2013 accountability hearing with the General Medical Council - Health Committee Contents


Conclusions and recommendations


Managing professional concerns

1.  The GMC now fields significantly more complaints regarding the practice of registrants than it did even five years ago. The Committee accepts that this trend is not exclusive to doctors, or even the medical profession as a whole, but we believe the GMC must now seek to better understand what has driven these complaints and the detail behind them. In advance of the Committee's next accountability hearing with the GMC the GMC should report on:

·  The profile of complainants and those who have had complaints made against them;

·  Trends in the triggers or stimuli which prompt registrants to report concerns regarding other doctors;

·  The impact of revalidation and the degree to which this has prompted medical directors to refer doctors to the GMC;

·  The extent to which complaints are vexatious or made in response to an earlier complaint;

·  The relationship between complaints made to the GMC by registrants and the ability of registrants to raise concerns with their own employers. (Paragraph 10)

2.  In oral evidence the GMC discussed the relationship that exists between referrals made to them by registrants, the willingness to doctors to flag their concerns locally and the ability of employers to manage those concerns. The Committee believes that the GMC should examine carefully whether high rates of referrals from a particular organisation indicates a willingness to refer concerns to the appropriate national regulator or an inability of local systems to act on professional concerns. In the long-term, the GMC should play a leading role in helping the Government and NHS England to understand the relationship between patient complaints, the ability of registrants to raise concerns and a provider's workplace culture. (Paragraph 11)

3.  The Committee believes that the GMC's national training survey and confidential helpline both represent useful mechanisms for registrants to report professional concerns, but these resources will not in themselves perpetuate a change in professional culture. It is equally important that the GMC concentrates its efforts on ensuring that a doctor's professional environment permits the raising and discussion of concerns within the workplace. As part of this, the GMC should reiterate to all of its registrants that they not only have a professional obligation to report concerns when they arise, but also to act to address problems if concerns are reported to them and that failure to do so raises issues of professional discipline. (Paragraph 16)

4.  The GMC observed in oral evidence that its responsibilities in relation to training means that it is more than just a professional regulator and it also has a responsibility as a system regulator to oversee elements of the system which operate across the UK. It must now begin to consider how it can formally contribute the knowledge and data gained from this role to the wider management and regulation of UK health services. (Paragraph 17)

Revalidation

5.  Revalidation has only been in operation for a little over 12 months and as yet the data does not exist to explain whether it is a fundamentally better process to identify and address failings in professional practice than the previous system which relied solely on employer led appraisals. From the perspective of employers, this process should be about more than simply helping their staff navigate revalidation and should embrace ongoing appraisal and the management of poor performance. Una Lane's comments in this regard are encouraging, but at our next accountability hearing the Committee would like to see a formal assessment of the evidence relating to revalidation to ensure that it is making a significant contribution to the improved practice of doctors. (Paragraph 22)

6.  The Committee notes that the tone and emphasis around responsible officers has altered as revalidation has been launched. The implication of the GMC's most recent remarks appears to be that responsible officers may not be held to account for a doctor's performance on an individual basis in the same way as was originally envisaged. The Committee is concerned about this development and recommends that the GMC should clarify precisely the nature of the personal responsibility of the responsible officer. (Paragraph 26)

7.  The GMC's commentary in relation to responsible officers suggests that whilst the responsible officer may embody the statutory obligations of an organisation, it is the organisation as a whole that must make sure that the resources are in place to meet its obligations in relation to revalidation. Therefore, any analysis of the success of responsible officers in overseeing revalidation must go beyond a basic assessment of the ratio of responsible officers to doctors and examine the overall resources deployed by the designated body. Nevertheless, the ability of each responsible officer to form the necessary professional relationship with the doctors they oversee will, in part, be determined by the total number of doctors they are required to support. The Committee is concerned that changes to the management structure of the NHS must not be allowed to undermine the effectiveness of professional regulation. (Paragraph 31)

8.  As part of their analysis of revalidation, the GMC should review the way in which responsible officers relate to individual doctors in order to ensure that responsible officers are able to discharge their responsibilities effectively on behalf of patients. This analysis should help to determine whether the number of responsible officers available is sufficient to properly oversee the work of doctors. (Paragraph 32)

9.  The Committee is pleased that significant progress has been made in ensuring that employers develop formal plans to improve the skills of the medical staff and address flaws in their practice. We believe that the GMC should continue to monitor the commitment of employers to effective remediation as well as examining why approximately 15% of employers have still not complied with the principles of good practice. The Committee is concerned that 15% of employers have not complied with this basic element of good practice. (Paragraph 37)

10.  In oral evidence the GMC made it clear that Employer Liaison Advisers are not part of the formal accountability structure for responsible officers. However, the Committee notes the significance the Professional Standards Authority has attached to the role of Employer Liaison Advisers in prompting medical directors to refer doctors about whom they have concerns. (Paragraph 40)

11.  The Committee agrees with the GMC that the successful incorporation of patient feedback into the process of revalidation depends on more than just the regularity by which feedback is required. The quality and applicability of feedback is crucial as the information has to be able to inform and improve a doctor's practice. The challenge for the GMC is to begin to develop more sophisticated mechanisms for incorporating the views of patients into revalidation. At our next accountability hearing with the GMC we shall seek specific evidence about the regularity and effectiveness with which patient feedback is incorporated into the revalidation process.(Paragraph 43)

Fitness to practise

12.  The Committee is satisfied with the Professional Standards Authority's overall conclusion that the GMC's processes protect the public. The Committee believes that failures to provide complainants with clear or adequate reasons for closing investigations must be addressed as a priority if the GMC's fitness to practise processes are to be regarded as fair and transparent. It is essential that complainants are presented with a comprehensive justification for the decisions that are reached, especially in cases where investigations are closed without sanction. Failing to achieve this will undermine public confidence in the GMC. (Paragraph 53)

13.  Clarifying the procedures for allocating investigations between stream 1 and stream 2 would also help to instil greater public confidence in the GMCs fitness to practise processes. The Committee expects the GMC to review its fitness to practise procedures as a result of the PSA's audit. The GMC should seek to ensure that in future audits no cases are called in to question because their triaging meant key information was not gathered. (Paragraph 54)

14.  The Committee believes that scheme for imposing sanctions without full fitness to practise hearings can only be regarded as successful if the registrant can demonstrate that they have genuinely learnt from the experience and changed their practice as a result of the sanction. Although safeguards are in place to check that sanctions are being adhered to, we remain concerned that registrants may accept sanctions to avoid full fitness to practise hearings without demonstrating that they fully understand and accept their own failings. In their analysis of the pilot scheme, the GMC must examine whether those doctors subject to sanctions have demonstrated an understanding of their own failings and changed their professional practices as a consequence. (Paragraph 61)

15.  To inspire public confidence, the scheme must not be regarded an easy mechanism for concluding cases quickly, or a process which allows registrants to escape the scrutiny of a fitness to practise hearing. The Committee accepts the GMC's argument that allowing tougher sanctions to be levied without recourse to a full hearing would strengthen the process and help to prevent it being seen as a soft option. (Paragraph 62)

16.  It is disappointing that the proposal to implement regulatory reforms which would allow the GMC to appeal Medical Practitioner Tribunal Service (MPTS) decisions are not be introduced by section 60 order in 2014. Given the number of cases adjudicated each year, the Committee believes that the Government should have prioritised the introduction of the section 60 order in 2014 in order to implement the provisions at the earliest opportunity. (Paragraph 70)

17.  With the expectation that the next parliamentary session will see pre-legislative scrutiny of the draft Law Commission Bill, rather than the passage of a Bill through Parliament, the Government's legislative timetable appears to be exceedingly optimistic. The Committee is concerned that incorporating the right to appeal in a draft Law Commission Bill will only further delay implementation, as there is little likelihood of Royal Assent before the end of the Parliament. Therefore, the Committee urges Ministers to use a section 60 order to implement the GMC's right to appeal MPTS decisions as soon as is reasonably practicable. (Paragraph 71)

18.  The Committee believes that carrying a conviction for a serious violent or sexual offence is incompatible with being a doctor. We welcome the GMC's commitment to pursue the most severe sanctions against registrants convicted of such offences. This issue illustrates the importance of legislation being implemented to allow the GMC to appeal Medical Practitioner Tribunal Service decisions. Whilst His Honour Judge Pearl's comments were reassuring, it is vital that the GMC is able to challenge panel judgements which may be too lenient or incompatible with professional practice. Similarly, implementing the legislative reform to allow the GMC to remove doctors from the register without recourse to a full fitness to practise hearing will enable the GMC to act in the interests of the public and the profession without undue delay. (Paragraph 76)

19.  The Committee welcomes the fact that the Government is legislating to allow the language testing of registrants from the European Economic Area in cases where a doctor's communications skills are of concern. This represents an important development in improving public protection as both Government and GMC data shows that language concerns have been prevalent in fitness to practise cases. The Committee notes that responsible officers will be tasked with identifying concerns and undertaking testing. In their assessment of the performance of responsible officers the GMC should evaluate whether they are sufficiently close to their registered doctors to make informed decisions concerning their ability to communicate with their patients. (Paragraph 81)

Doctors' participation in research

20.  The Committee believes that there is a compelling case for the GMC to hold a public register of doctors' interests with the responsibility for maintaining the accuracy of the register sitting with registrants. Although the Committee welcomes the fact that the GMC is willing to explore this, we believe that the regulator should examine the practical considerations of developing a register which is reliable and open to public scrutiny. At our next accountability hearing the Committee will ask the GMC to outline its progress in this area in detail. (Paragraph 5)

21.  The Committee welcomes the GMC's recognition that the contemporary research landscape no longer offers any valid justification for failing to publish the results of negative drug trials. The Committee believes it is now essential that the GMC re-words its guidance so that the need for transparency is made explicitly clear. The GMC's written evidence showed that there have been a small number of fitness to practise cases resulting from doctors failing to publish the results of medical trials. It is essential that all registrants are made aware by the GMC that the failure of a doctor to ensure publication of the results of medical trials constitutes a serious breach of professional obligation. (Paragraph 89)


 
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Prepared 2 April 2014