Draft Medical Act 1983 (Amendment) Order 2002

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Chris Grayling (Epsom and Ewell): I welcome you to the Chair this morning, Mr. Stevenson. It is a pleasure for all of us to serve under your leadership.

As the Minister said, the order is about the Government's plans to reform the way in which the GMC works and how it addresses some of the undoubted problems, issues and challenges that have arisen in the medical area over the past few years. He mentioned the changes to procedures, the constitution of the GMC, and the Government's objective of creating greater patient focus within the regulatory system.

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In general, the order is not controversial, and I am sure that most hon. Members share the aspirations behind it. However, my colleagues and I believe that the Government must demonstrate that they have understood certain issues and lessons as they press ahead with the implementation of this order and of the follow-throughs that the Minister described, whether those are orders, statutory instruments, or decisions taken by the GMC itself.

Our concerns relate to all three areas of the order: the structure, constitution and governance of the GMC; the restructuring of the processes for reviewing and taking action on doctors' fitness to practise through the two new sets of procedures, the investigation committees and the fitness to practise panels; and the new process for the revalidation and registration of doctors to ensure that they are regularly monitored and their training and skills are up to date. We do not have a problem with those three issues, but we have reservations about the detail, as do some of the outside bodies who have contributed to the process. I hope that the Government will implement the order with great care.

Mr. Hutton: I am sorry to interrupt the hon. Gentleman at such an early stage. He referred to the Government's plans for re-registration and revalidation, and the way in which those reforms will be implemented. I remind him that it is the GMC's responsibility to develop those proposals, not the Government's.

Chris Grayling: Indeed, but I would be astonished if the Minister did not admit that this was a partnership between the Government and the GMC, and that it has been the result of a widespread exercise across health service professions. Many of the principles in the order have been espoused in reforms of other parts of the medical professions. Certainly, if my understanding of what the Government are trying to achieve is correct, common themes range across the new bodies that have been set up to regulate individual parts of the health care professions.

Some of the lessons that we have learnt from what has happened in other parts of the medical profession cause me great concern about the potential follow-through from the order. The key element of the order is the requirement for every doctor to either register or revalidate every five years. That is not wrong in principle, but making it a reality will be a huge challenge for the GMC. We have seen how significant the knock-on effect can be when it goes wrong. It is expected that the process will involve collecting documentation, including the NHS annual appraisals and other papers, and completing health and probity declarations. All of those papers will have to be submitted to a revalidation group that will then make recommendations to the GMC.

While there has been widespread support for the principle of requiring doctors to demonstrate periodically that they are fit to practise, there are dangers in the scale of the approach set out in the order. More than 100,000 doctors will have to register or revalidate their qualifications over the next five years. In addition, we will have a new intake into the profession from overseas recruitment and from the

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medical schools. By any measure, it represents a huge logistical challenge for the GMC. It will work only if the NHS appraisal system works well. That has not always happened in the past.

I will watch with interest to see how the Government's proposed reforms to the appraisal system develop, but how will the reforms ensure that the system is enacted across the NHS and that it is consistent? We cannot have inconsistency in something that relates so centrally to the future careers of our doctors. There must be a level playing field when they come to seek revalidation on the basis of those appraisals. This is a giant logistical challenge for a body that is already going through significant organisational changes. Can it cope? The recent history of reformed medical bodies does not lead us to be too optimistic.

We must remember the experience of the past few months, in particular the lessons to be learned from the establishment of the Nursing and Midwifery Council. The NMC took over responsibility for registering nurses in April and within a matter of weeks nursing and midwifery were in a state of chaos. Many nurses found themselves unregistered and unable to practise. Some lost out financially as a result. Back in June, the Royal College of Nursing went so far as to say that it felt that there was a need to back damages claims from nurses for loss of earnings as a result of the shortcomings in the registration procedure. Many experienced NHS professionals who had worked in nursing or midwifery for a considerable period found themselves at risk or working illegally due to the delays, complications and failures of that registration process. They had to decide whether to continue. Those changes caused real desperation in the nursing profession; it was not just the delays but the way in which the chaos at the NMC manifested itself.

A constituent came to see me because she was hugely frustrated by her inability to continue her career as a result of the problems in the registration system. She received three letters from the NMC on the same day saying entirely different things about the process. The danger is that that could happen again if, when the GMC adopts this new registration requirement, it does not get its systems in order, does not have the right IT and does have the right administrative support in place. If that fails to work, we risk further problems in recruiting doctors from overseas—a central part of the Government's strategy. Again, the NMC experience weakened the recruitment process.

The Minister will be aware of various failings in the registration process that have been raised by hon. Members or in the press. The Guardian revealed the case of an experienced Australian nurse who had come to this country to work but could not be certain about when she could start doing so. She was quoted as saying:

    ''It's ridiculous. They are short of nurses and here's someone like me waiting and waiting. They have made mistake after mistake and now they are telling me my application has lapsed. Does the NHS want more nurses or not?''

Can we be certain that the registration process for doctors will work sufficiently smoothly to ensure that

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we do not leave overseas doctors in the same predicament as overseas nurses have been during the past few months? Will the Minister provide some detailed reassurances on what the GMC will be required to do and its ability to deliver on the registration process? The medical profession—outside this place and outside the GMC—has voiced concerns about our ability to achieve that.

In June the Medical Protection Society warned of the risks ahead, observing:

    ''The problem here is that the GMC is already hopelessly overstretched.''

The dangers of failing to get it right include ending up with unlicensed GPs and the cancelling of operations because a surgeon has to decide whether a delayed registration should be ignored or adhered to. Those issues are crucial and must be dealt with before we can approve the order.

I should like to speak to two other issues—the composition of the new structures and the criteria on which fitness to practice is based. The Minister will know that some of the medical royal colleges voiced reservations about losing their voice in a smaller council, while others were concerned that a slimmer council might have difficulty delivering reforms on the significant issues of registration, revalidation, discipline and education. Will the Minister explain how those issues have been addressed in the order or will be addressed in subsequent orders?

Concerns have been expressed that the reduced size of the council will mean that many members of the committees established under the order will be non-members of the new slimmed-down council. Will the Minister explain how these people will be recruited, how their performance will be monitored and how they will be replaced if their performance is inadequate? To that end, we should reflect on the different sector of Network Rail, which pulled in lay members to serve on its—

The Chairman: Order. I was a little worried about the hon. Member's reference to nursing. He has made his point, but now that we are moving on to Network Rail, I hope that he will convince the Committee—and particularly me—that Network Rail is relevant to our debate.

Chris Grayling: I will happily do so, Mr. Stevenson. Network Rail had more difficulty attracting the full range of lay members to its committees than was originally envisaged, so I wish to ask the Minister how the same process of securing a broad range of lay members for GMC committees will be carried out? I hope that it will not be restricted to those who already have an active interest in the medical profession and that the Minister will, in setting up the new structures, succeed in securing the broad representation to which he aspires. The Minister paid tribute to the three hon. Members who have served on the GMC. In future, will MPs be excluded from the GMC, or will they have the same right to apply as any other potential lay member?

I shall now move on to the application of the registration system and the process of assessing

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whether a doctor should retain their licence. Will the Minister explain why the rights of doctors trained in the Commonwealth to full registration have been removed, while the same rights are conferred on European economic area nationals? It may be logical to have a single structure for applications from outside the UK, but the Minister will know that the Royal College of General Practitioners expressed concern about the removal of the previous requirement for ''a necessary knowledge'' of English. This country has a long tradition of taking doctors whose origins are in the Indian subcontinent. Many GP practices depend strongly on those doctors, who come here with high-quality skills and a good knowledge of the English language. Doctors from many countries in the European economic area may not offer this country the same degree of experience and language skills. Can the Minister explain why there is a different approach for those from the Indian subcontinent and elsewhere in the Commonwealth compared with those from other parts of the European economic area?

Will the Minister reply to the point raised by the Harrogate community health council that a doctor removed from the register had the right to apply for re-registration after five years? The CHC's point was that in serious cases the GMC should have the power to remove a licence for life. Does the five-year rule allow anyone to reapply, regardless of their circumstances? Why has five years been chosen when several professional bodies have warned that that might be too long for doctors to be able to get back into the profession because the nature of the skills that they need changes? There was a significant representation for three, not five, years to be chosen.

How will the new process protect GPs against malicious complaints? The Consumers Association was concerned that the proposals did not reflect the great diversity of jobs that doctors do now, and that some of the structures were too rigid.

I conclude by returning to the issue of bureaucracy. Some doubts were raised in the consultation exercise about the benefits that would be gained, set against the bureaucracy that would be created. The exercise will work only if it does not put undue pressures on doctors. I echo what the Minister said about the need for the system to protect patients, but the system must not be so much about protecting patients that it makes that more difficult for doctors to do. One failing of the Government in the past five years has been to over-regulate in pursuit of highly laudable aspirations. In the end they have caused so many problems for the professions that they are trying to reform that they have made it much more difficult to deliver a quality service. That must not happen in this case.

The Royal College of General Practitioners made a telling contribution to the consultation exercise. It said:

    ''GPs are already subject to at least 11 clinically related disciplinary and performance systems—many of these overlap''.

The college said that it was keen to see how the reform fits with the other procedures.

This is not a controversial order and these are not controversial reforms; however, if they are mishandled

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and the Government over-regulate and lose sight of the need to balance the interests of the patient with the ability of the system to encourage and enable doctors to do their job, there is a risk that the order will not work in the way that the Government want. I hope that the Minister can explain how he will ensure that that does not happen and that the experience in the nursing and midwifery sector will not be repeated when the GMC tries to validate, register and re-register more than 100,000 doctors in the next five years.

11.3 am

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Prepared 26 November 2002