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Medical Act 1983 (Amendment) Order 2002

7.21 p.m.

The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath) rose to move, That the draft order laid before the House on 14th November be approved [First Report from the Joint Committee].

The noble Lord said: My Lords, the order before the House today will bring about major reform of the General Medical Council. In essence, these reforms have been designed to achieve three important objectives. First, to provide better protection and improved safeguards for the public; secondly, clearer and more straightforward procedures in relation to fitness to practice which are in the interests of both the medical profession and the public at large; and, finally, greater accountability and transparency around the working of the GMC itself.

I pay tribute to the GMC for the work that it does and for its specific work on reforms. I particularly mention Sir Donald Irvine, the former President of the GMC, and his successor, Graeme Catto.

The new GMC will be smaller and able to work more quickly in the public interest. It will have quicker and simpler procedures, particularly where a doctor's fitness to practise is in question. There will be far greater lay representation than before and, for the first time, the GMC will be able to link registration with performance through the introduction of revalidation for all doctors.

Proposals for reform have been developed by the GMC itself following careful and widespread consultation with patients and the medical profession. There was overwhelming support for reform in response to the consultation on the draft order.

The order makes a number of amendments to the Medical Act 1983 rather than replacing it altogether. We have tried to keep the drafting as simple as possible but the fact that we are amending the primary legislation in this way means that the order is inevitably a rather complex document.

We said in the NHS Plan that, as a minimum, regulatory bodies must change so that they are smaller with much greater patient and public representation in their membership; have faster more transparent procedures; and develop meaningful accountability to the health service. The order represents a big step forward in meeting those needs.

The order reduces the size of the General Council—or paves the way for such a reduction—from an unwieldy 104 to a maximum of 35. A smaller council will inevitably be required to work in different ways. For example, members of the new council will not have the same role in fitness-to-practice cases as their predecessors. Cases will be heard by panels made up of

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non-council members and will include both doctors and lay people. The effect of this, together with the opportunity for more non-council members to sit on working committees, will result in a welcome increase in the number of members of the public taking an active role.

The new council will meet more frequently, and this will help the new GMC to respond more rapidly to change and to take forward business more effectively. Lay members currently form only 25 per cent of the members of the General Council. In future, they will make up no less than 40 per cent—14 out of 35.

The links to Parliament are important and the GMC, as a statutory body, will continue to be accountable to Parliament. We have strengthened this link by ensuring that the council reports to Parliament, through the Privy Council, on an annual basis. The Act as revised by the order will now require that the report be laid before each House of Parliament. Like other regulatory bodies, the GMC will come under the remit of the new Council for the Regulation of Healthcare Professionals. This new body will report to Parliament and so help us to hold regulators to account more effectively.

Though detailed, the order does not go into every detail of the governance of the council. A great deal will be dealt with in secondary legislation and will be subject to scrutiny by both the Privy Council and Parliament. The first of these statutory instruments will be the General Medical Council (Constitution) Order. We have already published a draft of this order. The constitution order sets out the numbers of members, how they get selected and their terms of office, including that of the president. It also covers the termination of office for existing members and sets the quorum at 25. These orders will be subject to the negative procedure.

The order places a new duty on the GMC to co-operate, as appropriate and where practicable, with other bodies concerned with the regulation of healthcare professionals. As new clinical roles develop in the health service it is vital that the GMC plays a full part in ensuring that professionals working closely with doctors, perhaps taking over some of the roles traditionally delivered by doctors, meet similarly high standards expected of doctors.

In recognition of the new spirit of partnership with patients and the public, the order places a duty on the GMC to inform the public about its work.

From a public protection point of view, the medical register is perhaps the most fundamental part of the GMC's work. Keeping the register will be at the centre of the new GMC's functions. The order clarifies the GMC's freedom to publish the medical register on the Internet and, at the same time, abolishes the requirement for the GMC to publish an annual register.

But patients today want to know far more than whether a doctor is simply on the register. They want to know whether he or she is up to date with current practice. An important change that this order will bring is the introduction of a licence to practise. In

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future, only doctors who have a licence to practise will be able to treat patients and prescribe drugs. The licence may be withdrawn if doctors fail to maintain their fitness to practise or do not demonstrate, through the GMC's new validation procedures, that they are up to date and fit to practise.

The introduction of revalidation for all doctors is therefore a key feature of the changes we are debating. In future, every practising doctor will have to submit evidence to the GMC, collected over a five-year period, that their practice is up to date and of sufficiently high standard. Provided that they meet those standards they will retain their licence to practise. Those doctors who choose not to take part or who do not meet the required standard will not be issued with a licence to practise.

That process will be supported by the separate introduction of an appraisal system for all doctors working in the NHS. All NHS doctors will be discussing their practice with their employer or a recognised NHS appraiser on an annual basis.

Revalidation will help all doctors to show that they are giving good medical care and will support them to develop and improve their practice. It will also enable doctors to identify and correct any weaknesses they may have. If concerns are raised about a doctor's fitness to practise during the revalidation process, he or she can be referred to the GMC's fitness-to-practise procedures. These procedures—for handling concerns about a doctor's conduct, performance or health—are perhaps the most prominent aspect of the GMC's work.

I should stress that even though the number of complaints against doctors increases year on year, the vast majority of people receive excellent service from committed and caring professionals working to very high standards which the GMC helps to maintain. When things go wrong—as they inevitably do from time to time—it is important to have effective procedures in place for dealing with them.

The role of the GMC is to make decisions on those cases where a problem is so serious that a doctor's registration is called into question. The new GMC will concentrate on the most serious cases, and on those where local action is unable to secure adequate public protection.

It is in everyone's interest that procedures are fast, fair and efficient. The order provides for important changes to the GMC's fitness to practise procedures to ensure that they are just that, and that they maintain the right balance between the legitimate expectations of patients and the rights of individual doctors.

In effect, these changes will mean simpler proceedings and rules, speedier processes, the more meaningful involvement of those who bring cases to the GMC's attention and keeping interested parties informed of progress.

Streamlined fitness-to-practise procedures, together with the changes that we have made to the constitution and governance of the GMC and the introduction of revalidation for doctors fully meet the aims for modernised professional self-regulation. I believe that

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it is consistent with the changes that are being made with the other regulatory bodies. The new GMC will be more open, more accountable and more responsive to change than ever before.

The GMC has undertaken a tremendous amount of work in engaging the profession and other stakeholders in determining the future of professionally led self-regulation for doctors. Events at Bristol and the publication of the Kennedy report gave this exercise an additional imperative and urgency. Again, I pay tribute to the GMC for its work in taking this agenda forward.

The case for reform in this area has been debated extensively with stakeholders and has been widely accepted. The reforms before the House will ensure not only that the new GMC will be able to respond to the need for reform but that, crucially, it will be able to set the pace of reform. I commend the order to the House. I beg to move.

Moved, That the draft order laid before the House on 14th November be approved [First Report from the Joint Committee].—(Lord Hunt of Kings Heath.)

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