Select Committee on Health Written Evidence


Evidence submitted by the General Medical Council (WP 68)

  1.  The GMC welcomes the opportunity to assist the Health Select Committee in its Inquiry into workforce needs and planning for the health service.

  2.  The GMC's remit does not extend to workforce planning or employment issues. However, the GMC is an important component of the medical workforce supply chain and we believe it would be helpful to clarify our roles in registration and in the education and training of UK doctors.

STATUTORY PURPOSE

  3.  Under the Medical Act 1983, the GMC's purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.

  4.  In support of this purpose, the GMC has four main functions:

    a.  Registering doctors, who meet the required standards, for medical practice in the UK.

    b.  Defining the outcomes to be achieved through, and assuring the standards of, basic medical education; and promoting high standards in, and coordinating all stages of, medical education.

    c.  Setting the standards of practice, standards of performance, and ethics that society and the profession expect of doctors throughout their working lives.

    d.  Dealing firmly and fairly with doctors whose fitness to practise may be impaired.

REGISTRATION

  5.  Doctors who wish to practise in the UK must be registered with the GMC.

  6.  There are three main routes to registration:

    a.  For doctors who qualified at a UK medical school.

    b.  For doctors who qualified within the European Economic Area and are EEA citizens or have European Community rights.

    c.  For international medical graduates who qualified outside the EEA or who qualified within the EEA and do not benefit from European Community rights.

  7.  Table 1 shows the total number of new registrations each year from 2002-05, subdivided across the three main routes. Please note that this information is not necessarily indicative of the number of doctors entering the workforce in the UK. For historical reasons many doctors have held GMC registration, though they remain resident in another jurisdiction. In 2003 for example the closure of a former direct route to registration (without an assessment of medical knowledge and skills) for doctors qualifying from seven countries ceased. Several thousand International Medical Graduates (IMGs) secured registration prior to the closure of the route though there is no evidence that they planned to come to the UK in the foreseeable future.

Table 1



Year

UK doctors

EEA doctors

IMGs
Total new
registrations


200532%16% 52%14,835
200432%24% 44%14,737
200325%10% 65%18,684
200239%14% 47%11,235




EEA doctors

  8.  The surge in EEA registrations in 2004 was the result of the expansion of the EEA through the addition of the EU accession countries.

  9.  The numbers of newly registered EEA doctors may not provide a reliable indicator of the doctors who joined the UK workforce for the first time. Although all EEA doctors must now complete the registration process in the UK, we are aware that a proportion of EEA doctors secure registration in advance of deciding to practise here.

International medical graduates

  10.  Table 1 shows that IMGs represent the largest proportion of new registrations, ranging from 44% in 2004 to 65% in 2003.

  11.  The surge in IMG registrations in 2003 was stimulated by the impending withdrawal of the special recognition, for historical reasons, of qualifications from seven countries—Australia, Hong Kong, New Zealand, Singapore, South Africa, the West Indies, Singapore and Malaysia. Qualifications from those countries are now treated on the same basis as other countries outside the EEA.

  12.  From 2004 onward, the numbers of newly registered IMGs provide a reasonably reliable indicator of the doctors who joined the UK workforce for the first time. IMGs must complete the registration process in the UK and registration is granted only when they have secured an offer of employment. This was less true prior to 2004, for example because of special recognition explained above.

  13.  Most IMGs secure registration having demonstrated their knowledge and skills by passing the Professional and Linguistic Assessments Board (PLAB) test. The PLAB test is in two parts, with Part 2 being available only in the UK. Doctors must pass Part 1 before taking Part 2. The great majority of IMGs who secure registration are seeking employment in training grades, not as specialists.

  14.  The number of PLAB test applicants rose steadily from 2000, when about 3,400 doctors took Part 1, to a peak in 2004, when about 12,600 doctors took Part 1. The numbers taking Part 2 rose correspondingly, from about 1,349 in 2000 to about 8,200 in 2004.

  15.  There has been widespread concern that the numbers of IMGs who have passed Part 2, and are in the UK seeking work, greatly exceed the number of posts available. Among other things, this led to calls that the GMC should ration test places, particularly for Part 2, on the basis that this would help to secure a better match between demand for, and supply of, jobs. This, however, would be unlawful.

  16.  We have, however, sought to work with the Department of Health and others to improve the information available to IMGs who are considering coming to the UK and to ensure that they understood that passing the PLAB test did not guarantee employment. For example:

    a.  In 2004 we began a regular survey of IMGs who had passed the PLAB test, to collect information about their employment experience in the UK. The results are published on our website. We would be pleased to supply a copy of the most recent survey results if that would be helpful.

    b.  We recruited, as advisers, a group of doctors who had taken the test, to assist in rewriting the information we provide. It includes fuller information on job prospects, on finding work, and on life in the UK. Doctors must confirm that they have read the relevant sections of the guidance before booking a Part 1 test place.

    c.  We work with others to try to provide a picture of the UK job market. However, there is undoubtedly room for further improvement.

    d.  In 2005, in conjunction with the Department of Health and the BMA, we commissioned a survey that looked at the employment experience of recently qualified UK doctors. We would be pleased to supply a copy of the survey results if that would be helpful. It can also be viewed on our website at www.gmc-uk.org/doctors/employment—surveys/index.asp.

  17.  The steps we and others have taken to improve the availability of information, combined with feedback through IMG networks, have led to a sharp drop in applications for Part 1 of the PLAB test, from about 12,600 in 2004 to about 9,100 in 2005. This downward trend has continued in the first two months of 2006.

  18.  While further analysis would be required, the experience of recent years appears to demonstrate that the supply of IMGs who wish to work and train in the UK can be stimulated and depressed through the availability of good quality information about the market.

  19.  On 7 March 2006, the Home Office announced that all IMGs wishing to work in the UK would be required to have a work permit from July 2006. We are communicating this to potential candidates via our website. We foresee that this will lead to a further drop in the numbers of applicants.

MEDICAL EDUCATION AND TRAINING

  21.  Under the 1983 Act, our Education Committee has the general function of promoting high standards of medical education and coordinating all stages of medical education. The 1983 Act lays down specific roles for the Education Committee in relation to undergraduate education and training for doctors with provisional registration. Doctors are granted provisional registration, usually for one year, on completion of their medical degree to enable them to continue their training in a managed environment.

  22.  The Postgraduate Medical Education and Training Board (PMETB) has functions relating to postgraduate medical education and training, set out in the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003. Effective medical education and training requires doctors with the time and the skills to deliver it in the workplace.

  23.  Neither the GMC nor PMETB has a remit to set the number of medical students and trainees. In England, medical schools are funded through the Higher Education Funding Council for England (HEFCE) and the Joint Implementation Group of HEFCE and the Department of Health makes decisions on student numbers. The funding of medical school numbers in the devolved nations is similarly a matter for the health departments and analogues to HEFCE.

  24.  In relation to undergraduate medical education, the GMC Education Committee determines the "knowledge and skills" and the "standard of proficiency" required on graduation from a UK medical school and we also set standards for medical schools. The guidance is set out in Tomorrow's Doctors which is available on the GMC website www.gmc-uk.org. We would be pleased to supply a copy if that would be helpful.

  25.  The GMC Education Committee ensures that undergraduate medical education is appropriate but does not attempt to define the workforce or other resources needed. In Tomorrow's Doctors we state that medical schools must make sure that their staff follow our guidance and are provided with the necessary training (paragraph 97). The UK health departments must make facilities available for students to receive training and decide how students may have access to patients (paragraphs 99 to 100). "Doctors with particular responsibility for teaching students must develop the skills, attitudes and practices of a competent teacher. They must also make sure that students are properly supervised," (paragraph 103).

  26.  To develop appropriate knowledge, skills, attitudes and behaviour, medical students should have contact with patients throughout their undergraduate courses. Tomorrow's Doctors states, "From the start, students must have opportunities to interact with people from a range of social, cultural and ethnic backgrounds . . . Such contact with patients encourages students to gain confidence in communicating with a wide range of people, and can help develop their ability to take patients' histories and examine patients," (paragraph 50).

  27.  Medical schools therefore place students in a variety of NHS settings. It is important that workforce planning adequately takes into account the need for doctors to find the time appropriately to train and assess medical students, without detriment to NHS services. Training inevitably reduces the number of procedures that can be carried out in the NHS, as doctors must take the time to show students what to do. It is essential that workforce planning takes into account this relationship between training and throughput.

  28.  In addition, doctors and other health service staff are involved in teaching medical students on university premises and in associated research. Workforce planning therefore needs to reflect the requirements of medical schools with their expanding student rolls.

  29.  Following medical school, graduates now enter the two-year Foundation Programme, which takes place within the NHS. The GMC Education Committee has responsibility for the first year. To enter the second year, graduates need to secure full registration with the GMC. Thereafter, PMETB is responsible for postgraduate medical education and training, incorporating the second year of the Foundation Programme and subsequent GP and other specialist training. We are working closely with PMETB to ensure that the outcomes required of doctors in the Foundation Programme, and the standards required of those providing that training, are clear and coherent.

  30.  The New Doctor sets out our guidance for the first year of the Foundation Programme. The current edition, published in 2005, is transitional, in preparation for expected changes in the Medical Act to modernise the legal structure for training. The current edition states that the health departments should make sure that NHS organisations work with universities and must make facilities available (paragraphs 135-136). Health service organisations must "put in place appropriate structures for making sure that high quality training is provided," (paragraph 137). "Doctors with particular responsibility for supervising PRHOs [Pre-Registration House Officers, that is, doctors in the first year of the Foundation Programme] must develop the skills, attitudes and practices of a competent teacher. They must also make sure that PRHOs are properly supervised," (paragraph 140). It is important therefore that workforce planning reflects the need for doctors to have the skills and finds the time to train and assess Foundation Programme trainees.

  31.  Alongside the Education Committee's interest in workforce planning that takes full account of the requirements of medical education and training, the GMC is keen to ensure that the knowledge, skills, attitudes and behaviour required of doctors remain appropriate. During 2005, we held an international conference and conducted a full-scale formal consultation on strategic options for undergraduate medical education. This covered themes that should be reflected in the next edition of Tomorrow's Doctors (scheduled for publication in 2008) alongside consideration of changes to the present arrangements for assessment and for consideration of students' fitness to practise. The Education Committee has a stream of work to consider how medical practice could develop in the decades ahead. Separately, the GMC Standards Committee is reviewing Good Medical Practice, our key guidance for doctors.

General Medical Council

March 2006





 
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