2012 accountability hearing with the General Medical Council - Health Committee Contents

1  Introduction

1. We report below on the accountability hearing we held with representatives of the General Medical Council (GMC) and the new Medical Practitioner Tribunal Service (MPTS) in September 2012. This is the second such hearing in a series which we propose should be an annual feature of our work throughout the course of this Parliament.

2. On 4 September 2012 we took evidence from GMC witnesses Professor Sir Peter Rubin, Chair of Council, Niall Dickson, Chief Executive, Una Lane, Director, Continued Practice and Revalidation and His Honour Judge David Pearl, Chair of the Medical Practitioner Tribunal Service.

The role and functions of the General Medical Council

3. The GMC has two vital roles: it defines and applies the professional standards for the medical professionals on its register, and provides a focus of professional leadership for the medical profession more generally.

4. The Committee's purpose in its annual accountability hearings is to judge how effectively the GMC is performing each of these roles, examining the four basic functions with which the Council is charged under the Medical Act 1983, namely:

  • keeping an up-to-date register of qualified doctors;
  • fostering good medical practice;
  • promoting high standards of medical education and training; and
  • dealing firmly and fairly with doctors whose fitness to practise is in doubt.[2]

5. We discussed the GMC's role in medical education and training in the course of our recent inquiry into education, training and workforce planning.[3] The GMC supplied written evidence to that inquiry[4] and Professor Sir Peter Rubin, Chair of Council, gave oral evidence to us on 29 November 2011 as a member of a panel of witnesses discussing medical education and training.[5]

6. The GMC set out five regulatory aims in its Annual Report for 2011:

"We aim to deliver regulation that:

a.  raises standards and enhances patient safety

b.  fosters the professionalism of doctors

c.  is independent, fair, efficient and effective

d.  encourages early and effective local action

e.  commands the confidence and support of all our key interest groups."[6]

It also set itself eight strategic aims in its corporate strategy for 2010-13:

1.  "to continue to register only those doctors that are properly qualified and fit to practise and to increase the utility of the medical register

2.  to give all our key interest groups confidence that doctors are fit to practise

3.  to provide an integrated approach to the regulation of medical education and training through all stages of a doctor's career

4.  to provide doctors with relevant up-to-date guidance on professional standards and ethics

5.  to develop more effective relationships with delivery partners in order to achieve an integrated approach to medical regulation in the UK

6.  to help shape the local, UK, European and international regulatory environment through effective engagement with decision makers, other regulators and key interest groups

7.  to continue to use our resources efficiently and effectively

8.  to deliver evidence-based policies that demonstrate 'better regulation' principles, and promote and support equality and diversity"

7. The GMC announced on 23 November the outcome of the process of appointments to its General Council, which since 2009 has had 24 members. From 1 January 2013 it will have 12 members—six medical and six lay—including at least one member working or living wholly or mainly in each of England, Scotland, Wales and Northern Ireland. This reduction in size in the Council followed a Department of Health consultation on its constitution undertaken in early 2012.

Health Committee accountability hearings

8. The Committee instituted annual accountability hearings with the principal regulators in the health sector in 2011 in order to fill a gap in accountability structures. Other regulators examined as part of the Committee's cycle of annual accountability hearings have needed to a greater or lesser extent to clarify their role and their purpose. The GMC was established by statute in 1858 and there is little doubt about its role or purpose, though it has been required to adapt both to fit modern conditions. In this report we have also taken into account the outcome of the most recent performance review of the GMC undertaken by the Council for Healthcare Regulatory Excellence (CHRE: now the Professional Standards Authority for Health and Social Care).[7]

9. Formally the GMC is accountable to the Privy Council, to which it makes its statutory reports for laying before Parliament under the Medical Act 1983, and which approves and enacts rules and regulations which the GMC proposes to be made under that Act as Orders in Council or Orders of the Privy Council.[8]

10. The GMC is not accountable to the Secretary of State, and, as the Department of Health told us, that Department acts only "as advisor to the Privy Council on policy and legal matters arising from the activities of the health professional regulatory bodies", though it also "has an interest in the regulators' performance in terms of public safety and protection."[9]

11. Since the GMC derives its authority from an Act of Parliament it is appropriate that a Parliamentary committee should hold it accountable and provide a means whereby the Council's actions may be challenged. We welcome the GMC's willingness to adopt the present ad hoc arrangement for accountability to Parliament through the Committee as a substitute for the vestigial accountability nominally exercised by the Privy Council.

12. Niall Dickson, the GMC's chief executive, told us that in the Council's view "a clear line of accountability to Parliament is the right model".[10] He stressed the importance of independence from the Department and from any NHS structures:

"Our independence is very important, our ability—this is not simply theoretical—to eyeball an NHS trust, which is part of a state mechanism, and say, "This is not acceptable. You must put additional support into this emergency department and you must do it within 24 hours, otherwise we will be withdrawing the trainees from this situation."[11]

The Law Commission's consultation on regulation of healthcare professionals

13. The Law Commission has recently consulted on proposals to reform the regulatory structure for healthcare professionals.[12] It envisages a single Act of Parliament to provide the legal framework for health and social care regulators, replacing existing governing statutes and orders (in the GMC's case the Medical Act 1983 and associated legislation). Its provisional proposals on accountability include a proposal that "The House of Commons Health Committee should consider holding annual accountability hearings with the regulators which should be coordinated with the Council for Healthcare Regulatory Excellence's performance reviews."[13]

14. We await with interest the report of the consultation and the draft Bill which the Commission has undertaken to present to the Lord Chancellor and Scottish and Northern Ireland Ministers in 2014. We welcome the Law Commission's proposal that the Health Committee should play a role in the accountability process for professional regulation in the health and care sector. We stand ready to work with the Law Commission to prepare workable proposals which make this accountability effective.

2   "The main objective of the General Council in exercising their functions is to protect, promote and maintain the health and safety of the public": Medical Act 1983, section 1(1A). Back

3   The report of this inquiry was published as the First Report of Session 2012-13, Education, training and workforce planning, HC 6-I. Back

4   HC (2012-13) 6-II, Ev 116-119 Back

5   HC (2012-13) 6-II, Qq 116-164 Back

6   General Medical Council, Annual Report and Accounts 2011Back

7   The Council for Healthcare Regulatory Excellence, Performance Review Report 2011-12, HC (2012-13) 200-II, pp 35-43. Back

8   The Medical Act 1983 provides for secondary legislation to be made by Orders in Council or Orders of the Privy Council. Orders in Council are made by Her Majesty in Council Orders of Council are Orders that do not require personal approval by the Sovereign, but which can be made by Ministers as 'Lords of the Privy Council'. (The Cabinet Manual, 1st edition (October 2011), paras. 1.16 and 1.17).
Orders in Council are made at the monthly meetings of the Privy Council attended by Her Majesty (or two or more Counsellors of State in her stead), the Lord President of the Council and the ministers concerned with the business under discussion (The Privy Council, House of Commons Library Standard Note SN/PC/3708, July 2005).
Orders of Council do not require the personal attendance of Her Majesty: such orders proposed pursuant to the Medical Act 1983 may be made by two or more 'Lords or others of the Council' (Medical Act 1983, s. 52(1)). They are deemed to have been made at "The Council Chamber, Whitehall", though in fact they are all approved in correspondence, and no actual meeting takes place (Privy Council Office website, http://privycouncil.independent.gov.uk/privy-council/orders/, last accessed 28 November 2012). 

9   Ev 21 Back

10   Q74 Back

11   Ibid. Back

12   Law Commission, Scottish Law Commission and Northern Ireland Law Commission Joint Consultation Paper LCCP 202 / SLCDP 153 / NILC 12 (2012), Regulation of health care professionals; regulation of social care professionals in England, March 2012 Back

13   Ibid.. Provisional Proposal 2-9, p. 28. Back

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© Parliamentary copyright 2012
Prepared 3 December 2012