First Standing Committee
on Delegated Legislation
Tuesday 26 November 2002
[Mr. George Stevenson in the Chair]
Draft Medical Act 1983
(Amendment) Order 2002
The Minister of State, Department of Health (Mr. John Hutton): I beg to move,
That the Committee has considered the draft Medical Act 1983 (Amendment) Order 2002.
I can confirm that the provisions are compatible with the European convention on human rights.
The order will bring about major reforms of the General Medical Council, probably the most wide-ranging in its history, to help it to become more efficient and effective in discharging the important responsibilities that the House has asked it to perform on behalf of the public.
In essence, the reforms have been designed to achieve three important objectives: to provide, first, better protection and improved safeguards for the public, secondly, clearer and more straightforward procedures in relation to fitness to practice that are in the interests of both the medical profession and the public, and finally, greater accountability and transparency in the workings of the GMC.
The reforms have been the subject of extensive consultation and discussion for several years. The proposals command widespread support among consumer and patient groups and the profession. That consensus will be important in helping to ensure that the reforms have the best possible start.
In future, the GMC will be smaller, more focused and quicker to respond to change. It will be more accountable for all that it does and there will be greater involvement of people outside the GMC, both lay and professional. It will be better able to meet public expectations that a doctor's entry on the register means that they are keeping up to date with the latest developments in practice and research. It will be able to handle complaints against doctors more quickly and fairly where a doctor's continued registration has been called into question.
The reforms should not be seen in isolation, because this is a time of considerable reform to profession-led self-regulation. This year, for example, the new Nursing and Midwifery Council and the Health Professions Council have started to operate. The Government are committed to the principle of professional self-regulation, which is the right way to regulate these essential professions. The House has a responsibility to ensure that the system works efficiently and effectively and meets the needs of modern society, which is what the Government and the regulatory bodies have been working to achieve.
I want to place on record my gratitude to the GMC for the constructive and positive way in which it has
Column Number: 4
approached the case for change. It is not change for it's own sake. The changes represent the latest stage in our ongoing work to strengthen and modernise professional self-regulation for the benefit of both patients and professionals. The case for change is clear: professional regulation needs to be more accountable, open, transparent and responsive to the increasing pace of change in the delivery of health-care services. Regulatory bodies also need to develop a more consistent approach with greater integration and more co-operation between them. The reforms reflect the fact that patients must be the focus of everything that we do. The GMC shares the Government's belief that the system needs to put patients' interests first, but that does not mean that the procedures for registration or removing doctors from the register should not be scrupulously fair. The changes will be fairer to doctors as well as providing better protection for the public.
The new GMC will be smaller and able to work more quickly in the public interest. It will have quicker and simpler procedures, especially when a doctor's fitness to practice has been called into question. There will be far greater lay representation than before and for the first time the GMC will be able to link registration with performance through the introduction of revalidation for all doctors. Proposals for reform have been developed by the GMC, following careful and widespread consultation with patients and the medical profession. I am grateful to all those who have contributed.
There was overwhelming support for reform in response to the Government's consultation on the draft order. The Consumers Association described the reforms as crucial if the GMC is to modernise and better equip itself to respond to fundamental changes in the way that patients receive care and in their relationship with doctors, genuinely making protection of the public its first priority. The Royal College of Physicians welcomed the proposals for the reform of the GMC, saying that it recognised the need to streamline its procedures to ensure that it can respond more swiftly to cases that are reported.
The order makes several amendments to the Medical Act 1983 rather than seeking to replace it. We have tried to keep the wording as simple as possible, but the fact that we are amending primary legislation in this way inevitably means that the order is complex. I hope that the explanatory memorandum that we published when the order was brought before the House will have helped Members to understand the detailed changes that we are making.
The reforms cover three main areas: constitution and governance, licence to practise and revalidation, and fitness to practice procedures. In the national health service plan published in July 2000, we said that, as a minimum, regulatory bodies must change so that they are smaller, have more patients and members of the public as their members, have faster and more transparent procedures, and develop meaningful accountability to the health service. Article 4.2 is a large step forward in meeting those needs. It paves the way for a reduction in the size of the GMC, from 104 members to a maximum of 35 members. It will thus be
Column Number: 5
able to take decisions more easily by functioning more like a board and less like a debating chamber.
Inevitably, a smaller council will be required to work in different ways. Members of the new council will not have the same role in fitness to practice cases as their predecessors enjoyed. Cases will be heard by panels composed of non-members, including doctors and lay people. The effect of that, together with the opportunity for non-members to sit on working committees, will result in a welcome increase in the number of members of the public taking an active part in the work of the GMC.
Lay members currently form only 25 per cent. of the GMC. In future, they will form no less than 40 per cent.—14 out of 35 members. That will help to ensure that the voices of patients and the public are heard even more clearly, which will help to maintain public confidence in the medical profession and the way in which it is regulated.
I referred earlier to the changes to the membership of the GMC, and this is a suitable opportunity for me to thank the three right hon. and hon. Members who serve as lay members on it. I am thinking of my right hon. Friend the Member for Rother Valley (Mr. Barron), who has played a distinguished role on it, as have the hon. Member for South-East Cornwall (Mr. Breed) and the hon. Member for Woking (Mr. Malins). I know that the GMC has greatly valued their contribution to its work, especially during the process of developing the reforms.
As a result of the changes to the governance of the GMC, there will no longer be three places for MPs on the new council. However, the links to Parliament are important. As a statutory body, the GMC will continue to be fully accountable to Parliament. Indeed, we have strengthened that link by ensuring that the council reports annually to Parliament through the Privy Council. The Medical Act 1983, as revised by the order, will now require that the report be laid before each House. The GMC will come under the remit of the new Council for the Regulation of Health Care Professionals, as do other regulatory bodies. That new body will report to Parliament, thereby helping us to hold regulators to account much more effectively.
In his report of the public inquiry into children's heart surgery at the Bristol royal infirmary, Professor Sir Ian Kennedy said:
''An effective system of professional regulation must be owned collectively. Further, it needs an independence from the professions and from government which allows it to act in the public interest.''
I believe that the order will help us to realise those important objectives.
The order does not, of course, go into every detail of the governance of the new council. A great deal will be dealt with in secondary legislation, and will be subject to scrutiny by the Privy Council and this House. The first of those statutory instruments will be the new GMC constitution order, a draft of which we have already published. The constitution order sets out the numbers of members, how they are selected, their terms of office and those of their new president. It also covers the termination of office of existing members,
Column Number: 6
and sets the quorum of the new council at 25. As right hon. and hon. Members will know, those regulations will be subject to the negative resolution procedure.
I mentioned the need for regulatory bodies to be more consistent and to work together. That key theme emerged from our consultation on the draft order, and was a strong theme in Professor Sir Ian Kennedy's report. As a result, the order makes several changes to make the GMC more consistent with other regulatory bodies. Patients today expect a modern system of professional regulation to ensure the highest possible standards of public protection, whether they are treated by a doctor, nurse or other health care professional. For the first time, therefore, and in accordance with the approach that we are taking with the Nursing and Midwifery Council and the Health Professions Council, the order defines for the first time the main objective of the GMC as
''to protect . . . and maintain the health and safety of the public.''
Too often, we have heard the criticism that the GMC is about protecting doctors' interests. The reforms will ensure that that criticism can have no future validity. The objects of the new GMC will, by virtue of the order, be inserted into the Medical Act 1983 and explicitly place the patient at the heart of everything that the GMC does.
The order places a new duty on the GMC to co-operate, as appropriate and where practicable, with other bodies that are concerned with the regulation of health care professionals. As new clinical roles develop in the health service, it is vital that the GMC can help to ensure that professionals working closely with doctors, and perhaps taking over some of the roles traditionally played by doctors, meet similarly high standards to those expected of doctors.
In recognition of the new spirit of partnership with patients and the public, the order places a duty on the GMC to inform the public about its work. That will be important if the GMC is to maintain the public's confidence, which I hope right hon. and hon. Members accept is a very important objective.
Keeping a medical register will be at the centre of the new GMC's functions. Information and communication technology will help to provide up-to-date information for anyone seeking information about a doctor's registration. The order helpfully clarifies the GMC's freedom to publish the register on the internet.
The order makes a number of other changes in the registration of doctors, but these are essentially transitional arrangements, as the GMC is working on a more fundamental review of registration. It will report next year and there will be further consultation. A subsequent order will be made under section 60 of the Health Act 1999, and the House will have a full opportunity to consider that proposal, too. The most significant of the changes proposed today is probably the granting of more extensive rights of appeal against registration decisions—for example, against a GMC decision not to let a doctor progress from limited to full registration.
Today, however, patients want to know more than whether a doctor is simply on the register; they want to
Column Number: 7
know whether the doctor is up to date with current practice. Therefore, the order will make an important change by introducing a licence to practise. In future, only doctors with such a licence will be able to treat patients and prescribe drugs. A licence may be withdrawn if a doctor fails to maintain their fitness to practise or does not demonstrate through the GMC's new revalidation procedures that they are up to date and fit to practise.
Introducing revalidation for all doctors is a key feature of the changes that we are debating. In future, every practising doctor will have to submit evidence to the GMC, collected over a five-year period, that their practice is up to date and of a sufficiently high standard. Provided that a doctor meets those standards, they will retain their licence to practise. Those doctors who choose not to take part, or who do not meet the required standard, will not be issued with such a licence. That process will be supported by the separate introduction of an appraisal system for all doctors working in the NHS. They will discuss their practice with their employer or a recognised NHS appraiser annually.
Revalidation will help doctors to show that they are giving good medical care, support them in improving and developing their practice, and enable them to identify and correct any weaknesses. If concerns are raised about a doctor's fitness to practise during the revalidation process, they can be referred to the GMC's fitness to practise procedures. Those procedures, for handling concerns about a doctor's conduct, performance or health, are perhaps the most prominent aspect of the GMC's work, and bring it into close contact with the public and the media. Over the years, many right hon. and hon. Members will have been involved in dealing with such cases on behalf of their constituents.
I stress, however, that although the number of complaints has been increasing year on year, the vast majority of people receive excellent service from committed and caring professionals working to high standards, which the GMC helps us to maintain. When things go wrong, as they inevitably will from time to time, it is important to have effective procedures in place to deal with that.
In most cases, the best way to deal with concerns about a doctor's conduct, performance or health is through local action, at the source of the problem. The National Clinical Assessment Authority plays a key role in supporting doctors and employers in that, and has been involved in more than 400 cases since its establishment last April. However, the NCAA will not take over the role of the employer or regulatory body. The intention is that the NHS trust should be able to catch a problem early, before patients are harmed, and that the NCAA will help it to resolve the problem where possible.
The role of the GMC is to make decisions on those cases in which the problem is so serious that a doctor's registration has been called into question. The new GMC will therefore concentrate on the most serious
Column Number: 8
cases, and on those in which local action cannot secure adequate public protection.
It is in everyone's interests that the procedures are fast, fair and efficient. The order provides for important changes to the GMC's fitness to practise procedures, to ensure that they fulfil their purpose and maintain the right balance between the legitimate expectations of patients and the rights of individual doctors.
The order includes a radical overhaul of the initial stages of case handling, reducing them from two to one, so that the process will be quick, effective and fair. The detail of those rules will be set out in secondary legislation. Right hon. and hon. Members may refer to article 13 of the order.
The arrangements for handling fitness to practise cases will be improved. A unified process will replace the current three separate procedures. Formal conduct hearings will be confined to serious allegations that call into question the doctor's registration. There will be a new procedure for dealing with cases that are less serious, but that might deserve a lesser sanction, such as a formal warning.
The changes will mean that procedures and rules will be simpler and processes speedier. There will be more meaningful involvement of those who bring cases to the GMC's attention, and interested parties will be kept informed of progress.
The streamlined fitness to practise procedures, together with the changes that we have made to the constitution and governance of the GMC, and the introduction of revalidation for doctors fully meet the aims of the modernised professional self-regulation that I described. The new GMC will be more open, accountable and responsive to change than ever before.
The GMC has undertaken a huge amount of work in engaging the profession and other stakeholders in determining the future of profession-led self-regulation for doctors. Events at Bristol, and the publication of the Kennedy report, gave that exercise an additional imperative and urgency.
The case for reform was debated extensively with stakeholders and widely accepted. I believe that the proposals before the Committee today will ensure that the new GMC will be able to respond to the need for reform and to set the pace of that reform. I therefore commend the order to the Committee.