Memorandum of Understanding between the Citizens Advice Scotland and the General Medical Council

October 2007. Reviewed April 2010 and August 2011

Purpose of the Memorandum of Understanding

1. 1. The objective of this Memorandum is to set out the framework that Citizens Advice Scotland (known as CAS) and the General Medical Council (GMC) have agreed for co-operation and collaboration.
2. 2. The purpose of the relationship is to ensure that the two organisations complement and strengthen each other’s respective roles and functions. Collaboration between CAS and the GMC is necessary to ensure that complaints about medical practitioners and services are dealt with effectively and timeously with the appropriate involvement of both CAS and the GMC. This memorandum sets out the arrangements for co-operation and communication between CAS and the GMC in relation to complaints about medical practitioners and services provided in Scotland and to clarify the responsibilities of the two bodies.
3. 3. This memorandum does not affect existing statutory functions or amend any other policies or agreements relating to the activities of CAS, or the GMC.
4. 4. This memorandum is not a contract and is not legally enforceable. However, the GMC and CAS agree to adhere to its principles and to show proper regard for each other’s activities.
5. 5. CAS and the GMC will keep this protocol under review and update it as necessary.

Responsibilities of the parties to the Memorandum of Understanding

Citizens Advice Scotland

1. 6. The responsibilities of Citizens Advice Scotland are to support the provision and quality assure the advice provided by members of the Scottish Association of Citizens Advice Bureaux.
2. 7. The twin aims of the Citizens Advice Service are
   1. ‘to ensure that individuals do not suffer through lack of knowledge of their rights and responsibilities or of the services available to them or through an  inability to express their needs effectively’,
3. and equally
   1. ‘to exercise a responsible influence on the development of social policies and services, both locally and nationally’.
4. 8.  Citizens Advice Scotland
   1. a.  Provides a range of services to support its member bureaux to meet the needs of existing and potential clients.
   2. b.  Sets quality standards and regularly monitors bureaux’ compliance with these standards.
   3. c.  Uses the information that bureaux gain from contact with individuals to provide evidence to legislators and statutory organisations on how policies and procedures affect individuals, helping to influence changes in public policy.

General Medical Council

1. 9. The GMC is a statutory body responsible for regulating the medical profession in the United Kingdom. Its purpose is to:
   1. ‘protect, promote and maintain the health and safety of the community by ensuring proper standards in the practice of medicine.’.
2. 10. The GMC has statutory powers under the Medical Act 1983 to take action when concerns are raised about the performance, conduct or health of an individual doctor of a level of seriousness which calls into question the doctor’s fitness to remain on the medical register without restriction.
3. 11. The GMC is not a general complaints body and can act only where there is evidence that a doctor’s fitness to practise may be impaired.  Complaints can often be resolved at a local level, for example through the NHS complaints procedures, or independent and voluntary providers’ complaints procedures.
4. 12. The GMC licenses doctors to practise medicine in the United Kingdom. The law gives the GMC four main functions:
   1. a. Keeping up to date registers of qualified doctors.
   2. b. Fostering good medical practice.
   3. c. Promoting high standards of medical education and training.
   4. d. Dealing firmly and fairly with doctors whose fitness to practise is in doubt.
5. 13.  A key aspect of public protection is the GMC's responsibility to investigate complaints about doctors.  It does so using its 'Fitness to Practise’ procedures.  Where a complaint calls a doctor’s fitness to practise into question it is thoroughly investigated before being referred to 2 case examiners, one medical and one lay, and at this point they may close a case, sometimes with advice, or refer to a Fitness to Practise panel.  Case examiners can also issue a warning to the doctor at this stage or agree undertakings with the doctor in respect of their work practices, retraining needs or health and treatment.
6. 14.  The same sanctions are available where a case is referred to a Fitness to Practise panel, which has the added powers of imposing a period of conditional registration, suspension or removal from the register, in serious cases.
7. 15.  The GMC is currently planning to regulate doctors through a new system of registration. Doctors wishing to practise medicine in the UK will need a licence to practise in addition to their registration. The licence will be generic and there will be no differentiation by specialty or type of practice.
8. 16.  Licensed doctors will be required to satisfy the GMC regularly (normally every five years) that they remain up to date and fit to practise, in line with the template of GMC’s Good Medical Practice. They will do this by drawing evidence from all of their actual medical practice. This process known as re-licensing will be a condition of a doctor’s continued licensure with the GMC. It will be an important part of the GMC’s accountability to patients and the wider public.

Functions of the Memorandum of Understanding

1. 17. This Memorandum relates to the areas of interface between CAS and the GMC. It does not place additional responsibilities on either organisation; or imply any transfer of responsibility from one to the other, or sharing of statutory responsibilities.
2. 18. Interfaces may arise between the GMC and CAS:
   1. a. Through on-going exchange of information and co-ordination of activity.
   2. b. If CAS wishes to bring specific concerns to the GMC’s attention. 
   3. c. If the GMC wishes to bring specific concerns to the attention of CAS.  

Exchange of information and coordination

1. 19. Subject to the statutory and other constraints, the working relationship between CAS and the GMC will be characterised by regular on-going contact and open exchange of information, through both formal and informal contact, correspondence and meetings at all levels, including senior levels. The arrangements will be kept under review by the named contact points and others with relevant responsibilities at CAS and the GMC, whose details are at Annex A.
2. 20. CAS and the GMC will agree to exchange such information as is necessary to fulfil their statutory functions and to ensure the safety and well being of people who use health services.
3. 21. It is understood by CAS and the GMC that statutory and other constraints on the exchange of information will be fully respected, including the requirements of the Data Protection Act 1998, and the Human Rights Act 1998. Similarly the GMC is a named body under the UK Freedom of Information Act 2000.
4. 22. Each organisation will respect and, as appropriate, take steps to protect the confidential nature of documents and information that the other may provide.
5. 23. Where information exchanged between CAS and the GMC involves patient related or other confidential information, the case will be referred with the data anonymised. If the GMC after receiving the information considers that action on its part may be required, it will liaise with Citizens Advice Scotland to contact the referring bureau(x) to seek explicit consent from the client(s) for disclosure. No information will be disclosed by a bureau without the explicit consent of the client(s), unless there is an overriding public interest in doing so.
6. 24. The GMC recognises the Citizens Advice Service’s confidentiality policy and CAS recognises that the GMC has the power to require disclosure of documents from a third party, for use within its Fitness to Practise procedures. This includes documents provided to or prepared by CAS in confidence for an unrelated purpose.
7. 25. Should CAS provide documents relating to specific doctors, clinical incidents or investigations or any other information pertinent to Fitness to Practise for use by the GMC, such documents will normally be disclosed to the doctor or doctors concerned, if any, by the GMC.
8. 26. Examples of how the two organisations will exchange information and co-ordinate their activity include:
   1. a. CAS and the GMC will share information about trends, data, concerns and complaints that are relevant to the shared aims of protecting the safety and wellbeing of vulnerable people and providing an effective, equitable and high quality healthcare service.
   2. b. Each organisation will consult the other on internal guidelines or staff handbooks, where they relate to the other organisation’s responsibilities or interests.

Communication Issues

1. 27.  CAS and the GMC will also collaborate on relevant external communications. This will include, for example:
   1. a. Sharing and working together on relevant drafts, including sections of reports and guidance, as appropriate, in order to ensure factual accuracy, to benefit from each other’s knowledge and expertise, and to promote consistency of advice.
   2. b. Assisting each other to disseminate information about matters of mutual concern.
   3. c. Ensuring that potential and actual complainants receive accurate and helpful information on the appropriate avenue for pursuing any concerns.

Referring issues from CAS to the GMC

Issues relating to an individual registered medical practitioner

1. 28. CAS will ensure that matters that are clearly outwith the remit of the GMC are referred to the appropriate local organisation for investigation where possible.  Where there is some uncertainty as to the role of the GMC in addressing issues raised by an individual about a doctor, Citizens Advice Scotland will refer the matter informally to the GMC for advice.
2. 29. Information received by Citizens Advice Scotland may identify issues that raise concerns about a doctor’s fitness to practise. This information may arise from an individual, or group of individuals, raising concerns or complaints about a doctor’s fitness to practise. The information could relate to a complaint, or death of, or injury to patients, alleged professional misconduct, or health problems affecting the practitioner’s capabilities. 
3. 30. Where an individual (or group of individuals) raise serious concerns about a doctor’s fitness to practise but do not wish to raise the matter through the NHS or other complaints procedures Citizens Advice Scotland will endeavour to obtain the relevant information from the relevant bureaux and share what information it has with the GMC.  The GMC will make a decision on who is best placed to investigate these concerns in discussion with CAS.
4. 31. If, following investigation by the NHS complaints procedure or an independent health provider’s complaints procedure, Citizens Advice Scotland becomes aware that there are still issues about a doctor’s conduct or competence that have not been addressed, then Citizens Advice Scotland will draw these matters to the attention of the GMC.
5. 32. In all cases, CAS staff are encouraged to seek informal or formal advice from the GMC contact points (listed at Annex A).

Referring issues from the GMC to CAS

1. 33. In the course of fitness to practise investigations the GMC may acquire information relating to individual medical practitioners with whom CAS has a formal relationship. For example, the medical practitioner may be a member of a management committee, a Director of a Bureau, or a Bureau volunteer. Where the GMC is aware that a medical practitioner who is the subject of a fitness to practise investigation has a formal relationship with CAB Services, the GMC will share appropriate and relevant information with CAS about such investigations, including any decision to refer the matter to the local NHS complaints system or a local independent health provider’s complaints procedure.
2. 34. Where the GMC acquires other relevant information which it is appropriate to share with CAS, including information relating to relevant CAB cases, it will share this information with CAS.

Reconciliation of Disagreement

1. 35. Any disagreements will normally be resolved amicably at the working level. If this is not possible senior managers at both organisations should seek to settle any issue. The Chief Executive Officer of CAS and the Chief Executive and Registrar at the GMC will jointly be responsible for ensuring a mutually satisfactory resolution and will become personally involved only where necessary.

Monitoring and Review of Memorandum of Understanding

1. 36. This Memorandum will be reviewed annually by the named contacts listed at Annex A. They will report their review to the Chief Executive Officer of CAS and the Assistant Director, Strategy and Planning at the GMC who will jointly decide whether and how to report both to the Board of CAS and to the members of the General Medical Council.
2. 37. This Memorandum, and working relationships, will also be reviewed if necessary following any pertinent changes to legislation, policies, procedures and structures of the parties concerned.
3. 38. Each organisation will endeavour to ensure that their staff are aware of the content of this Memorandum – and any revisions – and the responsibilities it places on each individual member of staff.

Signed: ________________________________          Date: _____________

Lucy McTernan 
Chief Executive
Citizens Advice Scotland

Signed: ________________________________          Date: ______________

Niall Dickson
Chief Executive
General Medical Council

Annex A

Contact details

Citizens Advice Scotland

Spectrum House
2 Powderhall Road
Edinburgh
EH7 4GB

Lucy McTernan
Chief Executive Officer
0131 550 1079
lucy.mcternan@cas.org.uk

CAS Operational Contacts

Social Policy

Susan McPhee
0131 550 1025
susan.mcphee@cas.org.uk

Field Services

David Brownlee
0131 550 1024
ldavid.brownlee@cas.org.uk

IASS Development Worker

General Medical Council

Regents Place
350 Euston Road
London
NW1 3JN

Niall Dickson
Chief Executive
0207 189 5015
opce@gmc-uk.org

Responsible for: liaison, implementation and review of Memorandum of Understanding between CAS and the GMC:

Dan Wynn
Scottish Affairs Officer

5th Floor
The Tun
Jackson’s Entry
Edinburgh
EH8 8PJ

0131 525 8700
dwynn@gmc-uk.org

Responsible for: Fitness to Practise:

Blake Dobson
Head of Case Review

0161 923 6462
bdobson@gmc-uk.org

Registration queries:

GMC Contact Centre

0161 923 6602
registrationhelp@gmc-uk.org