Evidence submitted by the General Medical
Council (ISTC 38)
The General Medical Council (GMC) welcomes this
opportunity to respond to the Health Select Committee Inquiry
into Independent Sector Treatment Centres.
The GMC's role in the regulation of doctors
is defined in our statutory and charitable purposes: to protect,
promote and maintain the health and safety of the public by ensuring
proper standards in the practice of medicine. The law gives us
four main functions under the Medical Act 1983: keeping
up-to-date registers of qualified doctors; fostering good medical
practice; promoting high standards of medical education and dealing
firmly and fairly with doctors whose fitness to practise is in
doubt.
The GMC is not in a position to comment on the
main focus of the Inquiry, as it is beyond our remit. However,
there are some areas that we feel it would be useful to clarify
our position on to assist the Committee in its Inquiry. These
areas are outlined below.
REGISTRATION OF
DOCTORS
All doctors working in the United Kingdom have
to hold GMC registration. This applies equally to medical graduates
from the UK, the EEA and the rest of the world. All doctors working
within Independent Sector Treatment Centres, regardless of the
duration of their period of employment in the UK or country of
origin, must be registered with the GMC.
The GMC's ability to require all doctors who
want to practise medicine in the UK to be registered is essential
to our role in ensuring patient safety. In order to protect this
function we successfully fought the proposal originally contained
in the Directive on the Recognition of Professional Qualifications
that would have allowed EEA doctors to work unregistered in the
UK for a period of up to 16 weeks.
If doubts are raised about a UK-registered doctor's
fitness to practise, he or she will be investigated by the GMC's
Fitness to Practise Directorate. Decisions on this are taken regardless
of whether the doctor remains in the UK. If necessary a doctor
can be removed from the medical register preventing his or her
return to practise medicine in the UK.
Once we have taken action, we routinely notify
a wide range of interested parties including regulators outside
the UK.
INDEMNITY INSURANCE
To practise medicine in the UK a doctor must
be covered by the necessary indemnity insurance. This applies
to all doctors, working in all ISTCs.
Our core statutory guidance for doctors, Good
Medical Practice, imposes a professional obligation on doctors
to,
"obtain adequate insurance or professional
indemnity cover for any part of [their] practice not covered by
an employer's indemnity scheme."
To strengthen this requirement, the Department
of Health has just finished consulting on proposals, developed
with the GMC, to make possession of adequate insurance or indemnity
cover a statutory requirement for registration. If doctors do
not have adequate arrangements in place, they may be refused a
licence to practise or risk losing their licence.
It is expected that these changes will be introduced
under a Section 60 Order to the Medical Act 1983 later this year.
CONTINUITY OF
CARE
We are aware that concerns have been voiced
over the continuity of care and services provided in ISTCs.
In our key guidance for doctors, Good Medical
Practice, we provide advice for doctors on ensuring best practice
in continuity of care. The guidance states:
"It is in patients' best interests for one
doctor, usually a general practitioner, to be fully informed about,
and responsible for maintaining continuity of, a patient's medical
care."
The guidance describes the principles of good
medical practice and the standards of competence, care and conduct
expected of doctors in all aspects of their work. Serious or persistent
failures to meet those standards may result in referral to a Fitness
to Practise Panel, which has powers to restrict or remove a doctor's
registration.
MEDICAL TRAINING
The GMC Education Committee sets outcomes and
standards for undergraduate medical education in Tomorrow's
Doctors and quality assures this through the QABME (Quality
Assurance of Basic Medical Education) programme.
The Committee also sets outcomes and standards
for the training of provisionally registered doctors in The New
Doctor and in partnership with PMETB quality assures the Foundation
Programme, that now incorporates this period of training, through
QAFP (Quality Assurance of the Foundation Programme).
It is not clear how far medical students and
Foundation Programme trainees will be educated and trained within
ISTCs. It will be important to ensure that all such education
and training meets the standards set by the GMC and PMETB and
is subject to our quality assurance arrangements.
We understand that PMETB is making its own submission
to the Inquiry, which will go into more detail on these issues.
Hugh Simpson
Head of Public Affairs
General Medical Council
14 February 2006
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