Memorandum of Understanding between the General Medical Council (GMC) and the National Clinical Assessment Authority (NCAA)
October 2002
Purpose
1. The purpose of this Memorandum of Understanding is to describe the process that should normally be followed for informal and formal contact between the GMC and the NCAA.
Principles
2. 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 has statutory powers under the Medical Act 1983 to take action when concerns are raised about the performance, conduct or health of individual doctors of a level of seriousness which calls into question the doctor's fitness to remain on the medical register without restriction.
3. The GMC's statutory processes, which determine a doctor's right to practise medicine in any sector of employment in any part of the UK, are distinct from those of the NHS or of any other employer. However, the GMC has recognised that the public has a right to expect its fitness to practise functions to be "an effective and distinct part of a wider framework for protecting patients, including measures taken by the NHS and other employers" , and it is committed to working more collaboratively with the NHS to ensure that the public are protected sooner and more effectively. This requires good working communication, both formal and informal, with other parts of the framework. The GMC has stated publicly that it wants to work closely with the NCAA . However, as it is a statutory body with a distinct role it is not appropriate for the GMC to act as an agent of another organisation, for example an NHS or Government organisation, in discharging its functions in relation to allegations against an individual doctor.
4. The NCAA is a Special Health Authority set up by the Government as a central plank of its plans to ensure that patients have better protection and doctors, better support. The authority will deal with concerns about the performance of doctors by investigating problems, offering advice and assistance and arranging performance assessments where necessary. It will advise NHS trusts, PCTs and health authorities on the best way to take action to address poor performance, which may involve a period of retraining, or implementing powers for employing or contracting NHS bodies to discipline or suspend doctors whose practice gives rise to serious concern. The NCAA will not replace the GMC or replicate its work. Its main concern will be the practice of an individual within a team and a clinical setting, not the fitness of that individual to remain on the GMC Register. The NCAA will therefore complement the work of the GMC and other professional bodies, with particular emphasis on supporting employers, health authorities and individual doctors in both hospital medicine and general practice.
Areas of possible communication
5. Areas of possible future communication between the GMC and the NCAA may include:
- Informal discussion of appropriate response to emerging problems with individual doctors
- Sharing of expertise and experience in the development of assessment methodologies and use of assessors
- Formal notification of concerns about individual doctors
- Ad hoc requests for information
- Other areas of communication
a. Informal discussion of appropriate response to emerging problems with individual doctors
6. Both the GMC and the NCAA may be contacted by senior medical or non-medical NHS managers or the Department of Health to discuss what action it is appropriate to take on concerns about individual doctors. The GMC officer involved may contact an appropriate person at the NCAA to discuss the matter informally, and vice versa. Normally, those contacts will be through the people identified in Annex A, but that list is not exclusive. If the GMC is satisfied that sufficient action is being taken locally to protect the public, then it will not take formal action though it will maintain a record of the exchange. If at any point the GMC believes that the actions of a doctor may be putting the public at risk, it will initiate formal action. Where the outcome of informal discussion is a proposal for action by an NHS organisation (whether or not supported by the NCAA), the GMC may ask for a report later from that organisation in order to decide whether formal GMC action is required.
7. If the NCAA wishes to check whether the GMC is investigating or has taken action against a specific doctor, it may contact the GMC to find out if the doctor has any fitness to practise history. The GMC will normally disclose information about current cases against a doctor which have proceeded to or beyond the stages at which it is legally required to notify employers, viz referral to the Preliminary Proceedings Committee, invitation to the practitioner to agree to a performance assessment; or notification that the doctor's fitness to practise may be seriously impaired by reason of his or her physical or mental condition. Paragraph 19 of this document gives further information about disclosure of past cases which are in the public domain and disclosure of restrictions on a doctor's practice where he or she has been subject to the health procedures.
b. Sharing of expertise and experience in the development of assessment methodologies and use of assessors
8. The methodologies of assessment developed by the GMC for its performance procedures are distinct from those of the NCAA. However, there will be much that the NCAA can learn from the GMC's experience in this area (and vice versa, as the NCAA's own development work proceeds), and both organisations will need to draw on the same national experts. The GMC is willing to share any parts of its expertise and experience in assessment which may assist the NCAA. The appropriate GMC officer contact-points for such discussions are set out in Annex A.
9. In carrying out assessments the NCAA will take full account of the structure and template set out in Good Medical Practice, or any subsequent revision agreed by the GMC.
10. The GMC has over 200 trained assessors and lead assessors (medical and lay). If the NCAA wishes to contact GMC assessors or to seek to recruit them for NCAA work, it should inform the GMC first (see Annex A for appropriate contact-point). The GMC will then contact the assessor to check whether they are willing to participate in the NCAA assessment, and inform the NCAA accordingly.
11. The GMC and the NCAA should keep each other informed of plans for recruitment of assessors, to avoid unintended clashes or duplication of effort.
12. If the NCAA requires to make arrangements for a doctor to be assessed before the NCAA's own assessment processes are in place, it may consult the GMC informally for advice and suggested contacts. It will not, however, commission the GMC to carry out assessments on the NCAA's behalf.
c. Formal notification of concerns about individual doctors
GMC to NCAA
13. There are cases where, as a result of the exercise of its statutory functions, the GMC has information which raises concerns about the competence or performance of an individual doctor employed or contracted by an NHS organisation, but those concerns are not - yet - so serious as to raise an issue of seriously deficient performance. The GMC may consider it to be in the public interest to communicate those concerns to the appropriate NHS organisation (normally through its medical director), and may also inform the relevant Regional Office of the NHS Executive. The GMC will not, normally, notify the NCAA directly, although the NHS organisation concerned may do so as a result of the information provided by the GMC. The GMC may, if it considers it appropriate, seek informal advice from the NCAA about the content of any letter of advice to doctors or NHS organisations. It may also refer cases directly where it has a concern that the NHS organisation is not able to act appropriately on an individual case.
14. GMC committees that can place conditions on a doctor's registration should not specify the involvement of the NCAA in any conditions. It will normally be for the doctor's employer/contractor to decide whether to seek assistance from the NCAA, whereas it is the individual doctor's responsibility to fulfil conditions set by the GMC. Doctors may at any time seek to self-refer to the NCAA for assistance. On such occasions, the NCAA will normally inform the doctor's employer/contractor.
NCAA to GMC
15. If enquiries or assessments carried out or commissioned by the NCAA raise serious concerns about a doctor the NCAA should immediately contact the GMC and other appropriate authorities. Such serious concerns may, for example, be:
- that the doctor may be a danger to patients, whether in the NHS or the private sector - that the doctor has not co-operated with proposals to restrict practice to areas within his or her competence.
The NCAA should ensure that the GMC is informed immediately either by the doctor's employer/contracting authority or by the NCAA itself. If the NCAA informs the GMC, it should tell the employer/contractor that it is doing so.
16. If enquiries or assessments carried out or commissioned by the NCAA raise concerns that a doctor may have committed a criminal offence the NCAA should immediately contact the GMC and other appropriate authorities (such as, for example, the DOH, Regional Office, Health Authority, Trust, PCT or other employer and the appropriate police force) so that immediate action can be taken where necessary. If it appears that the doctor poses an immediate risk to the public then contact should, in the first instance, be by telephone or in person.
17. If the doctor has already been convicted of an offence the NCAA should contact the GMC with details of the conviction. This could be in writing unless the doctor appears to pose an immediate risk to the public or immediate action is necessary to maintain public confidence.
18. Any doctor employed by the NCAA has a personal responsibility under Good Medical Practice to 'protect patients from risk of harm posed by another doctor's…conduct, performance or health'. The requirement is to 'give an honest explanation of your concerns to an appropriate person from the employing authority…'. In specified circumstances, 'you should inform the relevant regulatory body' (GMP, paragraphs 26-28).
d. Ad hoc requests for information
NCAA to GMC
19. When the NCAA is considering assessing a doctor, it may contact the GMC to find out if the doctor has any GMC fitness to practise history. The GMC will normally disclose information about current cases against a doctor which have proceeded to or beyond the stages at which it is legally required to notify employers, viz referral to the Preliminary Proceedings Committee, invitation to the practitioner to agree to a performance assessment; or notification that the doctor's fitness to practise may be seriously impaired by reason of his or her physical or mental condition . Information about past cases which is in the public domain (for example, all past findings of the Professional Conduct Committee) will also be disclosed. Where a doctor has been subject to the health procedures, the GMC will disclose the scope of any restrictions on the doctor's practice, but will not disclose details of the doctor's illness or of any conditions imposed on his or her behaviour beyond medical practice.
20. Where the NCAA proposes to employ a doctor or engage him/her to carry out assessments, it may contact the GMC (see contacts at Annex A) to check if the doctor has any GMC history. Normally, the GMC's response to those enquiries will be governed by the principles in paragraph 19 above.
21. Exceptionally, the GMC may provide the NCAA with any other information which it considers it to be in the public interest to disclose.
GMC to NCAA
22.Where the NCAA has information about a doctor who is the subject of inquiries by the GMC, the GMC may seek information from the NCAA to assist its enquiries. Normally, the GMC's first port of call would be to the doctor's NHS employer or contractor, but if it requires further information which the NCAA can provide, it may require the NCAA to provide it under S35A(1) of the Medical Act.
f. Other areas of communication
23. The NCAA and the GMC will share information about trends, concerns, data, approaches and initiatives, which are relevant to the shared aim of helping the NHS and registered medical practitioners to provide high quality patient care.
24. The NCAA and the GMC will take a collaborative approach to educating employers, commissioners and medical staff about disciplinary, performance and health issues.
Review of this Memorandum of Understanding
25. This Memorandum will be reviewed annually in April by the focal points listed in Annex A. They will report to the Chief Officer and Medical Director of the NCAA and the Director of Fitness to Practise at the GMC, who will jointly decide whether and how to report both to the NCAA Board and to the members of the General Medical Council.
Annex A: Contacts
GMC
178 Great Portland Street London W1N 6JE
Finlay Scott, Chief Executive/Registrar
Focal points
Paul Philip, Director of Fitness to Practise (020 7915 7421) (pphilip@gmc-uk.org) (for matters concerning individual cases, assessment methodologies and assessors)
Isabel Nisbet, Director of Policy (020 7915 3575) (inisbet@gmc-uk.org) (for policy issues concerning the respective roles of the two organisations and GMC policy developments affecting the NCAA)
Neil Marshall, Head of Screening (020 7915 3540) (nmarshall@gmc-uk.org)
Adewale Kadiri, Casework Manager, Screening (020 7915 3732) (akadiri@gmc-uk.org)
Jackie Smith, Head of Performance and Health (020 7344 3753) (jsmith@gmc-uk.org)
Elizabeth Livingston, Performance Assessment Manager (020 7915 3574) (elivingston@gmc-uk.org) (for all matters concerning GMC performance assessments and assessors)
NCAA
1 Nine Elms Lane 9th Floor, Wing 2, London SW8 5NQ
Jane Wesson, Chairman 020 7273 0840
Focal points
Dr Alastair Scotland, Chief Officer and Medical Director (020 7273 0840/0852) (ascotland@ncaa.nhs.uk)
Dr Rosemary Field, Deputy Medical Director and Director of Primary Care (020 7273 0853) (rfield@ncaa.nhs.uk)
Dr Sheila Peskett, Director of Hospital and Community Health Services (020 7273 0831) (speskett@ncaa.nhs.uk)
Julie Eaton, Director of Human Resources and Organisation Development (020 7273 0854/0839) (jeaton@ncaa.nhs.uk)
Ms Barbara Mitchell, Head of Casework Management (020 7273 0086)
(bmitchell@ncaa.nhs.uk)
John Hennessey, Director of Finance and Information [from 1 October 2001] (020 7273 0849/0838) (jhennessey@ncaa.nhs.uk)