Memorandum of understanding between the General Medical Council (GMC) and the National Clinical Assessment Service (NCAS)
1. The purpose of this Memorandum is to set out a framework for the working relationship between the National Clinical Assessment Service (NCAS) and the General Medical Council (GMC). NCAS is an operating division of the National Patient Safety Agency. This Memorandum sets out the parties' respective responsibilities, identifies areas of communication and mechanisms for sharing information.
2. Annex A provides further contact details.
Roles of the two organisations
3. The GMC is a statutory body independent of the NHS and of Government, with responsibility for maintaining the medical register for the United Kingdom. The GMC's purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. The law gives the GMC four main functions under the Medical Act 1983:
- keeping up-to-date registers of qualified doctors
- fostering good medical practice
- promoting high standards of medical education
- dealing firmly and fairly with doctors whose fitness to practice is in doubt
4. Where the GMC finds that a doctor's fitness to practise is impaired, it has powers to erase that doctor's name from the medical register, to suspend the doctor from the register or to place restrictions on the doctor's practice. These restrictions apply to registration and practice in any sector of employment in any part of the UK.
National Clinical Assessment Service
5. NCAS (previously known as the National Clinical Assessment Authority) was established as a special health authority in April 2001 and became an operating division of the National Patient Safety Agency (NPSA) on 1 April 2005. NCAS is a clearly defined service within the NPSA with a Medical Director who carries responsibility as its Chief of Service. NCAS has offices in Wales, Northern Ireland and Scotland.
6. The National Clinical Assessment Service (NCAS) supports local health organisations and individual practitioners to enable effective management of doctors, dentists and pharmacists ('practitioners') whose performance gives cause for concern. NCAS currently provides a service to healthcare bodies and practitioners throughout the UK and in its associated island administrations, crossing both public and private sectors. Its primary duty is to ensure public protection and patient safety. If a concern comes to light, the employer, contracting body or practitioner can contact NCAS for help. Our aim is to work with all parties to clarify the concerns, understand what is leading to them, and make recommendations on how they may be resolved. Where the performance concern is significant or repetitious and steps have been taken at a local level which have not been successful in clarifying the concern and/or bringing the case to a resolution, a practitioner may be asked to undergo an NCAS assessment. NCAS can also assist a practitioner and referring organisation to develop an action plan to address the recommendations made following an assessment or as part of the handling of a complex NCAS support case, or following an exclusion or other process undertaken by another body.
7. NCAS also has a responsibility to share its experience and to help share good practice across the UK and internationally in the field of managing performance concerns and a research and development role in scoping, developing and promoting new tools for assessing and addressing poor performance.
8. The GMC's independent role in maintaining the medical register means that its processes are distinct from those of the NHS or any other employer. That said, the GMC's fitness to practise functions are an effective part of a wider framework for protecting patients, including measures taken by the NHS and other employers. The GMC is committed to working collaboratively with NCAS, the NHS as a whole, and others, to ensure that patients are protected effectively. Speedy and effective regulation requires good communication between the bodies involved. This MoU is intended to ensure that effective channels of communication are maintained between the GMC and NCAS.
9. The GMC and NCAS will work together in developing policies to ensure that any overlap between their roles and responsibilities is kept to a minimum, and that appropriate and effective channels of communication exist at both national and local levels.
10. Despite having differing core functions, NCAS and the GMC share a common goal, to protect the public and to improve standards of medical care. Both organisations will co-operate wherever possible to meet this common goal.
11. Both the GMC and NCAS hold and use sensitive information about organisations and personal information about individuals in order to perform their core functions. Both recognise the importance of confidentiality, maintaining security of this information and operating within the legal framework set out at paragraph 12 below.
12. Both signatories are subject to the Freedom of Information Act 2000 (FOI Act). In some cases, the information exchanged may contain personal information and/or be confidential in nature and is likely to be exempt from disclosure. However, there may be more general information shared which may be provided in response to a request for information. In all cases, if one of the signatories receives a request for information that originated from the other signatory, the receiving signatory must consult with the other signatory to take account of their views before responding to the request.
Areas of possible communication
13. Within the roles and function of each organisation set out at paragraphs 3 to 7 above, areas of possible communication between the NCAS and GMC include the following (the list is not intended to be exhaustive):
a. Sharing of expertise and experience in the development of assessment methods and approaches to research projects;
b. Point of referral discussion - regarding concerns about individual doctors prior to a formal referral to either GMC or NCAS, usually to establish how best to progress the case;
c. Post-referral discussions - discussion regarding concerns about individual doctors after one of the bodies has received a referral, usually to avoid unnecessary duplication of assessments and to coordinate activity where necessary, for example in action planning;
d. In some cases, NCAS may consider that a referral to the GMC is warranted and will advise the referring organisation to make such a referral. In exceptional circumstances, NCAS may make a referral directly in accordance with the Memorandum of Understanding as set out in paragraph 27.
e. NCAS and the GMC have established education programmes. Where opportunities for collaboration occur, these will be taken forward.
f. Other areas of communication.
Sharing method development, research and evaluation
14. The purposes of the assessment methods employed by the GMC and by NCAS are distinct. However, as each organisation learns from the experience of carrying out assessments, and reviews and improves those methods, it will be useful to share assessment methods, experience, expertise and plans for further development. Senior staff with lead responsibility for assessment method development will meet regularly.
15. Both organisations have research programmes and areas of common interest which may profit from a shared approach to research. Both organisations may seek opportunities for collaborative projects, and will keep each other informed about the progress of their respective research programmes.
Point of referral discussions about individual doctors
16. Both the GMC and NCAS are regularly approached for advice by organisations that have concerns about individual doctors. In most circumstances, the purpose of discussion between the GMC and NCAS at this stage will be to determine whether the referring organisation should take further steps locally, or whether the GMC or NCAS is best placed to assist.
17. In many cases, depending on the concerns raised, it will be apparent whether they are a matter for NCAS or the GMC. However, when it is not clear, it may be necessary for the GMC and NCAS to liaise in order to clarify the issues involved. Alternatively, if the referring organisation would prefer to make their own approaches to NCAS and/or the GMC, they should be offered contact details for both organisations (see Annex A) in order that they may conduct their own discussions.
Post-referral discussions about individual doctors
18. Whilst GMC and NCAS have their own processes for handling referred practitioners, each organisation will aim where possible not to run their processes for the same doctor at the same time. Where the GMC and NCAS processes do need to run either in parallel or sequentially both organisations will endeavour to ensure transparency of handling in order to minimise duplication and disruption.
19. It is important that when either the GMC or NCAS receives a referral, they take steps to establish whether the other body has a current referral and anticipates taking action. It may also be necessary to know whether there have been previous referrals or complaints about the doctor in question.
20. The first recourse of the GMC or NCAS is to request this information from the referring body, requesting information from each other directly only where necessary.
When the GMC receives a referral:
21. In some cases there will be an alleged immediate danger to patients and so swift GMC action will be appropriate. There will be other cases where there have been long-standing concerns which have proved incapable of local resolution, and in such cases the GMC will proceed with an investigation. There will be other cases however where GMC involvement may not be the most appropriate step at the point of referral, and NCAS involvement may be appropriate.
22. Where the GMC receives a complaint from a member of the public which appears to raise issues about the doctor's fitness to practise, contact will be made with the doctor's employer(s). It is expected that any organisation who had made a referral to NCAS would, at that stage, tell the GMC. In these cases, the GMC may subsequently approach NCAS for information about the referral and action taken/advice offered by NCAS.
23. If NCAS is already involved, the GMC, NCAS and the referring body will discuss the most appropriate route for dealing with the concerns raised.
24. In cases where there has been no contact between the NHS (or other referring) body and NCAS, and it is clear that further local measures should be tried before formal GMC action is taken, the GMC will advise that NCAS should be contacted, or may refer directly to NCAS, if this is in the public interest.
When NCAS receives a referral:
25. On receipt of a referral, NCAS will discuss options for taking matters forward with the referring body. In the course of these discussions, the referring body will be asked whether they had made a referral to the GMC and/or whether they were aware of any previous complaints against the doctor which had been handled by the GMC.
26. If a referral has been made to both NCAS and the GMC, NCAS will be able to advise the referring body as to whether further local action might be advisable (potentially including an NCAS assessment). If the GMC progresses the case NCAS may recommend a case conference between the GMC, NCAS and referring body to discuss how matters will be taken forward and to ensure maximum clarity between the organisations.
27. In cases where NCAS becomes aware of impaired fitness to practise or of the need for immediate action on registration for doctors not subject to GMC Fitness to Practise procedures, NCAS will strongly advise the referring body to inform the GMC. If referral to the GMC has not taken place within a reasonable period of time, NCAS will within the terms of this Memorandum of Understanding consider referral to the regulator directly.
Other areas of communication
28. The GMC will issue the monthly Decisions Circular to NCAS.
29. The NCAS and the GMC will share appropriate information about trends, concerns, approaches and initiatives, which are relevant to the shared aim of helping healthcare organisations and registered doctors to provide high quality patient care.
Review of the Memorandum of Understanding
30. This document will be reviewed within two years from the date of the date of its agreement.