Memorandum by the Department
NATIONAL HEALTH SERVICE (VOCATIONAL
TRAINING FOR GENERAL MEDICAL PRACTICE) REGULATIONS
1997 (S.I. 1997/2817)
The Committee has requested a memorandum
on five points concerning the above Regulations.
The Committee's first point
Regulation 6(6) imposes on the
Joint Committee on Postgraduate Training a duty in particular
to secure that training complies with the requirements of article
31(1) of the Medical Directive [in Schedule 1] in the case of
part-time training "as appropriately modified". Given
that article 31(1) (as distinct from 34) prescribes requirements
for minimum full-time training, explain what
the modifications are.
Regulation 6(6) derives from regulation
5(3A) of the National Health Service (Vocational Training) Regulations
1979 (S.I. 1979/1644) ("the 1979 Regulations") as inserted
by regulation 7(4) of the Vocational Training for General Medical
Practice (European Requirements) Regulations 1994 (S.I. 1994/3130).
In relation to part-time training, the obligation which is imposed
on the Joint Committee on Postgraduate Training by regulation
6(6) is to secure that it complies with the requirements of article
31(1) of the Medical Directive as appropriately modified, together
with article 34. Article 31(1) prescribes general requirements
for specific training in general medical practice. In the view
of the Department, those requirements apply equally to full-time
and part-time training, except in so far as paragraph (b) requires
training to consist of a full-time course lasting at least two
years, and paragraph (c) prescribes certain maximum and minimum
periods of training of different types. To interpret the relationship
between articles 31(1) and 34 otherwise would be to defeat a principal
objective of the Medical Directive, which is to set minimum standards
of training for doctors. The requirements in paragraphs (b) and
(c) of article 31(1) must be modified in their application to
part-time training so that the references to periods of full-time
training are treated as if they were references to part-time training
which is of equivalent duration, and meets the other requirements
of article 34.
The Committee's second point
Regulation 9(5) prescribes, for
statements of satisfactory completion of training, that, in the
case of periods of training within regulation 6(3), the statement
shall be completed and signed by "the practitioner or practitioners"
with whom the training took place and, in the case of periods
of training within regulation 6(4), by "the practitioner"
who has supervised the training. Given that the regulation 6(4)
training must be in several specialties, is it intended that the
statement applicable to that training shall be completed and signed
by more than one practitioner, or only by one.
The experience prescribed by regulation
6(3) is employment for at least 12 months as a General Practice
(GP) Registrar. That experience may be undertaken with one trainer,
or split between several different trainers, hence the requirement
that "the practitioner or practitioners with whom the training
took place" must sign the statement of satisfactory completion.
Whether or not it is undertaken with different trainers, employment
as a General Practice (GP) Registrar is assessed as a whole (by
means of summative assessment), hence all the trainers involved
will sign the same statement.
In contrast, the experience prescribed
by regulation 6(4) will always be undertaken by means of training
which is supervised by more than one practitioner, because the
requirement is for training in at least two different specialties.
It is envisaged that a statement of satisfactory completion of
training will be produced in respect of each specialty, hence
the requirement in regulation 9(5)(b) that the statement must
be signed by "the practitioner" who has supervised the
The Committee's third point
Regulation 15(2) precludes the
rescinding the appointment of a member of an appeal body for refusal
to carry out his duties if he has indicated to the other members
how he casts his vote. Explain how a member who has done this
could be regarded as having failed to carry
out his duties on the appeal.
Regulation 15(2) derives from regulation
11(2) of the 1979 Regulations. It covers the situation where
a member of the appeal body participates in the process as far
as deciding how he would determine the appeal, but then is unable
or unwilling to participate further (for example in relation to
the preparation of written reasons for the appeal body's decision,
in accordance with regulation 17(2)).
The Committee's fourth point
As regards regulation 15 and 17,
explain exactly what constitutes an "indication" of
how a member casts his vote and to whom it is made for the purpose
of participating in the decision.
Regulation 15(2), as mentioned above,
derives from regulation 11(2) of the 1979 Regulations, as does
regulation 15(4). The word "indicate[d]" in regulation
15(2) is intended to bear its ordinary meaning. "Indicate"
is defined in the Shorter Oxford English Dictionary as "to
make known" or "show", "to direct attention
to, by speech or writing or gesture". It is open to a member
of an appeal body to indicate how he casts his vote by any of
these means, and it is not intended that the Regulations should
require him to employ any particular method of doing so. Regulation
15(2) requires the indication to be given to the other members
of the appeal body. Again, it is not intended to impose any restriction
on how this might be done.
The Committee's fifth point
Regulation 17(1) provides that
the decision on an appeal is to be a majority decision but that
the member who is the Convenor is not entitled to vote "except
in the case of an equality of votes". Given that an appeal
body is to "consist of four persons" (regulation 14(3)),
explain how there can be an equality of votes.
Regulation 17(1) derives from regulation
10(7) of the 1979 Regulations. An equality of votes may in theory
occur if one of the members of the appeal body declines to express
a view on the appeal and of the other two members who are not
the Convenor, one votes in favour of granting the appeal, and
one votes against granting the appeal.
15th December 1997