| Draft Medical Act 1983 (Amendment) Order 2002
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Mr. Kevin Barron (Rother Valley): The Minister has already said that I am a lay member of the GMC. I was appointed with two other hon. Members in the autumn of 1999. We shall be finishing our stint a few months early, about 1 July 2003, when the new Council comes into being. I have been heavily involved in many of the changes that will be made as a result of this and other orders. The GMC is noted for the fact that any policy committee of any shape or size must be elected from within its ranks. It must also have a medical majority, of which I am in favour. I am pleased that there is a medical majority on the new statutory council that will come into being next year. The percentage of lay members has increased substantially, but it is right to have a medical majority. I was elected to what was called the governance working group of the GMC. It had a medical majority of four medical members, and was led by Dr. Brian Keighley, a GP from Scotland, who chaired the group throughout. The other medical members were Dr. Joan Trowell, Mr. Douglas Gentleman—a consultant from Scotland—and Professor Hilary Thomas. The lay members were Sue Leggatte, who unfortunately was not reappointed recently, Mr. Bob Nicholls, Isabel Nisbet, who is still serving, and Antony Townsend, who I believe is now the chief executive of the General Dental Council, Andrew Kettringham, who replaced him, and me. It was with some trepidation that we started to consider a regulatory system that, by and large, had been place for more than 100 years. I remember my first council meeting: I had never been to a meeting at which there were so many political agendas, most of which I did not understand. Over time, however, I realised that medical politics is, in many ways, far worse than what happens in Committees or on the Floor of the House of Commons. I tried to remain an independent observer, but it was interesting to see how changes in governance came about. The chairman of the group was also active in the British Medical Association and, especially in the early days, spent a great deal of time going to and fro between the BMA and the GMC trying to secure agreement on how the GMC should be governed. Patients' organisations and the profession were widely consulted. Governance used to be talked about largely in relation to the BMA, but as hon. Members will know, it was one of the GMC's most vocal critics and, in the end, agreed with much of what we recommended. Column Number: 14 As I said, the new council will have 35 members, rather than its current 104. The profession is not entirely happy with that. The hon. Member for Epsom and Ewell (Chris Grayling) mentioned two organisations that he believed were concerned about the proposed new constitution. It is true that the medical royal colleges have several seats on the current GMC, but we cannot reduce the number of members from 104 to 35 and still have proper representation of the profession. I leave aside the issue of lay members. At one stage, when people made representations to the GMC about how they wanted to be represented on the new council, it seemed that we should have more than 104 members rather than reduce the number to one that was more manageable. The hon. Member for Epsom and Ewell referred to the Consumers Association. To my knowledge, the association is upset not about what the new council will be doing but about the lay members who will sit on it. As was mentioned, that will be a matter for those who apply. I received a letter saying that I could fill in a form if I wanted to apply. I assume that the other two Members of Parliament who sit on the council have received the same letter. I understand that there will be advertising in the national press over the next few weeks, so that anyone from anywhere in the United Kingdom who wants to be a lay member on the new body can lodge an application. I also understand that when the process has finished—early next year—the number of applicants who attended an interview will be made public. We do not know who the new lay members will be at this stage. I shall deal with one issue that was mentioned and which we considered in earnest. As I said, there are regular internal elections at the GMC, but the election of medical members to the council also has a great history. In Northern Ireland, Scotland and Wales, there is not too much of a problem, but the English region, as it still is until the provisions go through, is one constituency. That is the case for the length and breadth of England. I had to look through the papers when I was a member of the governance working group. In the last full election for 42 medical places in England, there were 336 candidates and therefore 336 statements from those candidates. The documentation was very thick and was sent to every doctor in England so that they could examine it and vote on a single ballot paper. I do not want to start a debate about electoral systems, but they should at least be coherent, and looking at that documentation, anyone who had been active in elected politics would not say that it was at all coherent. The idea that everyone would read all 336 statements and then decide on the 42 candidates for whom they wished to vote would stretch anyone's imagination. As a consequence, we have recommended that there should be five constituencies in England. There is basically a system of weighted votes, as there is approximately for election to this Parliament. That means that my region in South Yorkshire starts in South Humberside. I think that it picks up the constituencies of the hon. Member for Cheadle (Mrs. Calton) and my right hon. Friend the Member for Manchester, Withington (Mr. Bradley) and gets as Column Number: 15 far as Liverpool. That might not be what we would think of as a region, but in hard reality, with 15 seats, it was the best that we could do. We hope that, as a result, people will recognise their regional medical practitioners more, in terms of the vote, and that the reporting back will be a little better than it has been in the past.I do not wish to be unfair to any of my colleagues in the GMC, but my instinct was, with the current election system in England, that there was a good chance that the London suits would be elected once more. We shall have to see the impact of breaking the area up into regions, but it will probably be a major step forward when it comes to electing medical members. The GMC retains the education committee as a statutory body, which I think is important, although I have never worked on that side. However, other committees that deal with fitness to practise are replaced with new committees, most of which are referred to as panels: the investigation committee, the interim orders panels and the fitness to practise panels. The order also provides for the establishment of registration decisions panels and a registration appeals panel. On the fitness to practise panels, which I think are the most important, the GMC and the order seek to make a clear separation between panels that adjudicate cases, such as fitness to practise panels, and those that take earlier decisions on behalf of the GMC. A good example is given in the explanatory memorandum, so I shall repeat it. On registration, it refers to decisions
In other words, someone may want to be registered, but there may be a question mark over whether that should happen without a particular matter being considered. The memorandum also states:
That relates to the point raised by the hon. Member for Epsom and Ewell. For more than 12 months, there have been many associate members, both lay and medical members, to help the GMC on conduct committees. Quite rightly, a particular gripe among the profession for many years has been the length of time that it takes for a doctor who has been accused of being unfit to practise to have a hearing and be put through the GMC procedures. However, that is not always the fault of the GMC. Occasionally, litigation or obstacles at local level delay the arrival of the case at the GMC. Nevertheless, we have not seen as many doctors before conduct committees as we should. There has been a large increase in the number of both medical and lay members of panels. They were all interviewed and found fit to sit on the panels. I sit on a number of panels. One is called the assessment referral committee. For the last two months, associate Column Number: 16 members have sat with us. The regulations allow them to do that. They have mixed with people like myself who have been on these committees for a number of years now. They have gained experience of the work of the committees before the introduction of the changes. That is not possible on some other committees, but we are trying to do it on the interim orders committee. We need people to get the experience so that an army of inexperienced people is not brought in when these committees come into being.The fitness to practise procedures will be divided into two stages. First, the investigation will be overseen by the investigation committee and the fitness to practise panels. The order then provides for the investigation committee to look at allegations about a medical practitioner's fitness to practise if it is impaired. The separation of those functions should be welcomed by everyone, especially the profession, whose representatives have had concerns for many years that the GMC has been both prosecution and judge. These arrangements should go a long way to satisfy the profession that that will no longer be the case. It will also satisfy the public because these new procedures will be more transparent; they will be easier to understand and give a clearer picture of how the GMC works. Having sat on the GMC for a number of years, I can quite understand why people say that they are not quite sure who sits on what and where. I have been invited on a number of occasions to the preliminary proceedings committee. It looks at allegations that have been examined by one or two screeners and are then given to the committee to see whether the case should be proceeded with under the fitness to practise procedures. I have sat on the committee only twice because when one deals with a case at that stage—one may handle up to 50 cases in a day—one cannot deal with it further on in the proceedings. I stopped sitting on the preliminary proceedings committee so that I could sit on other committees. There can be confusion about who sits on what committee, where and when. I can well understand why the profession and the public are a little apprehensive about the current system. The rules will also introduce a single concept of impaired fitness to practise by reason of misconduct, deficient professional performance, a conviction, adverse physical or mental health or a determination by another regulatory body. That replaces the existing charges of serious professional misconduct, a conviction, seriously deficient performance and serious impairment of fitness to practise by reason of a physical or mental condition.
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| ©Parliamentary copyright 2002 | Prepared 26 November 2002 |
