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Memorandum of understanding between the General Medical Council (GMC) and the National Clinical Assessment Service (NCAS)

December 2005

Purpose

  1. This Memorandum of Understanding (MoU) describes the distinct roles of the GMC and NCAS and identifies areas where cooperation between the two bodies is necessary for both bodies to meet their respective responsibilities. It sets down the principles underpinning the interaction between the two bodies and provides guidance on the exchange of information between them.

  2. The annex to this document provides more detail on information exchange, whilst the document Mechanisms for exchange of information (which is regularly updated) provides details of contacts within the GMC and NCAS, and describes the ‘routes' to take into each organisation in different circumstances.

Role of the GMC

  1. 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 where there are concerns about the fitness to practise of a registered medical practitioner.

  2. Where the GMC finds that a doctor is not fit to practise, it has powers to erase that doctor's name from the medical register, to suspend the doctor from the register or to place conditions on the doctor's practice. These restrictions apply to practice in any sector of employment in any part of the UK.

Role of the NCAS

  1. The NCAS 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 and dentists, better support. The Authority deals with concerns about the performance of doctors and dentists by offering advice and support, and where necessary by arranging a performance assessment of the doctor or dentist's practice. It advises NHS trusts and Primary Care Organisations on the best way to take action to address poor performance, which may involve a period of retraining, or using the powers which employing or contracting NHS bodies have to discipline or exclude doctors and dentists whose practice gives rise to serious concern.

Principles

  1. 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 is determined that its fitness to practise functions will be 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 the NCAS, the NHS as a whole, and others, to ensure that patients are protected effectively. Speedy and effective regulation requires good working communication between the bodies involved. This MoU is intended to ensure that effective channels of communication are maintained between the GMC and NCAS.

  2. The NCAS works in partnership with and liaises with the GMC in developing policies to ensure that overlap between the respective activities of the GMC and the NCAS is kept to a minimum, and that effective channels of communication exist at both national and local levels. The NCAS also liaises with the GMC and other bodies to establish and maintain lists of doctors who may act as assessors.

  3. The NCAS and the GMC, despite having differing and complementary core functions, share a common goal, to improve standards of medical care. Both organisations will co-operate whenever possible in working to meet this common goal.

  4. Both the GMC and the NCAS hold and use sensitive information about organisations and individuals in order to perform their core functions. Both recognise the importance of confidentiality and security of this information. It is necessary that such information is on occasion shared between the organisations if they are to perform their functions effectively. The GMC and NCAS recognise that this exchange of information needs to be carried out responsibly and within the guidelines set out in this document and its annex.

Note

  1. Following the outcome of the Department of Health's review of its Arms Length Bodies, the NCAS will be brought together with the National Patient Safety Agency in April 2005.  It is envisaged that this MoU will form the basis of collaboration between the GMC and the new agency pending the development of a new agreement between the two organisations.

Annex

Areas of possible communication between the GMC and NCAS

Introduction

  1. Communications between the GMC and the NCAS are based on an overriding duty to protect patients. Within that duty, areas of possible communication between the NCAS and GMC include the following (the list is not intended to be exhaustive):

    1. sharing of expertise and experience in the development of assessment methods and use of assessors;
    2. pre-referral discussion - discussions regarding concerns about individual doctors prior to a formal referral to either body, usually to establish how best to progress the case and which of the two bodies should most appropriately deal with it;
    3. 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;
    4. joint research projects;
    5. other areas of communication.

[NB: the document Mechanisms for exchange of information sets out likely contact points within the NCAS and the GMC for these areas of communication.]

Principles of information sharing

  1. This document sets out the ways in which the NCAS and the GMC would normally collaborate with each other. However, the governing principle in the relationship between the two organisations is that either organisation may provide the other with information provided that it does so within the legal framework.

  2. The legal framework governing information sharing includes obligations under the Data Protection Act 1998, the Human Rights Act 1998, the common law duty of confidence, and, in the case of the GMC, powers conferred on it under the Medical Act 1983. Both the GMC and the NCAS share information only in accordance with the legal framework.

Sharing of expertise and experience in the development of assessment methods and use of assessors

  1. The purposes of the assessment methods employed by the GMC and by the 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.

  2. The GMC and NCAS will keep each other informed of plans for recruitment of assessors, to avoid unintended clashes or duplication of effort. Both organisations are committed to exploring ways in which their assessor pools can be deployed effectively.

  3. The GMC will notify the NCAS of any fitness to practise concerns about known NCAS assessors.

  4. The NCAS will notify the GMC if it receives a referral about a known GMC assessor.

  5. To enable the process set out in paragraphs 6 and 7 above to function, each body will provide a list of the names of current assessors to the other.

Pre-referral discussions about individual doctors

  1. Both the GMC and NCAS are regularly approached for advice by NHS bodies who have concerns about particular doctors; the purpose of these discussions is to determine whether the organisation should take further steps locally, refer to the GMC, or refer to the NCAS.

  2. In many cases, it will be clear what advice should be given to the enquiring body at this stage. However, when it is not clear what the best course of action would be, it may be necessary for GMC and the NCAS to liaise in order to clarify the issues involved. In such circumstances, the organisation dealing with the initial enquiry will seek consent from the referring body to liaise with the other relevant organisation (i.e. NCAS would liaise with GMC or vice versa) in order to decide on a mutually agreed proposal for action. If the body making the enquiry does not wish to follow this route, they should be offered appropriate contact details for both organisations (as per Mechanisms for exchanges of information ) in order that they might conduct their own discussions.

  3. Where possible and appropriate, these discussions will take place without providing any information which would lead to the identification of the individual practitioner involved.

Post-referral discussions about individual doctors

  1. The GMC and the NCAS will not usually conduct simultaneous assessments on any single case, although in some circumstances assessments may follow serially. This is because normally, appropriate action on a case should be either to consider the individual doctor's registration (GMC) or to aim to address issues through the NHS body in the hope that the doctor in question can be brought back to an acceptable level of practice (through assistance by the NCAS). However, the NCAS may have a role in supporting effective local management of a case that is subject to GMC procedures (e.g. advice in handling of suspension from NHS employment/local GP list pending a GMC determination).

  2. It is important that when the GMC or NCAS receives a referral, they find out whether the other body has a current referral and is anticipating taking action. It may also be necessary to know whether there have been previous referrals / complaints about the doctor in question.

  3. 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

  1. The GMC's procedures require that when a referral is made by an NHS body, or other employer / contractor, contact is made with the referring body within a week of receipt. The purpose of this contact is to discuss with the referring body the options for handling the case. In many cases, there will be an (alleged) immediate danger to patients and so swift GMC action will be appropriate. This may also be the case where there have been long-standing issues which have proved incapable of local resolution.

  2. In some cases, however, referral to the GMC may seem premature. For example, there may be little more than anecdotal evidence against the doctor, or else a referral has been made in order to ‘notify' the GMC of current problems, which are still open to local resolution. In these cases, it may be appropriate for the referring organisation to consider withdrawal of the referral to the GMC (at least temporarily) whilst further local initiatives are attempted. In these cases, NCAS involvement may be desirable.

  3. 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) at the earliest opportunity (and normally within two weeks of receipt of the complaint). It is expected that any NHS body who had made a referral to the NCAS would, at that stage, tell the GMC. In such cases, the GMC would seek the NHS body's permission to discuss the matter with the NCAS and might subsequently approach the NCAS for information about the referral and the current state of play.

  4. Should the GMC choose to progress the case it will establish, in the course of initial discussions, whether the referring body has been in contact with the NCAS about the case and whether a formal referral to the NCAS was made.

  5. If the NCAS is already involved, the GMC will recommend a three-way discussion (either by telephone or in person) with the purpose of arriving at a consensus about how to take the case forward. As part of this, the GMC may ask the referring body's permission to approach the NCAS directly to exchange information. If, following this meeting between the three bodies, it still has not been possible to determine the best way forward, a further formal case conference will be arranged.

  6. Where the GMC approaches the NCAS for information regarding a referring body, the GMC will confirm that it has the written agreement of the referring body to contact the NCAS. In these circumstances, the NCAS will share relevant information about their involvement in the case.

  7. In cases where there has been no contact between the NHS body and the NCAS, and it is clear that further local measures should be tried before formal GMC action is taken, the GMC will strongly advise that the NCAS should be contacted. In exceptional circumstances, where it is clear that the local NHS body are not willing to seek advice from the NCAS and yet do not seem to be able to deal with the issue themselves, the GMC will refer directly to the NCAS, if this is in the public interest.

  8. In cases where no referral has been made to the NCAS, and GMC action seems immediately necessary because there is a risk to patients, the GMC will suggest that the referring body contact the NCAS (for information only at this stage), particularly if it seems likely that a possible outcome of the case would be remediation of one form or another.

When the NCAS receives a referral

  1. On receipt of a referral, the NCAS will discuss options for next action 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.

  2. If a referral has been made to both the NCAS and GMC, the NCAS would 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 the NCAS would usually recommend a case conference between the GMC, NCAS and referring body about the options for action in the case.

  3. In cases where the NCAS receives a referral and is aware that the GMC is not yet involved, but where the case seems so serious that immediate action against the doctor's registration may be necessary, the NCAS will strongly advise the referring body to make a referral to the GMC. If they will not do so, or will not assure the NCAS that they have done so, the NCAS will make a referral direct to the GMC.

Joint research projects

  1. The NCAS and GMC have areas of common interest which may profit from jointly-funded and resourced research projects. Any joint research projects will be ethically approved. Where possible information used in such projects will be anonymised. If this is not possible, the consent of the identifiable individual will be sought before information about them is used.

  2. The primary mechanism for identifying potential for linked research projects is the NCAS R&D forum. The GMC are represented on this group, which is composed of external stakeholders and NCAS staff; all research project proposals are taken before this forum, which prioritises proposals and advises which should be taken forward. At this stage areas of common interest which may lend themselves to collaborative projects can be identified; equally the GMC can bring proposals for joint projects to the forum. Day-to-day knowledge sharing between the GMC and the NCAS also keeps both organisations updated on opportunities for collaborative work.

Other areas of communication

  1. Where the NCAS proposes to employ a doctor or engage him/her to carry out assessments, they will contact the GMC to check if the doctor has any GMC fitness to practise history. On such occasions, the NCAS will be provided with the same information which would be provided to any other prospective employer.

  2. The NCAS 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.

  3. The NCAS and the GMC will take a collaborative approach to educating employers, commissioners and medical staff about disciplinary, performance and health issues.