Criminal doctors: Can they be stopped?

Crimes by GPs are rare

A government watchdog says that the NHS complaints system should be revamped to try to catch doctors who abuse their positions to commit serious crimes against their patients.

However, would their recommendations have prevented Dr Peter Green's series of sex assaults?

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The NHS gets plenty of complaints from unhappy patients, and almost as many from those unhappy with the way the complaints process has dealt with them.

Doctors who abuse their patients in a similar way to Dr Peter Green are extremely rare, and there are fears that no monitoring system can guarantee to detect those hellbent on breaking the law.

In the Green case, says the Commission for Health Improvement, there were a number of conspicuous failures.

Over the years, a number of people, both patients and staff, had either lodged a complaint about him, or expressed their worries about his conduct, but to no avail.

Strengthened system

Now CHI wants change - most principally, a centralised register of complaints against doctors which it hopes would make it easier to spot a series of worries about the same doctor.

We want to see a much earlier trigger of discussion about concerns so that things don't go on so long

Liz Fradd, CHI

It also wants a system which triggers a swift and rigorous investigation if more serious abuses of trust are suspected.

Liz Fradd, one of those who drew up the recommendations, told the BBC: "We want to see a much earlier trigger of discussion about concerns so that things don't go on so long."

The NHS complaints system has already undergone one reform since the time these offences were committed.

This, however, was mainly intended to increase the pace of its deliberations than improve watchfulness for the worst doctors.

Shipman failures

However, there have been other changes, some perhaps prompted by the Harold Shipman case - another doctor whose crimes went undetected for decades.

At the moment, health authorities and the primary care trusts which run GP services cannot step in and stop doctors from working - even if there are serious complaints.

Soon, they will be able to do this.

The General Medical Council, which regulates the profession, has also already taken on new powers which allow it to suspend a doctor swiftly from the register, even before their investigations are complete.

These measures handle one end of the process - actions which can be taken once problems have come to light.

Finding criminals

However, there still remains the problem of unearthing crimes and misdemeanours in the first place.

The government is introducing annual appraisals of doctors, but again, the focus of these is arguably more towards checking that doctors' clinical skills are up to date and that they are in tune with the latest medical thinking and treatments.

Professor Mike Pringle, the chairman of the Royal College of GPs, told BBC News Online that he believed that appraisals and routine monitoring would never be able to trap criminal doctors such as Green.

Many doctors are suspended yet then completely exonerated - but the process has left them psychologically scarred.

Professor Mike Pringle, Royal College of GPs

He said: "Criminals who wish to evade discovery will know how to beat these systems."

If this is the case, the way the NHS handles its patient complaints may be the key to an effective "early warning system".

One recommendation is that if a member of staff has a concern about a colleague, there should be a case conference to check that this is not simply an isolated worry.

Professor Pringle said: "I do think that it should be possible to share this sort of information more effectively - this is what appears not to have happened in the Dr Green case."

But some doctors fear that the more sensitive trigger mechanisms demanded by CHI could make the lives of the wrongly-accused even more difficult.

There are many unfounded complaints - many of a very serious nature - made against GPs every year.

In fact, a great many GPs will face such an accusation at some point in their careers.

At the moment, they are mostly allowed to carry on working while the tortuously slow complaints system exonerates them.

In future, in common with doctors in the hospital sector, they may have to be suspended during this investigation, which could last months.

Professor Pringle said: "Many doctors are suspended yet then completely exonerated - but the process has left them psychologically scarred.

"We need far more rapid assessment of these complaints and concerns."