Select Committee on Health Written Evidence

Supplementary memorandum by the Postgraduate Medical Education and Training Board (MMC 27A)


  Following the recent telephone conversation with the Committee Specialist I am writing to set out PMETB's position regarding recommendation 30 of the MMC Inquiry report. As you know the report recommends that:

    "PMETB should be assimilated in a regulatory structure within GMC that oversees the continuum of undergraduate and postgraduate medical education and training, continuing professional development, quality assurance and enhancement".

  As Professor Rubin indicated when giving oral evidence to the Committee on 24 January 2008 he has a conflict of interest given his chairmanship of both the GMC Education Committee and PMETB, he has therefore stood back from discussions on this topic.

  PMETB's Board has discussed the issue of merger on a number of occasions in the past 18 months and the Board is opposed to any change to the structure of the regulatory bodies at this time.

  In coming to this position the Board has considered a number of key issues which I set out below.

  Firstly, government has already considered this issue in the last year and concluded that a merger would not be appropriate at this time.

  Sir Liam Donaldson's report into the future of medical regulation Good Doctors, Safer Patients recommended that the education functions of the GMC should be merged with PMETB to provide a single regulator for the continuum of medical education. The government rejected this proposal, and the various alternatives suggested during the consultation on Sir Liam's report.

  In the subsequent White Paper, Trust, Assurance and Safety—The Regulation of Health Professionals in the 21st Century? published in February 2007, the government gave two principle reasons for this position:

    —  First the proposed wide-ranging reforms to the GMC will be a significant challenge for the regulator to manage while continuing to exercise its core functions.

    —  Second, PMETB is a relatively new organisation, which, after a difficult start, is beginning to consolidate its performance.

  If anything, one year later PMETB believes these arguments are even more cogent and nothing in the past year has changed the rationale for this decision.

  Secondly, PMETB is making strong progress and its work is now widely recognised as improving the quality and standards of medical education and training in the UK. During the passage of its work the MMC Inquiry made no suggestion that PMETB failed to meet its statutory responsibilities nor was the Board criticised by the Inquiry. The Inquiry highlighted the significant achievements of PMETB over the last two years and this progress has been highlighted by a number of witnesses before your Committee during the recent oral evidence sessions.

  Thirdly, the coming years am likely to be a period of further uncertainty and change within postgraduate medical education and training, following the report of the MMC Inquiry and the government's forthcoming response to that report. PMETB itself is currently putting in place a new framework for quality assurance which has wide support from those with an interest in postgraduate medical education and training. During this time it would seem appropriate that the regulators are focused not on structural change but on ensuring the impact of any changes is properly monitored to ensure that training standards are maintained. Indeed some of the changes suggested by the MMC Inquiry require the regulator to implement them.

  Fourthly, as a relatively new regulator PMETB has been able to bring a new approach to the regulation of medical education. For example, in reviewing the content and outcomes of postgraduate medical education training, the Board has drawn on its statutory responsibilities to take into account a wide range of stakeholders. The new quality framework seeks to meet the principles of good regulation set out by the Cabinet Office, significantly reducing the burden of regulation whilst developing new tools to ensure ongoing pressure to improve quality.

  Finally, some have suggested that PMETB is not independent of government and this is a key reason for placing the Board within the structure of the GMC. PMETB protects its independence strongly and we seek to balance all of the different Interests in postgraduate medical education and training. We are not aware of any evidence that our independence has been undermined. To ensure our autonomy in the longer term we are moving to a self-financing business model.

  The government is committed to reviewing the structure of medical education regulation in 2011. This would be the right time to have a proper debate about continuum of regulation from undergraduate to continued professional development. To change the structure now would be an unwelcome distraction which will do nothing to tackle the current Issues facing the training of doctors within the UK.

Luke Bruce

Director, Policy & Communications

13 February 2008

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