Conclusions and recommendations
Introduction
1. Although, therefore, the Committee recognises that the GMC achieves a high level of operational competence, it remains concerned that the leadership function of the GMC within the medical profession, and within the wider health community, remains underdeveloped particularly in the areas of fitness to practise, revalidation, education and training and voluntary erasure. We hope that the GMC will embrace more ambitious objectives for professional leadership, some of which are described in this report.
(Paragraph 4)
Revalidation of doctors
2. The work undertaken by the Society of Cardiothoracic Surgery of Great Britain and Ireland in setting standards for that part of the medical profession is commendable. Its transparency will be welcomed by patients and should be a template (where clinically relevant) for further refinement of the revalidation process.
(Paragraph 11)
3. The GMC clearly has a considerable amount of work to undertake between now and the implementation of revalidation in 2012. Although we agree that all disciplines will not have developed their standards to an advanced level by that date, the GMC needs to accelerate its work with the medical royal colleges to further refine the standards for revalidation in specialist areas and to ensure that the process is meaningful to clinicians and transparent to the public.
(Paragraph 12)
4. As the GMC states, some doctors may decide to retire rather than undergo the process of revalidation; of those who pursue revalidation, some may require retraining and some may fail to meet the required standards. The GMC needs to ensure that it monitors the number of doctors who retire, leave the profession, have conditions placed on their practice or fail revalidation. It must develop and share this evidence with employers to ensure that future workforce planning includes the developing outcome of the revalidation process.
(Paragraph 14)
5. Of the Officers who will have to make recommendations about revalidating doctors, only a minority feel that the process will help with the early identification of doctors with performance issues. Early identification of problem doctors is a core task of the professional regulatory system, and the GMC needs to ensure that its systems of appraisal and revalidation achieve this task.
(Paragraph 15)
6. The Committee notes the negative media reports about the time taken to undertake revalidation and hopes that the GMC will ensure that lessons are learned from the revalidation pilots, particularly in how it can support locum doctors. It also needs to ensure that the underlying processes that doctors are expected to undertake are not unwieldy and overly time-consuming, and that they are an effective means of gathering the required evidence.
(Paragraph 18)
7. Doctors from the European Economic Area and Switzerland seeking to practice in the UK cannot routinely be language and competence tested by the GMC.
(Paragraph 21)
8. The GMC along with the Government is working towards resolution of this with partner organisations across Europe. The Committee takes the view that current legal framework is at odds with good clinical practice, which is clearly unacceptable. The GMC has plans, within the boundaries of UK law and the EU Directive, to manage the constraints on language and competence testing by using the Responsible Officer role to establish that EEA (the EU plus several other European countries) doctors are fit to practise in the UK. The Committee accepts this way forward as a short term measure.
(Paragraph 22)
9. Although this short term measure is welcome, the Committee believes that public confidence in the medical profession requires the issue to be addressed authoritatively. It is clearly unsatisfactory that the competence to practise of health professionals should be assured by a work-around, and we look to the Government, GMC and the relevant European bodies to work as a matter of urgency to produce a long-term solution to this problem.
(Paragraph 23)
Fitness to practise
10. The Committee notes that there is an increase in referrals of doctors to the GMC, and of nurses to the NMC, as well as an increase in the number of general NHS complaints. The Committee welcomes the fact the GMC has commissioned research into this phenomenon in order to better understand what is driving this increase, and to ensure that their systems and processes are adequate for meeting the future needs of the public. We look forward to reviewing the preliminary findings of this with the GMC at our next accountability hearing.
(Paragraph 27)
11. The Committee welcomes the ongoing good performance of the General Medical Council (GMC) in resolving 90% fitness to practise cases within fifteen months. However, we agree with the GMC that fifteen months is indeed too long to conclude such cases and we recommend that the Council for Healthcare Regulatory Excellence (CHRE) their regulatory body, should set the GMC a more demanding target for future years.
(Paragraph 29)
12. Some of the decisions made by fitness to practise panels of the GMC defy logic and go against the core task of the GMC in maintaining the confidence of its stakeholders. Furthermore, they put the public at risk of poor medical practice.
(Paragraph 35)
13. The GMC holds the dual but potentially conflicting roles of prosecutor and adjudicator in fitness to practise cases. The GMC proposes to establish an Independent Medical Practitioner Tribunal Service to create a greater separation between these functions, and the Committee supports this proposal. We also urge that performance management of fitness to practise panellists commence as soon as is practicable.
(Paragraph 36)
14. The GMC currently has no right of appeal over decisions made by independent fitness to practise panels. The Committee does not seek to undermine the existing power of appeal held by the Commission for Healthcare Regulatory Excellence, but agrees that the GMC needs also to have a right of appeal in cases where it thinks panellists have been too lenient. We urge the Government to move quickly to make the necessary legislative amendments.
(Paragraph 40)
15. Doctors from Mid Staffordshire NHS Foundation Trust whose practice was in itself blameless but who failed to act and raise concerns about colleagues are now also under investigation by the GMC. A clear signal needs to be sent by the GMC to doctors that they are at as much risk of being investigated by their regulator for failing to report concerns about a fellow registrant as they are from poor practice on their own part.
(Paragraph 43)
16. The Committee recognises, however that doctors and other practitioners who have raised concerns by other staff have sometimes been subject to suspension, dismissal or other sanctions.
The Committee therefore intends to examine this issue in more detail in due course.
(Paragraph 44)
17. In contrast to the approach of the Nursing and Midwifery Council, the GMC has put its fitness to practise cases relating to Mid Staffordshire "on hold" until the inquiry has concluded. The Committee believes that this is neither fair to the public, or to the registrants under investigation. We urge the GMC to set out its rationale for this, publically and clearly.
(Paragraph 45)
18. We suggest that the GMC further considers risk-based approaches to proactive regulation and
how these could be developed with its employer liaison services.
(Paragraph 49)
19. The Committee appreciates the seriousness with which the GMC has treated the suggestion that doctors from black and minority ethnic backgrounds are over-represented in fitness to practise cases. The finding that this relates to overseas trained doctors and not ethnicity per se does not alter the fact that a problem exists.
(Paragraph 53)
20. The GMC needs, as matter of urgency, to do more to understand the risks associated with overseas-qualified doctors. It should offer timely induction and needs to assure itself that those doctors in peripatetic locum positions are adequately supervised and supported. If a doctor is not safe to practise in the UK then the GMC must ensure that they do not do so.
(Paragraph 54)
Voluntary erasure
21. Several cases have been brought to the attention of the Committee of doctors applying to remove themselves from the register during an ongoing investigation into their practice by the GMC (so called voluntary erasure). The Committee has no objection to the principle of voluntary erasure as it can be a useful tool to protect the public. However, in some cases, interested parties have been given little or no time to raise an objection to applications for voluntary erasure, and the GMC was not able to offer a clear explanation of this.
(Paragraph 61)
22. Applications for voluntary erasure must not be granted by the GMC unless interested parties have been given adequate notice of an application and have been offered an opportunity to voice an opinion on the matter.
(Paragraph 62)
23. The Committee fully supports the publication of the facts of any case of voluntary erasure where there is a fitness to practise allegation about the doctor concerned. The GMC needs to ensure that turning voluntary erasure into an admission of guilt does not have a perverse impact in reducing the numbers seeking it and therefore erode public protection.
(Paragraph 64)
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