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Memorandum Of Understanding between the Commission for Health Improvement and the General Medical Council

April 2002

Preamble

1. The objective of this Memorandum is to set out the framework that the Commission for Health Improvement (CHI) and the General Medical Council GMC) have agreed for co-operation and collaboration.

2. Collaboration between CHI and the GMC will:

  • Help the NHS – in particular registered medical practitioners – to provide high quality care.
  • Minimise demands on the NHS – and, in particular, on registered medical practitioners – by co-ordinating activities and advice.
  • Maximise benefit and efficiency by pooling efforts and resources.

3. This Memorandum does not affect existing statutory functions or amend any other policies or agreements relating to the activities of CHI and the GMC.

4. This Memorandum should be read in conjunction with the Memoranda between CHI and the National Clinical Assessment Authority (NCAA) and between the GMC and the NCAA.

Functions of CHI and GMC

5. The GMC sets standards and may investigate the professional performance of individual doctors. CHI monitors and may investigate the broader systems within which health professionals, including doctors work.

Commission for Health Improvement

CHI was established by the Health Act 1999 as an independent body covering England and Wales. Its key tasks are:

  • To conduct regular reviews of clinical governance arrangements in NHS organisations.
  • To carry out national studies of particular types of health care, for example progress in implementing National Service Frameworks.
  • To investigate serious and persistent systemic problems in the NHS.
  • To provide advice, information and, over time, leadership in clinical governance.
  • Other matters related to clinical governance and the quality of NHS patient care, as requested from time to time by the Secretary of State for Health and the National Assembly for Wales.

CHI’s functions relate to clinical governance systems, rather than individual health care professionals.

General Medical Council

The GMC licenses doctors to practise medicine in the United Kingdom. The law gives the GMC four main functions:

  • 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 practise is in doubt.

Scope of this Memorandum

6. This Memorandum relates to the areas of interface between CHI 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.

7. Interfaces may arise between the GMC and CHI in England and Wales:

  • Through on-going exchange of information and co-ordination of activity.
  • If CHI wishes to bring specific concerns to the GMC’s attention.
  • If the GMC wishes to bring specific concerns to CHI’s attention.

Exchange of information and coordination

8. It is understood by CHI and the GMC that statutory and other constraints on the exchange of information will be fully respected.

9. The working relationship between CHI and the GMC will be characterised by regular on-going contact and open exchange of information, through both formal and informal meetings and at all levels, including senior levels. This will be kept under review by focal points at CHI and the GMC, whose details are at Annex A.

10. Examples of how the two organisations will exchange information and co-ordinate their activity include:

  • CHI 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.
  • The GMC will inform CHI of any investigations it conducts which raise significant issues about clinical governance, including failures in information and appraisal systems.
  • CHI will inform the GMC of any issues emerging from the reviews and investigations it conducts, or specific concerns within an NHS organisation, which raise significant issues about the fitness to practise of individual registered medical practitioners.
  • Each organisation will notify the other on a ‘for information’ basis of information they receive about concerns relevant to their responsibilities. This might include anonymous and unsubstantiated reports where the organisation with the information considers that it should notify the other organisation.
  • If asked, each organisation will endeavour to assist the other in securing expert advice and provide information for investigations and initiatives to promote the objectives of the two organisations, as needed and to the extent that it is reasonably able to. Where CHI asks the GMC to identify a source of expertise from GMC performance assessors, the GMC will approach the assessor(s) before replying, and will not pass names to CHI without the assessor's agreement.
  • The organisations will share details of their procedures for dealing with complaints and guiding principles for initiating an investigation or assessment.
  • 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

11. CHI and the GMC will also collaborate on external communications.

This will include, for example:

  • Consultation on relevant drafts, or 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.
  • Involving each other, as appropriate, in conferences and other public discussion about clinical governance and good medical practice.
  • Assisting each other’s activities to disseminate information about good practice in clinical governance and in medicine.
  • Involving each other, as appropriate, in working groups, meetings and discussions between organisations on clinical governance, good medical practice and inquiries.

12. Each organisation will respect and, as appropriate, take steps to protect the confidential nature of documents and information that the other may provide.

13. CHI has powers to require information from an NHS body for legitimate purposes. All CHI reports are published.

14. The GMC has the power to demand documents from a third party. This includes documents provided to or prepared by CHI in confidence for an unrelated purpose. The GMC may ask CHI representatives to give evidence in person. Any oral evidence given by CHI representatives would, other than in exceptional circumstances at the discretion of the relevant GMC Committee, be given in public.

15. Should CHI provide documents for use by the GMC, such documents will be disclosed by CHI according to the provisions in the 1999 Health Act and will normally be disclosed to the doctor or doctors concerned by the GMC.

Referring issues from CHI to the GMC

Issues relating to an individual registered medical practitioner

16. A clinical governance review or investigation conducted by CHI may identify an issue that might raise a question about an individual doctor’s fitness to practise.

17. In such a case, the first course of action for CHI staff will be to discuss their concerns with CHI’s Medical Director or Deputy Medical Director and local NHS management with a view to resolving the issue. Where appropriate, CHI will refer the doctor to the GMC. Local NHS management may also refer the doctor to the GMC.

18. CHI staff will be guided by the following principles when referring a doctor to the GMC:

  • CHI staff will work within the existing framework of responsibilities.

Employment by CHI does not confer any specific responsibilities for monitoring standards of professional conduct. Members of CHI staff who are health care professionals should base their actions on their standing responsibilities. For example, Good Medical Practice states that registered medical practitioners must protect patients when they believe that a doctor’s or other colleague’s health, conduct or performance is a threat to patients. In any cases of uncertainty about the professional conduct of a registered medical practitioner, the GMC may be consulted via the focal points listed at Annex A. CHI staff should also keep local NHS management fully informed.

  • CHI staff will assess whether the public interest is at stake and act accordingly.

CHI staff will use their judgement, based especially on the standing responsibilities of all health professionals and registered medical practitioners in particular, and discuss with the NHS body’s management (and the Department of Health/National Assembly for Wales as they judge appropriate), to decide:

    1. Whether the action plan arising from the current review or investigation will be sufficient to address the concern identified.
    2. Whether to inform a GMC focal point of the situation informally and without naming (unless requested) any individual registered medical practitioner.
    3. Whether to refer an individual practitioner or practitioners to the GMC, (in this case, CHI would also consider whether a clinical governance review should be suspended until resolution of the problem or whether an investigation should be initiated),
    4. Whether other courses of action are also possible or necessary, on a case-by-case basis.

19. In all cases, CHI staff may seek informal or formal advice from the GMC focal points (listed at Annex A).

Issues relating to information and appraisal systems that could compromise revalidation assessments.

20. CHI’s work with NHS bodies on clinical governance arrangements will cover information systems which provide data relevant to individual doctors’ fitness to practise. CHI’s work will also cover annual appraisal for registered medical practitioners. These information and appraisal systems will underpin the five-yearly revalidation of registered medical practitioners by the GMC. Where CHI staff consider that failures in either or both of these clinical governance systems at any NHS body are so acute as to compromise assessments made by revalidation groups, they will raise this concern specifically and explicitly with the Medical Director of CHI. He or she will decide whether it is appropriate to contact a focal point at the GMC.

21. CHI and the GMC will continue jointly to consider how CHI’s activities relate to the quality assurance of processes that are relevant to revalidation.

Referring issues from the GMC to CHI

22. In keeping with the character of their working relations, the GMC and CHI will discuss matters as openly and as regularly as possible by both formal and informal contact. The GMC may raise issues with CHI through these meetings, and may also write formally to the Medical Director to invite CHI to consider action that might include undertaking an investigation or fast track clinical governance review. In such a case, CHI will assess the invitation against its guiding principles

23. In particular, performance assessments under the GMC fitness to practise procedures may identify dysfunctional units or services. Any formal approaches to CHI that result will be taken by, or on behalf of, the Director of Fitness to Practise. The person referring the issue to CHI will decide, on a case by case basis, whether it is appropriate to identify to CHI the doctor being considered by the Fitness to Practise Directorate.

24. In the event that revalidation groups, or individual members of those groups, consider that CHI should be informed of a concern, they will raise this issue specifically and explicitly with a focal point at the GMC. The GMC will decide whether to raise the matter either formally or informally with CHI.

Investigations and inquiries relevant to both bodies’ functions

25. It is possible that an investigation by the GMC into a doctor’s practice could coincide with a CHI investigation or inquiry at the doctor’s place of work. Should such a situation arise, both organisations will be guided by the following principles:

  • CHI and the GMC will co-operate closely with each other.
    This will necessitate planning activities so that they are complementary, keeping each other informed of developments, sharing information (within statutory limitations) in order to minimise burdens and enable greater efficiency and effectiveness, and pooling effort wherever possible.
  • CHI and the GMC will clarify boundaries of responsibilities and remits for the two investigations.
    Whilst those conducting investigations will work closely together, the investigations would remain separate and the limitations of each investigation will be clearly defined.

Reconciliation of Disagreement

26. 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 Medical Director of CHI and the Director of Fitness to Practise at the GMC will jointly be responsible for ensuring a mutually satisfactory resolution and will become personally involved only where necessary.

Review of this Memorandum of Understanding

27. This Memorandum will be reviewed annually in April by the focal points listed at Annex A. They will report their review to the Medical Director of CHI and the Director of Policy at the GMC, who will jointly decide whether and how to report both to the CHI Commissioners 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 T: 020 7915 3564

Fitness to Practise

Paul Philip - Director of Fitness to Practise T: 020 7915 7421

Neil Marshall - Head of Screening and Health T: 020 7915 3540

Jackie Smith – Head of Performance and Conduct Case Presentation T: 020 7344 3753

Corporate Affairs and Policy

Andrew Ketteringham – Director of Policy and Corporate Affairs (for policy developments, roles and relationships with other organisations, responses to reports and consultation documents) T: 020 7344 3977

Jane O'Brien, Policy and Corporate Affairs Directorate - Head of Consultations Team 020 7915 3567

Commission for Health Improvement

1st Floor Finsbury Tower
103-105 Bunhill Row
London EC1Y 8TG

Principal Contact: Dr Nicholas L Bishop Assistant Medical Director T: 020 7448 9297

Other Contacts: Dr Linda Patterson  Medical Director T: 020 7448 9262

Dr Jocelyn Cornwell  Deputy Chief Executive  T: 020 7448 9246