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The Medical Act 1983, as amended by the Medical Act 1983 (Amendment) Order 2000, states that no application for restoration of a name to the register can be made to the professional conduct committee until five years from the date of erasure. Also, if an application has already been made and rejected, another application cannot be made for a further 12 months. That order
took effect on 3 August 2000, which means that any doctor whose name was erased on or after that date must wait for five years before they can apply for restoration.
Dr. Garfoot applied for restoration at the end of the initial five-year period. His application was heard in March 2008, when he informed the panel that he had reflected on his prescribing practices and that he now considered them to have been “ridiculous”. He also accepted the need to undertake further training in order to return to practice. However, the fitness to practise panel refused his application. In summing up, it remained very concerned about his lack of insight into general and fundamental problems and his failure to keep records, to monitor or review treatment and to keep his knowledge and skills up to date. He became eligible to reapply for restoration last week, on 10 March.
As I said, the new rules about applications for restoration raised by the hon. Member for North-West Norfolk came into force on 3 August 2000. The 2000 order included transitional arrangements for applications and the effect of those transitional arrangements was that the new rules applied unless erasure had already taken place by 3 August, even if the allegations related to an earlier time. That was the case even if the GMC had already started proceedings. The amendment therefore takes effect from the date that the decision is made and not the date on which the alleged incident or incidents took place. In Dr. Garfoot’s case, his name was not erased from the register until 26 June 2002 and so it was clear that the new rules applied to him.
The hon. Gentleman raised concerns about the dual function that the GMC used to have of hearing and adjudicating on processes. The GMC provides clear and concise guidance for doctors on restoration following erasure by a fitness to practise panel, and that guidance is published on its website. The criticism that the GMC faced during the Shipman inquiry led to the putting in place of new procedures in 2004. However, we believed that public and professional confidence in the system of regulation had already been undermined. The GMC was quick to recognise that reform was needed to change that perception, and to do so it made significant changes, including moving towards an internal separation of its investigation and adjudication functions. However, given the level of—
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Motion lapsed (Standing Order No. 9(3)).
Motion made, and Question proposed, That this House do now adjourn.—( Mark Tami.)
Mr. Bradshaw: However, given the level of public concern, the Government felt that the creation of an office of the health professions adjudicator would send a strong signal to the profession and the public that decisions regarding a doctor’s fitness to practise should be impartial and independent of those who investigate. We legislated to create the office of the health professions adjudicator in last year’s Health and Social Care Bill, and we expect it to be fully up and running by 2011.
As I have already stated, Dr. Garfoot became eligible to reapply on 10 March. I understand from the GMC that he has not so far done so, but that would be the next step if he wants to get back on the register.
Mr. Bellingham: I am very grateful to the Minister for giving way and for some of the points that he has made, which are very helpful. Does he agree that it seems inflexible and too rigid for the GMC, in a reinstatement hearing, not to be able to reinstatebut with conditions? Obviously, its main concern inDr. Garfoot’s case is not his suitability as a GP, but the way in which he ran the Laybourne clinic.
Mr. Bradshaw: I was just about to come to that, and I shall certainly reflect on the point that the hon. Gentleman makes and write to him in more detail about it. My understanding is that, if the GMC were able to do what he suggests it should, the problem would be that it refuses applications for initial registration where there is evidence that the applicant’s fitness to practise may be impaired. Therefore, it would not be consistent to make provisions for restoring an applicant to the register with conditions if he or she would be refused registration in the same circumstances at initial registration. It would be unfair to those people who have to prove that they are completely fit to practise for the initial registration.
The council discussed erasure and restoration in November 1999 and agreed an important principle:
“Doctors who have been erased have been excluded from the profession indefinitely. Only exceptionally will any doctor be restored to the register following erasure.”
The hon. Gentleman and my hon. Friend the Member for Bolton, South-East also raised the general issue of wider drugs policy. Both recognised that we have come a long way in the past 12 years or so in improving both provision and the general approach taken to helping drug addicts manage their addictions. We have increased substantially the number of people entering drug treatment, and the proportion of those who are receiving treatment that is having a long-term, positive impact in tackling their addiction continues to rise year on year. More than 202,000 people received treatment in 2007-08— 138 per cent. more than in 1998, when the figure was 85,000, and well in excess of our previous drug strategy public service agreement target, which was to double the number by 2008. We are keeping 78 per cent. of people in treatment for at least 12 weeks—we believe that that is an indicator of treatment effectiveness, with evidence showing that treatment of at least that length has a lasting, positive impact in tackling an individual’s addiction—which is 3 per cent. more than in 2006-07. Collectively, that has led to improvements in the lives not only of the drug user but of the wider community, with drug-related deaths lower now than they were in 2000, following a doubling in the 1990s. Drug-related crime has also fallen by 22 per cent. since 2003.
We have raised a number of difficult issues today. There were a couple of detailed points that the hon. Gentleman raised that I am afraid I have not managed to respond to, but I promise to write to him about them—
Mr. Bradshaw: Unless the hon. Gentleman can remind me of them now.
Mr. Bellingham: The key point was the use by the GMC of draft determinations and predetermined sentences of erasure. If the Minister wrote to me about that, I would be very grateful, because it is probably the most important recent development.
Mr. Bradshaw: I will happily write to the hon. Gentleman. My officials did send me a helpful note on that, but it was not quite helpful enough for me to use. Either I did not understand it properly, or I did not think it a comprehensive answer to the point that he was making.
It is important that we all focus on what matters most: the protection of the public and patient safety. Public protection and patient safety require robust systems of professional regulation. In 2007, we published our White Paper “Trust, Assurance and Safety”, which set out our intention to establish a new independent body to adjudicate in medical fitness to practise cases. There is often a difficult judgment call to be made about the acceptable degree of risk associated with certain forms of treatment. We believe, therefore, that it is right and proper that these judgments are made by a body that is independent of the individual and of the profession.
In future, there will be a clear separation between the GMC’s investigation function and its decision-making process, and that separation of adjudication will ensure that there is no perception of bias on the part of the decision maker for or against medical practitioners. Although we have no reason to doubt the GMC’s processes, independent adjudication will address the perception of bias in some quarters. Independent adjudication can only be seen as a positive development in cases such as Dr. Garfoot’s, where competing opinions about the appropriateness of clinical intervention need to be weighed up.
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