Memorandum of Understanding between the General Medical Council (GMC) and the Conference of Post Graduate Medical Deaneries (COPMeD)

April 2007

Purpose

1. 1.  The purpose of this Memorandum of Understanding is to set out a framework between COPMeD and the GMC to facilitate effective liaison between the GMC and constituent Postgraduate Deaneries in relation to individual doctors and areas of mutual interest.
2. 2.  This Memorandum covers the main interfaces between Postgraduate Deans and the GMC, clarifies respective roles and responsibilities and outlines the mechanisms in place to promote effective working. This agreement does not affect existing statutory functions or amend any other policies or agreements relating to the activities of COPMeD or the GMC.

Functions of the GMC and COPMeD

GMC

1. 3.  The GMC is the 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. 4.  The GMC has statutory powers under the Medical Act 1983 to take action on a doctor’s registration when concerns are raised which call their fitness to practise into question.
3. 5.  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. Lesser problems can usually be resolved locally, for example through the NHS procedures. A memorandum of understanding is in place between the GMC and the National Clinical Assessment Service (part of the National Patient Safety Agency) to encourage effective co-operation.
4. 6.  Further details on the GMC's remit can be found at Annex A.

COPMED

1. 7.  COPMeD is the Conference of Postgraduate Medical Deans. Postgraduate Deans manage the postgraduate training of doctors, and the continuing professional development of GPs.
2. 8.  COPMeD provides a forum in which members can meet to discuss current issues, share best practice and agree a consistent and equitable approach to training in all Deaneries. It acts as a focal point for contact between the Postgraduate Medical Deans and other organisations, e.g. Medical Royal Colleges, GMC, BMA, MRC, AMRC and NHS Executive.
3. 9.  Postgraduate Deans are responsible for organising remedial training for those doctors employed in the categories above. They are also well-placed to provide career advice for doctors who are currently not employed.

Collaborative working arrangements

1. 10.  Collaborative working between the organisations falls into two strands:
   • Referral of doctors between the GMC and Postgraduate Deans
   • Communication and liaison mechanisms.

Referral of doctors between the GMC and Deaneries

1. 11.  Doctors may be referred by the GMC to the Postgraduate Dean following an investigation, which may have included an assessment of the doctor’s health and/or performance, and following which the doctor is found to have impaired fitness to practise. In practice these referrals will be contained either in undertakings agreed between the GMC and the doctor, or in determinations of Fitness to Practise panels. 
2. 12.  Whilst the GMC defines the policy framework within which Fitness to Practise panels operate the panels are independent of the GMC in relation to individual cases. The GMC will take all practical steps to ensure that the referral conforms to agreed protocols and does not impose obligations on Deaneries outside the remit specified within this memorandum. The GMC will also ensure that all doctors referred to a Postgraduate Dean are informed in writing that the Deanery is under no obligation to locate employment or fund training courses for them.
3. 13.   On receipt of the referral, for doctors who are currently in a training programme of the relevant Deanery, the Postgraduate Deanery will:
   • plan targeted or remedial training following local performance procedures, RITA panel outcomes, or GMC or NCAS performance assessment
   • where appropriate, identify an alternative training placement or placements suitable to meet the needs of the trainee
   • identify a named clinical and educational supervisor
   • agree arrangements for monitoring performance against objectives in action plans, either locally or at Deanery level
   • advise on provision of mentoring and coaching when required
   • provide access to confidential psychological support
   • report to the GMC at regular, agreed intervals on the progress of the doctor
4. 14.  For doctors who are not appointed to, or substantively employed in, a Deanery training programme, or at all, the Deanery will see doctors referred by the GMC who live or work in their catchment area, and will:
   • help the referred doctor to develop a personal development plan to address identified weaknesses in performance
   • agree a means and timescale for monitoring that the objectives in the plan have been carried out
   • offer information with regard to career opportunities
   • explain how to access training placements through open competition
   • offer guidance with respect to preparing a CV and covering letter for potential employers
   • identify sources of appropriate educational supervision, coaching or mentorship
   • organise where appropriate and practicable, an unpaid clinical attachment (observership) with a consultant who will be asked to provide a report
   • provide a report to the GMC relating to the extent to which the doctor has cooperated with and benefited from the above
5. 15.  Doctors may be referred to the GMC by the Postgraduate Dean where the Dean has developed concerns that the doctor’s fitness to practise may be seriously impaired. In such cases it will often be appropriate to discuss the referral prior to making it. Where this discussion takes place the GMC will advise the Dean on potential referrals to the GMC, and agree responsibilities for actions in individual cases. These discussions should normally take place between those listed at Annex B.
6. 16.  Where the Dean does make a referral the GMC will:
   • investigate the fitness to practise of the doctor
   • where appropriate, assess the doctor’s performance and/or health through fitness to practise procedures
   • make decisions as to whether the doctor’s fitness to practise is impaired, and if so apply proportionate restrictions to their registration
   • send a copy of any performance assessment report, and of any restrictions imposed on the doctor’s registration, to the Deanery
   • monitor compliance with any restrictions, and take appropriate action
   • communicate regularly with the Deanery throughout the period of restriction

Communication and liaison mechanisms

1. 17.  Both bodies are committed to effective communication at whatever level is most effective for the circumstances. Areas of communication between the GMC and Postgraduate Deans outside the referrals described above include:
   • Informal discussion of appropriate response to emerging problems with individual doctors
   • Discussion on individual doctors already referred
   • Other areas of communication

Informal discussion of appropriate response to emerging problems with individual doctors

1. 18.  Either body may need to contact the other to discuss what action it is appropriate to take on concerns about individual doctors. Normally, these contacts will be through the people identified in Annex B, but that list is not exclusive. If the GMC is satisfied that sufficient action is being taken locally, either by the employer or the Postgraduate Dean, 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 the Postgraduate Dean the GMC may ask for a report later from the Dean in order to decide whether formal GMC action is required.
2. 19.  If a Postgraduate Dean wishes to check whether the GMC is investigating or has taken action against, a specific doctor they will contact the GMC. The GMC will normally disclose information about current cases against a doctor which have proceeded to or beyond the stages at which it is required to notify the doctor’s employers.

Discussion on individual doctors already referred

1. 20.  Each doctor that has been referred between the Postgraduate Dean and the GMC will have a named investigation officer based within the Fitness to Practise directorate at the GMC who is responsible for managing the case, and a named member of staff at the relevant Deanery. Communication concerning these doctors will normally be between these staff members at the Deanery and the GMC, however may also take place between those identified in Annex B where appropriate.

Other areas of communication

1. 21.  The GMC and COPMeD will share information about trends, concerns, data, approaches and initiatives, which are relevant to improving the quality of patient care.
2. 22.  The GMC and COPMeD will take a collaborative approach to educating employers, commissioners and medical staff about fitness to practise issues.
3. 23.  The GMC and COPMeD will invite contributions from each other to policy and operational guidance, reports and other mechanisms, as appropriate, in order to ensure factual accuracy, to benefit from each other's knowledge and expertise, and to promote consistency of advice.
4. 24.  The GMC and COPMeD will assist each other, as appropriate, in providing information for investigations and initiatives to promote the objectives of the two organisations.

Privacy provisions

1. 25.  It is agreed that statutory and other constraints on the exchange of information will be fully respected.
2. 26.  Under Section 35B(2) of the Medical Act 1983, as amended, the GMC may disclose to any person any information relating to a practitioner’s fitness to practise which the GMC considers to be in the public interest to disclose. The GMC’s policy intent is to disclose such information to COPMeD when the GMC considers it to be in the public interest. Each organisation will respect and, as appropriate, take steps to protect the confidential nature of information that the other may provide.
3. 27.  The GMC is subject to the general disclosure provisions of the Freedom of Information Act 2000 (FOI), and as such may be required to disclose information to a third party which COPMeD has provided to the GMC. If this occurs the GMC will discuss the FOI request with COPMeD to ascertain whether the request may be exempt from the FOI disclosure provisions.

Reconciliation of disagreement

1. 28.  Any disagreements will normally be resolved amicably at working level. If this is not possible, the contact points listed at Annex B will seek to settle the issue and ensure a mutually satisfactory resolution. Senior management of both parties will be involved as necessary.

Review of Memorandum of Understanding

1. 29.  This Memorandum will be reviewed annually and if necessary following any pertinent changes to policies, procedures and structures of the parties concerned.

Signed: ........................ Date:
Mr Finlay Scott
Chief Executive, General Medical Council

Signed: ....................... Date:
Professor Elisabeth Paice
Chair, Conference of Post Graduate Medical Deaneries

Annex A

• 19 doctors elected by the doctors on the register
• 14 members of the public appointed by the Privy Council
• 2 academics appointed by educational bodies - the universities and medical royal colleges.

The Privy Council nominees are not medically qualified. Their task is to speak for the public, act as a focus for debate between doctors and patients and play a vital part in all areas of our work.

Functions

The GMC is required by law to:

keep up to date registers of qualified doctors
foster good medical practice
promote high standards of medical education
deal firmly and fairly with doctors whose fitness to practise is in doubt

Registration

Maintaining the medical register is at the heart of the GMC’s work. The register shows who is properly qualified to practise medicine and lists over 200,000 doctors. It is held on computer and updated every day as doctors move, gain new qualifications, change jobs, retire or are registered by the GMC for the first time. No doctor can practise medicine in the UK if he or she is not registered; and to be registered they must have a recognised medical qualification.

The GMC publishes a specialist register, showing the doctors who have completed specialist training. Doctors must be included in this to be eligible for most substantive or honorary consultant posts in the NHS.

Good Medical Practice

Registration carries both privileges and responsibilities. The GMC summarise these responsibilities in key principles, which it calls the duties of a doctor - the contract between doctor and patient which is at the heart of medicine.
The GMC builds on these principles in guidance covering both general aspects of good medical practice and more specific areas, such as confidentiality and consent. This guidance describes the principles of good medical practice and standards of competence, care and conduct expected of doctors in all aspects of their professional work. Serious or persistent failures to meet these standards may put a doctor's registration at risk.

Medical education

Registration requires high standards of medical education; and the GMC has general responsibilities to promote high standards in and to co-ordinate all stages of medical education. It has varying specific responsibilities for education and training throughout a doctor's career. For example, it ensures that doctors who become registered have the knowledge, skills and attitudes that they will need to maintain a good standard of practice and care.

Fitness to practise

The GMC has strong and effective legal powers to maintain the standards the public have a right to expect of doctors. It is not a general complaints body and can act only where there is evidence that a doctor may not be fit to practise. It can take action if a doctor's fitness to practise is impaired. This may be for a number of reasons:

• misconduct;
• deficient performance;
• a criminal conviction or caution in the British Isles (or elsewhere for an offence which would be a criminal offence if committed in England or Wales);
  physical or mental ill-health;
• a determination (decision) by a regulatory body either in the British Isles or overseas.

Action can range from issuing a warning to - in the most serious cases - erasing the doctor from the register, with a range of options in between.

Annex B

Contacts:

GMC

Paul Philip, Director of Fitness to Practise, 0207 189 5124
Blake Dobson, Head of Case Review, 0161 923 6462
Jackie Smith, Head of Investigations, 0207 189 5132

COPMED

Professor Elisabeth Paice, Post Graduate Dean Director, London & Chair of COPMeD
Postgraduate deans (or their Nominated deputy), from each Deanery in the UK