Health CommitteeWritten evidence from the Council for Healthcare Regulatory Excellence (GMC 04)

Introduction

1. Council for Healthcare Regulatory Excellence (CHRE) is grateful for the opportunity to submit written evidence to the Committee ahead of the accountability meeting in September 2012. CHRE reviews the performance of the nine health professional regulators annually. Our evidence provided here is drawn from our recent annual performance review. This report was presented to Parliament on 28 June 2012.1

2. We set out below a brief summary of our findings about the GMC’s performance, and comments on the role of regulation generally, to set our findings in context.

Key Finding

3. The General Medical Council is an effective regulator and has demonstrated that it is meeting almost all of our Standards of Good Regulation.

CHRE Performance Review 2011–12

4. Under our legislative framework, CHRE has the statutory power to review the performance of nine UK health professional regulators on an annual basis and to present our findings to Parliament. The Performance Review has two important outcomes:

It enables improvement in the work of the regulators as we identify areas of strengths and areas of concerns in their performance and recommend changes.

It informs everyone about how well the regulators are protecting the public and promoting confidence in health professionals and the system of regulation in their work.

5. The performance review also allows regulators to learn from good practice demonstrated elsewhere to help address any areas for improvement identified in our review.

6. Our performance review considers how effective the regulators, including the General Medical Council, have been in protecting the public and promoting confidence in health professionals and regulation. We assess the regulators’ performance across their four regulatory functions using our Standards of Good Regulation. The four functions are:

Guidance and standards.

Education and training.

Registration.

Fitness to practise.

7. The Standards of Good Regulation are outcome-focused and describe what the public should expect the regulators to do, rather than how they should do it.

The General Medical Council

8. In 2011–12, our overall assessment of the GMC is that it has maintained and in many ways improved its performance as an effective regulator across all of its regulatory functions. Whilst it does not yet meet the standard “Through the regulator’s continuing professional development (CPD)/revalidation systems, registrants maintain the standards required to stay fit to practise” it has made significant progress in this area. The GMC’s good performance is notable given the extensive work it has undertaken in preparation for the launch of its revalidation scheme and the major programme of review of its fitness to practise function which is now underway, including the separation of its adjudication function into the Medical Practitioners Tribunal Service.

9. Based on this year’s review, we have highlighted to the GMC the following areas we will focus on in the 2012–13 assessment:

In “guidance and standards” we will be interested in the outcomes of GMC’s research into the factors that influence doctors’ decisions to follow guidance and standards and the barriers that prevent doctors from raising concerns where patient care or safety may be at risk.

In “education and training” we will consider the progress that the GMC have made in implementing revalidation, its role in overseeing CPD, its review of its approach to quality assurance of education, and the impact of the new approach to handling concerns about education and training providers.

In “registration” we will consider progress of the review of the Professional and Linguistic Assessments Board (PLAB) tests, development of guidance for doctors on maintaining adequate indemnity insurance, and review of the information the GMC publishes about doctors.

In “fitness to practise” we intend to review any changes to the handling of fitness to practise cases at the end of the investigation stage, the establishment of the new Employer Liaison Service, the outcome of the support process for doctors going through fitness to practise proceedings, and the work to establish the Medical Practitioners’ Tribunal Service.

10. The full review of the General Medical Council can be found on pages 35–43 of the Performance Review report.2

The Role of Professional Regulation

11. Professional regulators are one key element of a network of organisations and individuals who all contribute towards the delivery of high-quality healthcare to patients and other members of the public. Reforms over recent years have clarified and emphasised the role of regulators in protecting the public and maintaining public confidence in health professions and the regulatory system. This additional clarity has been demonstrated through changes to regulators’ governance arrangements, addressing perceptions of influence or bias of the professions over the organisations regulating their practice, and in operational focus upon core duties as described in legislation.

12. 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.3 This is in line with the principles of right-touch regulation.4

Conclusion

13. The General Medical Council is an effective regulator and has demonstrated that it is meeting almost all of our Standards of Good Regulation. We would be happy to meet with the Committee and discuss our evidence further, if that would be helpful to your inquiries.

July 2012

1 CHRE, 2012. Performance review report, 2011–12 [HC 200-II, SG/2012/9-II]. London: The Stationery Office. Available at: http://www.chre.org.uk/satellite/479

2 CHRE, 2012. Performance review report, 2011–12 [HC 200-II, SG/2012/9-II]. London: The Stationery Office. Available at: http://www.chre.org.uk/satellite/479 Presented to Parliament pursuant to schedule 7, paragraph 16(2) of the National Health Service Reform and Health Care Professions Act 2002, as amended by the Health and Social Care Act 2008.

3 We provide further commentary on the role of regulation in our report Strategic Review of the Nursing and Midwifery Council (2012) Available at: http://www.chre.org.uk/satellite/485

4 CHRE. 2010. Right-touch regulation. Available at: http://www.chre.org.uk/_img/pics/library/100809_RTR_FINAL.pdf

Prepared 3rd December 2012