The Health Committee took evidence from representatives of the General Medical Council and the new Medical Practitioner Tribunal Service on 4 September 2012, as part of its annual exercise of accountability hearings with the principal regulators in the health sector.
We focused on three areas of particular interest: the arrangements for revalidation of doctors, which are to commence on 3 December 2012, and associated matters such as patient involvement and examination of the language competence of doctors from elsewhere in the EEA and Switzerland; the professional leadership activity undertaken by the GMC in the last year; and the regulation activity undertaken by the GMC, including the establishment of the Medical Practitioner Tribunal Service.
We find that the Council is performing effectively in its two roles of defining and applying standards for the medical profession and providing a focus of professional leadership. We look forward to the outcome of the Law Commission's consultation on professional regulation in the health and care sector, which proposed a formal role for the Health Committee in the accountability structures for such regulators.
We welcome the commencement of the legislation authorising the five-yearly revalidation of doctors licensed to practice medicine by the GMC, but point out that the system needs effective management and rigorous monitoring if it is to achieve its aims and command public confidence. Doctors will soon begin to receive the dates on which their revalidation recommendations are due: it is important that all doctors now consider the steps revalidation will require them to take. We recommend that the GMC monitors the composition of the cohorts of doctors presented for revalidation in its early stages to ensure that they are properly representative of all geographical areas and all areas of practice.
We have welcomed the introduction by the GMC of employer liaison officers, who are intended to support responsible officers in designated bodies in assessing any concerns which arise about a doctor's practice during revalidation. This initiative should support early and robust action in identifying such concerns and dealing with them appropriately. We recommend the development in all organisations which employ doctors of formal and effective procedures for reskilling, rehabilitation and remediation of practice among medical staff where deficiencies in practice are identified. We also look to the GMC to maintain its role as owner and leader of the revalidation process, and to actively monitor and upgrade the operation of the new system as it is implemented.
There has been some progress on the amendment of domestic legislation which restricts the language testing of doctors from elsewhere in the EEA and Switzerland who wish to practise medicine in the UK, and the proposed work-around which will enable responsible officers to assure themselves of the language competence of doctors should be in place by the end of 2013. This is nevertheless no substitute for the revision of the European legislation which presently prohibits language testing of doctors on a national basis, and we press for a statement from the Government on the steps it is taking to seek revision of the relevant directive.
Arrangements for informing patients of circumstances where a doctor has been required to undertake remediation measures are insufficiently clear, and we press the GMC to clarify such procedures as a matter of urgency. The present requirement under revalidation that doctors should seek feedback from their patients at least once every five years is not sufficiently challenging, and we have pressed for a target frequency which will provide greater assurance to patients that their doctors will regularly seek and reflect on their views.
Steps which the GMC has taken and continues to take to develop a broader understanding among doctors of their professional obligations are welcome. Doctors must be encouraged and supported to raise concerns where high professional standards are not being met; other regulators, and health and care managers in the public and private sector, should foster a culture where it is unacceptable not to raise such concerns where they are identified. We have applauded the GMC for its leadership of the medical profession and we encourage it to continue such activities.
We have noted the continued upward trends in complaints against doctors received by the GMC, and we expect to examine in 2013 the outcomes of further research the GMC has commissioned into these trends. The GMC proposes to pilot arrangements where a doctor under investigation may accept a sanction without a hearing where the case is clear-cut: we recommend careful evaluation of these pilots to ensure there is no detriment to the public interest in not holding a hearing, and call for detailed and clear published guidance on the circumstances in which such a procedure may be appropriate.
The present 15-month target for the GMC to complete 90% of its fitness to practise cases is insufficiently challenging, and we think the target should be lowered to 12 months.
We welcome the establishment of the Medical Practitioner Tribunal Service and are encouraged by what we have heard from its first Chair about his priorities for case management, consistency and the dissemination of best practice in panel hearings. We believe the establishment of this service will provide greater assurance to the public about the quality of regulatory decisions in fitness to practise cases. We also welcome proposed legislation to enable the GMC's investigatory arm to appeal against decisions made by the MPTS where the outcome of a hearing is disputed.