Second Standing Committee on Delegated Legislation
Tuesday 25 March 2003
[Mr. George Stevenson in the Chair]
Draft General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003
The Minister of State, Department of Health (Mr. John Hutton): I beg to move,
The order has already been considered and passed by the Scottish Parliament: the Committee will be aware that some of the matters that we shall discuss today are devolved, particularly regulations on the training of general practitioners.
The order will establish a new body that will be able to reform the way in which we train and educate the doctors of the future, so that they are better able to meet the needs of patients and of the national health service. Those reforms have several objectives. They will introduce a more flexible system for regulating the education and training of doctors. For the first time, the NHS and the public will be well represented, as well as the medical royal colleges. The arrangements for training general practitioners and specialists will be brought together in one organisation, and there will be a new GP register to sit alongside the existing specialist register.
The new body will be charged with ensuring that training standards are maintained for independent medical practitioners in primary care in the NHS and for specialists. Faster, fairer and more effective processes will be introduced to assess doctors on the practical demonstration of their competencies, as well as on their medical knowledge and qualifications. For the first time, those assessment processes will address properly the needs of doctors qualifying or training outside the European economic area. In short, it will be a fairer and more transparent system.
The order is a more flexible and adaptable piece of legislation, which will make it easier to make future improvements to the system of postgraduate medical education and training in the United Kingdom. However, any such changes will be for the board to determine.
The Government have consulted twice on the reforms. Issues raised in the responses—a total of more than 300 were received—have helped to shape the details of our policy and the order before the Committee. The response to that consultation showed a clear consensus for change. In bringing forward the proposals, I believe that we have met the concerns
Column Number: 004
initially expressed by the medical royal colleges and others.
Reforms of such magnitude need to rest on the broadest possible support—that of the professions as well as of patients and the wider public. The two consultation exercises, and the changes we made to the original draft order, have been designed to achieve that. Indeed, the Academy of Medical Royal Colleges has said that it ''strongly supports the philosophy'' behind the changes, and it recently confirmed that
''all the Colleges, without dissent, are in agreement''.
The order is recognised and accepted as an important step forward for medical education and training in the UK. In fact, a great deal of developmental work, on which the board will be able to draw, has already been taken forward by the profession—for example, on examinations and assessments, and on better ways of quality-assuring training. It is in the wider public interest that that close working relationship is further developed and strengthened when the board is established, and we will do all that we can to ensure that that happens. The recent memorandum of understanding between the Academy of Medical Royal Colleges and the Department of Health marks a significant step forward in that direction.
One of the key features of the reforms is that patients and the NHS will in future make a greater contribution in determining the standards of education and training for doctors. That wider representation will also be reflected in the board's committees, where the detailed work will be done.
Peter Bottomley (Worthing, West): Before the Minister tells us about those committees, I understand that the royal colleges are happy, but can he say whether the body that represents virtually all doctors—the British Medical Association—is happy? Is there some reason that it does not have an automatic place on the board?
Mr. Hutton: I understand that the BMA is content with the reforms. The BMA has no direct representation now vis-à-vis the specialist training authority or the joint committee for postgraduate training of general practitioners, so we are not proposing to change the arrangements for that aspect of representation on the board.
The opportunity to act as one of the six representatives from the medical royal colleges who will eventually join the new postgraduate medical education and training board will provide only one route on to the board for the medical profession. As I shall explain, there will be a medical majority on the new board, as there should be, because professional education and training should be regarded as an important part of professional self-regulation. After all, it is the gateway into medicine and a career as a doctor, so it is right that issues relating to professional standards should be determined by qualified members of the profession. That is a normal feature of professional self-regulation in all fields and we would not want to change it. I am sure that there will be members of the BMA on the postgraduate medical
Column Number: 005
education and training board, but they will not be there simply because they are members of the BMA.
As I was saying, it is right that the detailed work should be carried out by the committees. That will ensure that the broader competencies required of modern doctors, such as team working and communication skills, are also included in training curricula, alongside the detailed clinical knowledge that doctors clearly need. In that important respect, the order will help to support our efforts to improve the quality of care in the NHS. The provisions will contribute to the implementation of the major programme of reform that we have announced to modernise medical careers, bringing more structure and coherence to the early stages of postgraduate training. We need to ensure that doctors in both training grades and service posts are well supported and able to plan and develop their careers in the NHS. The new postgraduate medical education and training board will be crucial to the success of the wider reforms to medical careers.
Hon. Members will obviously want to ask why the change is required at all. Our medical training system is, rightly, admired throughout the world, but the order recognises that it needs to develop further to ensure that our future doctors are able to deliver quality services in the ways that patients want and in partnership with other members of wider health care teams. Furthermore, the medical education and training system must be flexible and adaptable and capable of responding quickly to changes in the delivery of health care services in the NHS. So this is not change for change's sake. We recognise that we must not lose the many excellent features of our current training system, and the order will ensure that that does not happen. For example, the order recognises the established role and expertise of the medical royal colleges. However, we should change those aspects of the present arrangements that do not work so well, such as the current separation of general practice from the rest of medical training, and the way in which colleges sometimes work almost in isolation from each other.
I want to place on record my appreciation of the work done by the two outgoing bodies. The joint committee on postgraduate training for general practice has formally supervised general practice training since 1981. Since 1995, the specialist training authority of the medical royal colleges has supervised specialist training. Both bodies have made a significant contribution to the development of medical education and training and have done as much as they could within a limiting regulatory system.
I should like to highlight several especially important changes that we are making. In future, all GPs will need to be on the new GP register. This move has been strongly supported by the medical profession as a whole, not just by those in general practice. Anyone currently eligible to work in general practice in the NHS will be entitled to register. No one currently working as a GP in the NHS, who is correctly registered and legally able to work as a GP, will be prevented from entry to the new GP register and from working as a GP in the NHS. The GP
Column Number: 006
register will make a big difference to patients and employers, who will easily be able to check a doctor's registration online.
Secondly, the new system will be required to work more efficiently. The board and the General Medical Council will be required to give decisions about the eligibility for registration of both general practitioners and hospital specialists within three months of receiving a full application. That will end the current situation in which doctors, particularly those applying from outside the European economic area, often have to wait a considerable length of time for a decision. Many doctors who have obtained qualifications outside the European economic area and are currently working in the UK are unable to progress in their careers because the current educative system does not recognise their training and qualifications. Many, as a result, have no prospect of developing their careers, and therefore no chance of becoming a consultant. That must change, because it denies the NHS the benefits of those doctors' full potential contribution. It is a waste of valuable expertise and resources.