Appendix - General Medical
Council response
The General Medical Council (GMC) is
the independent regulator of the medical profession in the UK.
Our main statutory purpose is to "protect, promote and maintain
the health and safety of the public" by ensuring high standards
of medical practice. We achieve this aim by:
- Maintaining the Medical Register
- Regulating all stages of medical
education
- Determining and regularly reviewing
professional standards
- Taking action against doctors who
fall below our required standards.
The Health Select Committee published
its third accountability report on the GMC on 2 April 2014. We
welcome the Committee's continued scrutiny of our work, and this
document sets out our initial response to each of the Committee's
main recommendations.
Managing professional concerns
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)
In oral evidence the GMC discussed
the relationship that exists between referrals made to them by
registrants, the willingness of 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)
We agree that it is important to understand
the factors driving enquiries and complaints to the GMC and have
therefore been publishing data in this area for some time. In
respect of these recommendations there are a number of strands
of our work we wish to draw to the Committee's attention:
In our most recent report on the State
of medical education and practice in the UK, published in
October 2013, we explored the nature of complaints to the GMC
including an analysis of from whom and from where we receive complaints
and which doctors are most likely to be complained about. We will
continue to explore our data in this area and use it to inform
our work and engagement with the public, the profession and their
employers.
· Chapter
4 of the report included an examination of the extent to which
variations and patterns in GMC complaints data are associated
with differences in indicators of care at the local level. Our
aim was to understand whether GMC data on individual doctors'
fitness to practice or the quality of training environments match
indicators of system variation and concern, such as mortality
rates, in different healthcare settings. This initial examination
provided provisional conclusions and we will be looking to build
upon this analysis in this year's edition of the report. This
report has already been shared with partners across healthcare
including the system regulators across the UK to inform their
work.
· We
will soon be publishing the findings from an independent study
which found that complaints to the GMC are rising fairly uniformly
across the UK. This pattern is seen by other complaint-handling
bodies, suggesting that at least part of the explanation lies
in wider social developments. In addition, the advent of revalidation
in 2012 drove significant improvements in clinical governance
across the UK, which may well be an important factor in the substantial
rise in referrals to us from Medical Directors.
· The
GMC's Employer Liaison Service continues to support employers
and Responsible Officers to understand and apply the GMC's thresholds
for referral. This support, offered across the UK, is improving
the consistency in the application of the GMC's thresholds which
we believe will reduce risks to patient safety and reduce referrals
to the GMC that don't cross our thresholds.
· Our
national training survey also provides a unique insight into workplace
culture and the ability or willingness of doctors to raise concerns.
We know that 75% of patient safety issues were reported and dealt
with locally, suggesting that the culture of local reporting is
improving in many organisations. Where issues have not been raised
locally we follow up on each of these with partners including
local education providers and employers.
The Committee's recommendations will
form an important element of our planning process for future research
work. Some of the Committee's recommendations build upon the work
we have already begun. Other issues that the Committee have asked
us to investigate will however take more time to implement and
may not be completed before our next annual accountability hearing.
Revalidation, for example, is still being rolled out and it will
be some years before there is sufficient information to allow
robust research.
We will ensure the Committee are kept
updated on our progress in each of these areas and look forward
to reporting to the Committee at our next accountability hearing.
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)
We are committed to doing whatever we
can to empower medical students and doctors to raise concerns
about patient safety where they believe these exist and to remind
them of a doctor's professional obligation to act on concerns
brought to their attention.
We welcome the Committee's comments
about the way in which we have ensured the national training survey
and confidential helpline in particular provide useful mechanisms
for doctors to report concerns directly to the GMC. We are committed
to continuing to develop and promote both these initiatives. We
also welcome the CQC's use of the national training survey data
in their new intelligent reporting model as system regulators
have a key role to play in driving organisational culture change
in this area.
We have worked together with stakeholders,
including deaneries/LETBs and trainees, to further develop the
national training survey for 2014. For example we have refined
the process for reporting and investigating concerns about patient
safety and undermining.
In respect of this recommendation there
are number of strands of our work we wish to draw to the Committee's
attention:
· The
Committee rightly highlights that our guidance makes it clear
that doctors have a duty to report concerns when they arise as
well as act to address them. In Raising and acting on concerns
about patient safety we set out the steps that a doctor should
take to raise a concern, including advice on when it would be
appropriate to involve a regulator and what protections are offered
by the law for individuals who make public interest disclosures.
Our guidance also makes clear that these concerns should be acted
upon and investigated by doctors in management roles. We have
developed an interactive web tool which helps doctors and others
understand how the principles in the guidance may apply in situations
doctors face. Our guidance on Leadership and management for
all doctors also sets out the wider management and leadership
responsibilities of all doctors including that they must help
to develop and improve services as well as raise and act on concerns
about patient safety.
· Our
Confidential Helpline continues to prove a valuable resource for
doctors to raise concerns where they exist. Since it was launched
in December 2012 the helpline has received more than 1200 calls.
These calls have led to 81 fitness to practise investigations.
We will continue to support this helpline and to increase awareness
of its operation among doctors and professional bodies.
· Together
with the Nursing and Midwifery Council (NMC), we are working with
the other statutory regulators of professionals to agree a common
professional duty for all healthcare professionals to be candid
with patients when mistakes occur, whether serious or not. Additionally,
we will be working closely with the NMC to produce joint wording
for doctors, nurses and midwives that will be included in new
explanatory guidance on candour including the role of apologies
and dealing with near misses, which we will consult on later this
year.
· Our
Regional Liaison Service in England and Devolved Offices across
the UK are engaging at scale with doctors, medical students, patients
and educators to promote, explain and encourage the practical
use of our guidance on raising concerns and will continue to do
so. In the last year we have engaged with over 15,000 doctors
and every medical school in the UK directly on our professional
standards and their application to good medical practice, including
on raising and acting on concerns. For example:
· Since January 2013 our Regional
Liaison Service alone has held 110 meetings in England about our
raising concerns guidance with over 3000 doctors and over 700
students and educators.
· In Scotland we continue to
work with partners to highlight doctors' responsibilities in this
area. For example, we presented on raising concerns at the Scotland
Patients Association Whistleblowing Conference (supported by the
Scottish Government) in June 2013, as well as participating in
the Patients First Whistleblowing Meeting hosted by the Scottish
Parliament in November 2013. We also promote our raising concerns
guidance at Identification checks for all 1250 medical students
in Scotland and at professionalism days throughout the year.
· In Wales, we have delivered
sessions on Good Medical Practice and Raising Concerns
to over 300 students at Swansea and Cardiff universities. Additionally,
we are speaking with academic staff at Cardiff about integrating
a raising concerns workshop into the final year curriculum. In
addition we also delivered professionalism workshops between May
and June 2013 to 250 doctors at all major hospital sites in Wales
on the updated Good Medical Practice and our Raising Concerns
guidance.
· In Northern Ireland we have
promoted this guidance by distributing it to doctors, students
and different healthcare disciplines. We also do this at our stand
at the all-Ireland patient Safety conference, led by the Patient
Safety Forum in March 2013 had over 350 attendees from across
the island of Ireland. In addition to this we have a further series
of events aimed at doctors coming up in Autumn 2014 and a medical
professionalism event in Northern Ireland planned for later in
2014.
· We
believe in time that revalidation and the associated requirement
for an annual appraisal and associated reflection among all doctors
will encourage a more open culture where concerns can not only
be raised where they exist but are seen as a source of learning,
and used to support annual appraisals by doctors and employers.
Although some doctors already ask their patients for feedback,
with the introduction of revalidation we now expect all doctors
to do this regularly. Doctors then need to review this feedback
with their appraiser, and act on any issues concerning their practice
and performance. Doctors will also be expected to bring a review
of any complaints - or compliments - they've received from patients
to each one of their annual appraisals in the five-year revalidation
period.
· Later
this year we are holding a major consultation on what actions
we take when a doctor has harmed or put patients at risk. As part
of this we will be consulting on what sanctions should be imposed
by a panel when doctors fail to raise concerns where something
has gone wrong.
Education
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)
We agree that it is important that the
GMC continues to work in partnership with the wider healthcare
system to share knowledge and data gained from our responsibilities
for the education and training of doctors.
In respect of this recommendation there
are a number of strands of our work we wish to draw to the Committee's
attention:
· We
already proactively share our education data and information with
other regulators. For example we provide CQC with detailed data
packs for their inspections, comprising information drawn from
our annual national training survey, revalidation statistics and
fitness to practise data. We are currently developing similar
information sharing arrangements with Monitor, the NHS Trust Development
Authority and other system regulators across the UK.
· We
are already working closely with Health Education England (HEE),
NHS Education for Scotland (NES), Northern Ireland Medical and
Dental Training Agency (NIMDTA) and the Wales Deanery on postgraduate
training inspections and reviews.
· We
regularly publish openly on our website and share with HEE, NES,
NIMDTA and the Wales Deanery details of the hospitals and other
providers where we have imposed enhanced monitoring of postgraduate
training environments because of concerns about the quality of
education and training and therefore patient safety.
· We
provided information from our education and fitness to practise
work to the Keogh review of 14 trusts with high mortality rates.
· Our
local liaison teams have regular meetings with medical directors
across the UK, attend risk summits and work with the new local
Quality Surveillance Groups in England (and their equivalents
elsewhere in the UK) to share our data - including what we know
about education - with other regulators and the four UK Governments
and agree how we can best work together where we believe patient
safety may be at risk.
· We
ensure that all patient safety concerns raised in our annual national
training survey are reviewed and shared with deaneries and local
education training boards so they can be investigated. They then
report back to us to state whether they were able to verify the
concern and to share their action plans. We monitor the local
action and improvement being taken for any new and confirmed issues.
More than one in twenty of the 50,000 doctors in training responded
with a patient safety concern in 2013.
· We
are working with a range of partners including the Medical Schools
Council, UK Medical Education Database, the UK Clinical Aptitude
Test, NHS Scotland and the Academy of Medical Royal colleagues
to develop a UK Medical Education Database which brings together
data from across the continuum of a doctor's medical education
and training.
· We
are working with the Medical Schools Council to produce a set
of reports this autumn on the destination of graduates, showing
how they progress through postgraduate training.
· We
are using the knowledge gained from our education role to contribute
towards wider efforts aimed at ensuring services are designed
and the profession is prepared to meet society's future needs,
including our work in supporting the recent UK wide Shape of Training
review.
· We
will be providing an analysis of our data on education and training
in this year's report on the state of medical education and practice.
· Finally,
the report of this year's national training survey will be published
on 23 June 2014.
We will ensure that all our key partners
and the Committee are aware of the main findings from these reports.
Revalidation
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)
We are grateful for the Committee's
continued support for revalidation. We are committed to demonstrating
that revalidation will be good for doctors, good for patients
and good for employers. However, recognising the scale and complexity
of revalidation and the fact that it has only just started in
earnest, it will inevitably take some time to evaluate thoroughly.
There will not be any findings from our assessment of revalidation
by the time of our next annual accountability hearing.
There are a number of strands of work
we wish to draw to the Committee's attention at this stage:
· We
have gone to tender for a partner to conduct a three year study
on the impact of revalidation, which is scheduled to commence
in the summer. This is a significant operational and financial
commitment by the GMC which we hope reflects how seriously we
take our obligation to demonstrate the value of revalidation.
· The
most recent NHS England Revalidation Support Team report published
in March 2014, shows the positive impact that the introduction
of revalidation is already having on the number and quality of
annual appraisals of doctors and it suggests the new system may
be helping to spot concerns at an earlier stage.
· The
Department of Health (England) are in the process of tendering
for an evaluation which will look at the benefits and impact of
revalidation in England.
· The
NHS Revalidation Support Team commissioned the King's Fund to
conduct a qualitative assessment of the impact to date of revalidation
on the behaviour of doctors and the culture of organisations within
seven case study sites across England. Their report, 'Medical
revalidation: From compliance to commitment' published in March
2014, highlighted that revalidation has been successful in helping
to achieve compliance in the appraisal process for doctors.
· Across
the UK, around 1.5% of doctors have had their revalidation dates
deferred because of an ongoing local process. This happens where
the Responsible Officer feels unable to make a positive recommendation
to the GMC until the outcome of that local process is known. This
will usually involve a review of concerns about a doctor's practice.
It is too early to say whether the introduction of revalidation
is driving the investigation of these concerns but it may be an
early indicator.
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)
We do not believe our approach to working
with, or our expectations of Responsible Officers, has changed.
We therefore regret that the Committee has concluded that our
oral evidence suggests otherwise.
Responsible Officers have clear statutory
duties and personal responsibilities which are laid out in The
Medical Profession (Responsible Officers) Regulations 2010 and
the equivalent legislation for Northern Ireland.
As registered doctors, Responsible Officers
also have a clear line of accountability to the GMC to fulfil
their professional obligations and we will hold them accountable
for doing so.
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)
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)
The four UK Governments and the health
service in each country, not the GMC, are ultimately responsible
for ensuring that organisations are meeting the statutory requirements
set out in the Responsible Officer regulations. The purpose of
these regulations is to place statutory duties on organisations
to ensure that they have systems in place to evaluate the fitness
to practise of all doctors they appoint and employ. The regulations
also place clinical governance arrangements in England on a statutory
footing. Responsible Officers are accountable for ensuring that
their organisations meet these statutory requirements.
We do however recognise that we have
an important role to play in this area. We want to support the
four UK Governments, health services and employers throughout
the UK in ensuring that Responsible Officers are working effectively.
In the context of this recommendation
there are a number of points we wish to bring to the Committee's
attention:
· NHS
England has recently developed a Framework of Quality Assurance
for Responsible Officers and Revalidation which is particularly
important given the changes to the management structure of the
NHS in England. This Framework, which was published on 4 April
2014, outlines a number of mechanisms by which it will assure
itself and others of the quality and effectiveness of local arrangements
to support revalidation and Responsible Officers, including:
· annual reports from Responsible
Officers to their boards.
· quarterly reporting from
local level Responsible Officers to second tier Responsible Officers.
· an annual organisational
audit (AOA). The collated reports will form the basis of an annual
report to ministers and, ultimately the public, on the overall
status of the implementation of revalidation across England. The
AOA must be accompanied by a standard statement of compliance
signed by the Chair of the Board or the Chief Executive.
· independent verification
of compliance at least once every five years which will be undertaken
by a team from the office of the level 2 Responsible Officer or
by a regulator or commissioned external review.
· Echoing
this work in the Devolved Nations:
· In autumn 2013, Healthcare
Improvement Scotland produced a report, 'From readiness to
revalidation: a report on medical revalidation progress in 2012-2013
' which supports the implementation of revalidation by Scottish
providers. This process is on-going and Healthcare Improvement
Scotland will continue to monitor Scotland's progress to meet
revalidation requirements. This includes providing individual
reports with feedback from the evaluation panels to every NHS
board and Scottish Government.
· In October 2013 we met with
Department of Health Social Services and Public Safety (DHSSPS),
Regulation and Quality Improvement Authority (RQIA), statutory
patient bodies and other professional regulators to discuss sharing
of information across the healthcare sector in Northern Ireland.
This work is being taken forward by DHSSPS and RQIA under the
Northern Irelands Quality 20:20 strategy.
· In Wales, we continue to
be a member of the Wales Revalidation Delivery Board; a Board
that meets to review revalidation progress reports from each Health
Board in Wales. In addition to this, in spring 2014 we partnered
with the Wales Deanery to host five revalidation events for doctors
across Wales.
· We
have developed a guide on effective clinical governance to help
boards and governing bodies assess if their organisations have
systems in place that are sufficiently robust to support quality
patient care and revalidation. This handbook was produced in partnership
with the CQC, Monitor, Healthcare Improvement Scotland, Healthcare
Inspectorate Wales and Northern Ireland's Regulation and Quality
Improvement Authority as well as the Government Procurement Service.
This handbook is being issued to all Chairs and Chief Executives
of provider organisations across the UK.
· Through
our Responsible Officer Reference Group we are continuing to work
closely with and support Responsible Officers throughout the UK.
· We
have processes in place to deal with circumstances where there
is information that may give rise to questions about the quality
of the revalidation recommendations from Responsible Officers
and will keep this under review.
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)
Patient feedback is already a required
component of the revalidation process. We will keep this aspect
of revalidation under review and it will form part of our public
evaluation of revalidation later this year. The results of that
evaluation will not be available by the time of the next accountability
hearing.
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)
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)
The need for remediation is not new,
although the introduction of revalidation has perhaps highlighted
the issue more explicitly. The provision of funding and resources
for remediation is a matter for the four health departments of
the UK, not the GMC.
Fitness to practice
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)
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)
We agree with the committee's comments
about the importance of complainants being fully informed of our
fitness to practise procedures including the reasons for closing
an investigation. In September 2012 we commenced a pilot of meetings
with complainants intended to improve our relationship with them,
reduce the isolation they feel within the fitness to practise
process, ensure we fully understand their concerns and explain
our role, the investigation process and the outcome of the case.
We offer to meet them at the outset of an investigation and again
at the end of the process to explain and talk through the outcome
of the case.
We are currently reviewing our process
for dealing with 'Stream 2' complaints and our communications
to patients, doctors and employers in those circumstances where
a complaint or enquiry to the GMC is closed. We are working closely
with all our key interest groups including patient groups and
the four governments of the UK on this review and expect to implement
a new, clearer process including updated communication materials
on Stream 2 in September this year.
The Committee believes that the 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)
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)
We agree with the Committee that any
such changes must hold public confidence. We will continue to
be open about what we are doing. Any action taken as a result
of our investigation would still be made public via the GMC's
website and annotated in the doctor's record in the public medical
register.
We expect to publish an evaluation on
this scheme in summer 2014 and we will be mindful of the Committee's
concerns during this evaluation with the aim of reporting our
findings to the Committee at our next accountability session.
We also agree with the Committee about
the importance of ensuring that doctors learn from their experience
and change their practice. We will this year be holding a major
consultation on the appropriate sanctions that are required to
protect patients and the trust the public has in the profession,
which will consider issues such as how much insight the doctor
has shown and whether they should be required to apologise if
they have harmed patients.
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)
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)
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)
We greatly appreciate the Committee's
unyielding support for these proposed reforms and will continue
to keep the Committee informed of progress in securing legislative
change.
We are working with the Department of
Health to ensure the already well developed Section 60 Order is
taken forward as a matter of urgency in time for it to be approved
by Parliament and the Privy Council before the 2015 general election
and we are in regular contact with the Department of Health about
this issue.
Language
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)
We too welcome the Government's decision
to give the GMC new powers to check the English language skills
of doctors from Europe when we have concerns about their ability
to communicate effectively with patients and colleagues.
These important changes to the Medical
Act 1983 will enable us to strengthen our processes for ensuring
that all licensed doctors have the necessary knowledge of English
to practise safely in the UK. We are very grateful for the Health
Select Committee's consistent and strong support around this change
to our legislation.
This first line of defence provided
by the GMC will be backed up by employer organisations who will
continue to be responsible for ensuring doctors have the necessary
language skills before they are employed. In addition, under the
changes to the Responsible Officer regulations introduced in 2013,
Responsible Officers in England now have a statutory duty to do
so, and - as registered doctors - they have a line of accountability
to the GMC to fulfil their obligations.
We have worked with employers and Responsible
Officers so that they are aware of their responsibilities to continue
to ensure that the doctors they employ have the necessary clinical
and language skills to provide high quality, safe care to patients.
As the changes to the GMC's registration and licensing processes
come into effect this summer we will communicate with employers
and Responsible Officers to ensure they understand that their
duties and responsibilities will remain unchanged in this regard.
In terms of whether Responsible Officers,
and those acting on their behalf, are well placed to make decisions
about the language capability of doctors, this is ultimately a
decision for the Department of Health (England), not the GMC.
However, we recognise that we have an important role to play in
this area and we want to continue to support the four UK Governments,
health services and employers throughout the UK in ensuring that
Responsible Officers are working effectively.
Publication of research findings
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 85)
Including doctors' interests on the
GMC register would require a change in legislation and is therefore
in the hands of parliament.
We wish to make the register more informative
and have established an internal working group to look at the
future of our register and how it can be developed. As part of
this review, we will look at the feasibility of doctors declaring
their interests publicly on our register. We will also be commissioning
research later in the year to support this work and we will seek
views on how our published register could be developed to meet
the needs of those involved in healthcare and that of patients.
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)
We share the concerns of the Committee
about the small number of doctors who fail to publish the results
of medical trials. Our view is that doctors cannot conduct research
and then decide the results are not to their liking and not publish
them.
Our core guidance for all doctors, Good
Medical Practice tells doctors they must act with honesty
and integrity when carrying out research and must follow national
research governance guidelines as well as our guidance.
Our guidance on Research makes
clear that results must be reported accurately, objectively, promptly,
and in a way that can be clearly understood. Doctors should publish
research results, including adverse findings, through peer reviewed
journals. Failing to publish the results of negative drug trials
would likely breach all of these principles, as well as national
research governance guidelines.
We have been in discussions with the
research community including the Health Research Authority about
raising the profile of our Research guidance with doctors
in the context of their duty to support medical research by involving
themselves or willing patients. As part of any promotional activities
we will be sure to emphasise our expectation that doctors will
act with honesty and integrity not only in designing and conducting
research but also in reporting research results.
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