performance assessment by the GOC. That can go badly because of nerves and can lead to a set of charges which are actually relatively minor. We could all end up there. If we start to be less judgmental about our colleagues going through the system then it may be easier to speak out when going through a case
3 Keep good records. My case was definitely helped by my record keeping – once the original complaint had been found to have no validity, there was no further case to answer with my record keeping. I am not advocating that we practice ultra defensively, which is often just as bad and is not in the public interest. However, routinely review your practice, and make sure your record cards are up to date, have enough salient information and make sense.