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

3  Professional leadership

GMC leadership activity in 2011-12

68. In its 2011 report the Committee acknowledged the positive assessment of the GMC made by the CHRE in its performance review for 2010-11, and had received no evidence to the contrary. Its financial performance was good and it was making progress in a range of issues, including many identified by the Committee.

69. Nevertheless it considered that the GMC's leadership function 'within the medical profession and the wider health community' was underdeveloped, particularly in the areas of fitness to practise, revalidation, education and training and voluntary erasure. It encouraged the GMC to 'embrace more ambitious objectives' for professional leadership.

70. The GMC sets out in its memorandum[60] ways in which it has provided leadership to the profession since the last hearing:

  • increasing its profile and leadership activities, being more active on the ground and taking action to ensure more fair and transparent systems;
  • developing stronger local liaison services (a) to advise employers and (b) to liaise with patients, doctors and medical students in the regions of England;
  • providing updated guidance to doctors: a revised edition of Good Medical Practice, and a patient version, is awaiting publication;
  • new guidance on child protection, and important guidance on remote prescribing of Botox and other injectable cosmetics, has been issued;
  • more work is being undertaken to ensure doctors know what is expected of them;
  • increasing its work to create a culture where clinicians are empowered to raise concerns about patient safety;
  • surveying doctors in training to ask about training quality, patient safety concerns and taking follow-up action: one in 20 of the approximately 47,500 trainees responding to the most recent survey - about 2,000 - raised patient safety concerns about the institution in which they were training; and
  • sharing data on, experience and insights into the medical profession.

71. In particular the GMC indicated that it had sent specific guidance on Raising and acting on concerns about patient safety to every doctor in the UK, stating that doctors must act wherever patient safety is at risk and must never enter into contracts which seek to prevent or restrict them from raising such concerns. The GMC also plans to launch a confidential helpline for doctors and others to raise serious concerns and seek advice about patient safety and other issues which they cannot raise at local level.

72. While Niall Dickson admitted to us that "guidance is guidance",[61] he considered that the guidance issued had raised awareness among doctors of their responsibilities in considering patient safety. He also suggested that there was still some way to go to instil the principles in the guidance throughout the medical profession through dialogue and discussion. He indicated that the GMC had more than one approach to ensuring high standards of professional responsibility in respect of patient safety: while the sanction of investigation and disciplinary action was an incentive to encourage doctors to reflect upon their professional responsibilities, the change in culture to empower doctors to raise concerns in healthcare organisations could also be brought about by offering doctors greater professional support, for example through the helpline.

73. We welcome and applaud the steps which the GMC has taken and continues to take to develop a broader understanding of professional obligation among doctors. We regard this ongoing process as the indispensable foundation of high quality care and we applaud the steps being taken by the GMC to encourage and support doctors to raise concerns when high professional standards are not met. We look to other regulators, and to health and care managers in both the public and private sector, to foster a culture in all health and care organisations where it is unacceptable not to raise such concerns when they arise.

74. We raised concerns with our witnesses over the potential of financial incentives to compromise clinical decisions, and asked for the GMC's views. Professor Sir Peter Rubin stated that he had written to every doctor in the UK to address the question of potential conflicts of interest under new commissioning arrangements:

I was unambiguously clear in what I said: "your patient comes first". Clearly, there will be high-level rationing issues, as there always have been since 1948. But for individual patients, financial incentive for the individual doctor or for the individual patient is unacceptable and I have made that very clear in writing to every doctor in the country. We will act if we have evidence that that is not being followed.[62]

75. The Chair of the GMC has written to all doctors to remind them that in the new world of commissioning, their decisions must not be influenced by a conflict of interest, and that patients come first. This unambiguous statement is commendable. We look to the GMC to take action on any evidence of conflicts of interest that have the potential to affect patient care adversely.

76. The Council for Healthcare Regulatory Excellence (CHRE) rated the GMC very highly in its annual review for 2011-12. In evidence to us, however, the CHRE expressed the view that a professional regulator should not develop a leadership function for a profession:

It is our observation that the extent of the role of professional regulators as intended by statute can be misinterpreted on occasion. Professional regulators need to be independent of the profession they are regulating to be successful. It is not the role of a professional regulator to fulfil a leadership function for a profession, or to develop professional practice. These are the responsibility of professional representative organisations. We welcome any efforts to ensure that regulatory bodies to focus on delivering their statutory duties and that seek to avoid burdening regulators with expectation that their role includes activities and responsibilities that they cannot and should not meet. This is in line with the principles of right-touch regulation.[63]

77. When questioned on the CHRE's view, Professor Sir Peter Rubin disagreed with the suggestion that the GMC should not be undertaking leadership activities: "I would be intrigued to know what problem they are trying to solve in they think we should not be providing leadership".[64] He referred to the international standing of the GMC and its work in establishing standards for the medical profession, through its publication of Good Medical Practice—the basis for professional medical standards in the UK and a number of other countries—and its introduction of professional standards into the undergraduate medical curriculum.

78. We consider that the GMC is uniquely placed to undertake a leadership function for the medical profession and the healthcare professions more generally and we applaud its willingness to do so. The GMC is of course not the only body with a leadership role in the medical profession: Niall Dickson acknowledged that it shares the responsibility with, for example, the Medical Royal Colleges and with the British Medical Association.[65] We have seen no evidence to suggest that it is acting in conflict with these professional representative organisations or that it does not have constructive relations with them in leading the medical profession. Nor do we have any concerns about the burdening of the GMC with leadership responsibilities which it cannot meet.

79. We consider that the GMC is uniquely placed to exercise a leadership function in the medical profession, and the healthcare professions more generally, and we applaud its willingness to do so. We encourage the Council to continue its leadership activities in concert with professional representative organisations.

60   Ev 35-36, paras 22-38 Back

61   Q65 Back

62   Q65. The letter to all doctors was issued in November 2011, with a briefing note on all GMC guidance on conflicts of interest. Back

63   Ev 31 Back

64   Q68 Back

65   Q65 Back

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© Parliamentary copyright 2012
Prepared 3 December 2012