A Memorandum of Understanding NHS Education for Scotland and General Medical Council

October 2006 (amended March 2010)

Preamble

1. 1.  The objective of this Memorandum of Understanding (Memorandum) is to set out the framework that NHS Education for Scotland (known as NES) 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 function. Collaboration between NES and the GMC will improve the quality of healthcare through raising standards and promoting professional development.
3. 3.  This Memorandum does not affect existing statutory functions or amend any other policies or agreements relating to the activities of NES, or the GMC.
4. 4.  Throughout this Memorandum, NHS Education for Scotland includes its four postgraduate deaneries and their respective organisations.
5. 5.  This Memorandum is not a contract and is not legally enforceable. However, the GMC and NES agree to adhere to the principles within the Memorandum and to show proper regard for each other's activities.
6. 6.  NES and the GMC will keep this protocol under review and update it as necessary.

Functions of NHS Education for Scotland and GMC

NHS Education for Scotland

1. 7.  The responsibility of NES is to help provide better patient care by designing, commissioning, quality assuring and, where appropriate providing education, training and lifelong learning for the NHS workforce in Scotland. Quality assurance of medical training is discharged in partnership with other bodies concerned with quality and regulation.
2. 8.  The aims of NES are based on eight fundamental principles:
   1. a. Patient-centred outcomes for all NES's work streams;
   2. b. Equity of access to educational support for all NHS Scotland staff;
   3. c. An appropriate balance between uni/multi-disciplinary approaches to education.
   4. d. Responses to service needs that are speedy and effective;
   5. e. Working in partnership;
   6. f. Evidence based and quality assured frameworks for all developments;
   7. g. A value-added dimension to all NES's initiatives; and
   8. h. Valuing diversity and striving for a culturally competent workforce.
3. 9.  NES has statutory responsibilities set out in its commissioning Order; The NHS Education for Scotland Order, 2002: SSI 2002 No.103. This provides for NES to be a Special Health Board for the whole of Scotland and for it to exercise functions of the Scottish Ministers in respect of providing, co-ordinating, funding and advising on education and training for persons providing services under the National Health Service (Scotland) Act 1978 (article 4). The Board discharges the functions formerly carried out by the Scottish Council for Postgraduate Medical and Dental Education, itself a Special Health Board, which was abolished in 2002.

General Medical Council

1. 10.  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. 11.  The GMC has statutory powers under the Medical Act 1983 as amended 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. 12.  Amongst its other functions set out below, the GMC regulates medical education and training in the United Kingdom. This covers undergraduate education, the Foundation Programme and specialty including GP training. The GMC runs quality assurance programmes for UK medical schools and postgraduate deaneries to ensure that these standards and outcomes are achieved.
4. 13.  The GMC licenses doctors to practise medicine in the United Kingdom. The law gives the GMC four main functions:
5. 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.
6. 14.  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. Complaints are thoroughly investigated before Case Examiners make a decision on whether to refer the doctor to a `Fitness to Practise Panel'. Case Examiners can also issue a warning to the doctor, or agree practice undertakings with the doctor where their health or performance impairs their fitness to practise. The same sanctions are available where a case is referred to a Fitness to Practise Panel, which has the added powers of imposing conditions, a period of suspension or, in more serious cases, removal from the register, known as erasure.
7. 15.  Doctors wishing to practise medicine in the UK need to hold both registration and a licence to practise from the GMC.
8. 16.  It is proposed that 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 revalidation, 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.

Scope of this Memorandum

1. 17.  This Memorandum relates to the areas of interface between NES 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 NES :
   1. a. Through on-going exchange of information and co-ordination of activities including those involving quality assurance.
   2. b. If NES wishes to bring specific concerns to the GMC's attention and/or if the GMC wishes to bring specific concerns to the attention of NES. This will include specific concerns about individual doctors.
   3. c. Through their partnership working on standards setting and quality assurance.
   4. d. Through their mutual interest in the professional development of individuals and, where appropriate, their remedial training.
   5. e. Through mutual dialogue on educational provision with other professional bodies.
   6. f. Through the NES role in the delivery of appraisal for doctors and the relationship between revalidation and doctors' appraisal.

Exchange of information and coordination

1. 19.  Subject to statutory and other constraints, the working relationship between NES and the GMC will be characterised by regular on-going contact and open exchange of information, through both formal and informal 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 NES and the GMC, whose details are at Annex A .
2. 20.  NES and the GMC will agree to exchange such information as is necessary to fulfil their statutory functions and to improve the quality of healthcare through raising standards and enhancing professional development.
3. 21.  Both organisations are committed to valuing diversity and promoting equality, ensuring processes and procedures are fair, objective, transparent and free from unlawful discrimination.
4. 22.  It is understood by NES 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. Similarly NES and its constituent deaneries are subject to the requirements of the Freedom of Information (Scotland) Act 2002 and the GMC is a public authority subject to the UK Freedom of Information Act 2000. The principles of the common law duty of confidentiality will also be maintained.
5. 23.  Each organisation will respect and take appropriate steps to protect the confidential nature of documents and information that the other may provide.
6. 24.  Where information exchanged between NES and the GMC involves patient related or other confidential information, the case will be referred with the patient identifiable data anonymised. If the body receiving the information considers that action on its part may be required, the referring body will seek consent to disclosure.
7. 25.  The GMC has the power to demand documents from a third party, for use within its Fitness to Practise procedures. This includes documents provided to or prepared by NES in confidence for an unrelated purpose.
8. 26.  Should NES provide documents relating to specific doctors 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 .
9. 27.  Examples of how the two organisations will exchange information and co-ordinate their activity include:
   1. a. NES and the GMC will share information about trends, concerns, data, approaches and initiatives, which are relevant to the shared aim of improving the quality of healthcare through raising standards and promoting professional development.
   2. b. The GMC will inform NES of any investigations it conducts which raise significant issues about professional development in NHS Scotland, including failures in systems of information, appraisal and review and, in appropriate cases, will disclose to NES information about individual medical practitioners. Subject to the constraints of paragraphs 20, 21 & 22, NES will provide relevant information to the GMC about NHS Scotland services.
   3. c. NES will inform the GMC of any issues emerging from its activities, or specific concerns within NHS Scotland, which raise specific issues about the fitness to practise of individual registered medical practitioners. In doing so it will follow the provisions set out in the section: “Referring issues relating to individual registered medical practitioners from NES to the GMC.”
   4. d. Each organisation will notify the other of information they receive about concerns relevant to their mutual responsibilities - including trainee issues.
   5. e. 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.
   6. f. Although NES may receive written and oral complaints from members of the public concerning aspects of medical care and treatment (including care delivered by doctors under supervision), NES has no direct role in dealing with such complaints. Where such complaints are received, the complainer will be advised to contact the NHS Board concerned, the GMC or any other appropriate body and given the necessary contact details.
   7. g. 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. 28.  NES and the GMC will also collaborate on 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. Involving each other, as appropriate, in conferences and other public discussion about matters of mutual concern.
   3. c. Assisting each other's activities to disseminate information about matters of mutual concern.
   4. d. Involving each other, as appropriate, in working groups, meetings and discussions between organisations on matters of mutual relevance.

Referring issues relating to individual registered medical practitioners from NES to the GMC

1. 29.  A review or investigation conducted by NES, or information received by NES, may identify an issue that raises a question about an individual doctor's fitness to practise. The information could relate to (but is not restricted to): complaints; death of or injury to patients; alleged professional misconduct or health problems - including substance abuse - affecting the practitioner's capability; serious service failures; failure to supervise trainees; adverse incidents or events; adverse clinical or performance indicators instances of plagiarism; or the findings of patient satisfaction surveys.
2. 30.  In such a case, the first course of action for NES staff is to consult the relevant postgraduate dean and the NES Medical Director . NES can raise such matters with the Chief Executive or Medical Director of the practitioner's employing Health Board for detailed investigation and appropriate action (which may or may not include suspension from duty in the interests of patient safety or the effective provision of NHS services). The case for a referral to the GMC may be considered separately or jointly by NES and/or the relevant Health Board. Where in the opinion of the Chief Executive and Medical Director of NES inappropriate, insufficient or timely action is not taken, the Chief Executive, Medical Director of NES or relevant postgraduate dean of NES may, after giving notice to the employer, make a direct referral to the GMC.
3. 31.  NES staff will be guided by the following principles when asking a Board to refer a doctor or when directly referring a doctor to the GMC:
   1. a. The need to assure patient and staff safety.
   2. b. That referral to the GMC is proportionate to the situation.
4. 32.  In all cases, NES and Deanery staff will be encouraged to seek informal or formal advice from the GMC contact points (listed at Annex A).
5. 33.  Where NES staff have concerns about the operational delivery of remedial training for an individual doctor, required as an outcome of GMC Fitness to Practise procedures, the issue must be raised with both the relevant Health Board Medical Director and NES Medical Director who will liaise and refer their concerns to the GMC Director of Fitness to Practise.
6. 34.  NES and the GMC will continue jointly to consider how the activities of NES relate to any processes that are relevant to GMC revalidation.

Referring issues relating to individual registered medical practitioners from the GMC to NES

1. 35.  In keeping with the character of their working relations, the GMC and NES will discuss matters as openly and as regularly as possible by both formal and informal contact. The GMC may raise issues with NES through these meetings or at any other time by contacting one of the individuals named at Annex A.
2. 36.  Personal information is subject to the Data Protection Act 1998, and should not normally be disclosed without the consent of the subject. The law permits the disclosure of confidential information where a countervailing public interest can be identified. Such a public interest might relate to the proper administration of justice and to the prevention of wrongdoing or a threat to public health.
3. 37.  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 conduct, professional performance or fitness to practise which the GMC consider to be in the public interest to disclose. The GMC 's policy intent is to disclose such information to NES when the GMC considers that to be in the public interest. The GMC may write formally to the Medical Director of NES to disclose information about a fitness to practise investigation and/or to invite NES to consider appropriate action. Any formal approaches to NES will be taken by, or on behalf of, the Director of Fitness to Practise. The person referring the issue to NES will decide, on a case-by-case basis, whether it is appropriate to identify to NES the doctor being considered by the Fitness to Practise Directorate. The GMC will only disclose information if such a disclosure is consistent with the common law duty of confidentiality, the Medical Act 1983 and the Data Protection Act 1998. NES will assess any information or invitation received against its guiding principles.
4. 38.  Information passed to NES may result from fitness to practise investigations. These investigations may relate to individual medical practitioners with whom NES has a relationship. For example, the medical practitioner may be an employee, a trainee an adviser, an educational or clinical supervisor, lead or tutor.

Reconciliation of Disagreement

1. 39.  Any disagreements relating to this Memorandum 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 of NES 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.

Review of this Memorandum of Understanding

1. 40.  This Memorandum will be reviewed annually by the named contacts listed at Annex A . They will report their review to the Chief Executive of NES and the Assistant Director, Strategy and Planning at the GMC . In NES the report will form part of a consolidated report on all Memoranda of Understanding with partner organisations to be considered annually as part of the NES Audit Committee's review of governance.
2. 41.  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. 42.  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.

Annex A

Contact details

NHS Education for Scotland

Dr Michael Watson

Medical Director

2nd Floor, Hanover Buildings, 66 Rose Street, Edinburgh, EH2 2NN

Tel: 0131 220 8695 E-mail: Mike.watson@nes.scot.nhs.uk

Professor Bill Reid

Postgraduate Dean

South East Deanery

Lister Postgraduate Institute, 11 Hill Square, Edinburgh, EH8 9DR

Tel: 0131 220 8695 E-mail: bill.reid@nes.scot.nhs.uk

Professor Alastair McGowan

Postgraduate Dean

West Deanery

3rd floor, 2 Central Quay, 89 Hydepark Street, Glasgow, G3 8BW

Tel: 0141 223 1506 E-mail: alastair.mcgowan@nes.scot.nhs.uk

Professor Gillian Needham

Postgraduate Dean

North Deanery

Aberdeen Postgraduate Centre, Medical School, Foresterhill, Aberdeen, AB9 2ZD

Tel: 01224 553 537 E-mail: Gillian.needham@nes.scot.nhs.uk

Professor Philip Cachia

Postgraduate Dean

East Deanery

Postgraduate Office, Level 8, Ninewells Hospital and Medical School, Dundee, DD1 9SY

Tel: 01382 632 927

E-mail: Philip.cachia@nes.scot.nhs.uk

General Medical Council

Responsible for: Scottish Affairs, Formal review of Memorandum of Understanding between NES and the General Medical Council

Jane Malcolm

Head of Scottish Affairs

Tel: 0131 525 8702 E-mail: jmalcolm@gmc-uk.org

Responsible for: Education

Martin Hart

Assistant Director, Education

Tel: 0207 189 5282 Email: mhart@gmc-uk.org

Responsible for: Registration

Clare Barton

Head of Applications

Tel: 0161 923 6589 E-mail: cbarton@gmc-uk.org

Responsible for: Fitness to Practise

Jackie Smith

Head of Investigations

Tel: 0207 189 5132 E-mail: jsmith@gmc-uk.org