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
70. The GMC sets out in its memorandum
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
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.
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.
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".
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 Practicethe basis
for professional medical standards in the UK and a number of other
countriesand 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.
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
Q65. The letter to all doctors was issued in November 2011, with
a briefing note on all GMC guidance on conflicts of interest. Back
Ev 31 Back