**Under Review**Memorandum of Understanding between the General Medical Council (GMC) and NHS Quality Improvement Scotland

September 2005

Preamble

1. 1.  The objective of this Memorandum is to set out the framework that NHS Quality Improvement Scotland (known as NHS QIS) 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 NHS QIS and the GMC will:
   1. a. Help NHS Scotland – especially registered medical practitioners - to provide high quality care.
   2. b. Minimise duplication of demands on NHS Scotland and, in particular, on registered medical practitioners by co-ordinating activities and providing consistent advice.
   3. c. Maximise benefit and efficiency by pooling efforts and resources wherever practicable.
3. 3.  This Memorandum does not affect existing statutory functions or amend any other policies or agreements relating to the activities of NHS QIS, or the GMC.
4. 4.  This Memorandum is not a contract and is not legally enforceable. However, the GMC and NHS QIS agree to adhere to its principles and to show proper regard for each other’s activities.
5. 5.  NHS QIS and the GMC will keep this protocol under review and update it as necessary.
6. 6.  This MoU covers Scotland only.

Functions of NHS QIS and GMC

NHS Quality Improvement Scotland

1. 7.  The responsibility of NHS Quality Improvement Scotland (NHS QIS) is to improve the quality of health care in Scotland by setting standards and monitoring performance, and by providing advice, guidance and support to NHS Scotland on effective clinical practice and service improvements.
2. 8.  The two key aims of the organisation are to report to the public on the performance of NHS Scotland against nationally agreed standards and to support NHS Scotland in improving the quality of care and treatment it provides. NHS QIS checks, through the review process, that NHS bodies are delivering health services to a high standard and reports to the public and Minister for Health and Community Care.
   General Medical Council
3. 9.  The GMC is a statutory body responsible for regulating the medical profession in the United Kingdom. Its purpose is to:
   ‘protect, promote and maintain the health and safety of the community by ensuring proper standards in the practice of medicine.’
4. 10.  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.
5. 11.  Amongst its other functions set out below, the GMC deals with complaints against medical practitioners registered in the UK that raise serious doubts about their fitness to practise. It does not handle all complaints about doctors, the majority of which will be resolved at the local level.
6. 12.  The GMC licenses doctors to practise medicine in the United Kingdom.
   The law gives the GMC four main functions:
   1. a. Keeping up to date registers of qualified doctors.
   2. b. Fostering good medical practice.
   3. c. Promoting high standards of medical education.
   4. d. Dealing firmly and fairly with doctors whose fitness to practise is in doubt.
7. 13.  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 a Case Examiner makes a decision on whether to refer the doctor to a `Fitness to Practise’ panel. Case Examiners can also issue a warning, 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 suspension or removal from the register, in serious cases.
8. 14.  The GMC is currently planning to regulate doctors through a new system of registration. Doctors wishing to practise medicine in the UK will need a licence to practise in addition to their registration. The licence will be generic and there will be no differentiation by specialty or type of practice.
9. 15.  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
10. 16.  This Memorandum relates to the areas of interface between NHS QIS 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.
11. 17.  Interfaces may arise between the GMC and NHS QIS:
    1. a. Through on-going exchange of information and co-ordination of activity.
    2. b. If NHS QIS wishes to bring specific concerns to the GMC’s attention.
    3. c. If the GMC wishes to bring specific concerns to the attention of NHS QIS.

Exchange of information and coordination

1. 18.  Subject to statutory and other constraints, the working relationship between NHS QIS 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. The arrangements will be kept under review by the named contact points and others with relevant responsibilities at NHS QIS and the GMC, whose details are at Annex A.
2. 19.  NHS QIS and the GMC will agree to exchange such information as is necessary to fulfil their statutory functions and to ensure the safety and well being of people who use health services.
3. 20.  It is understood by NHS QIS 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, and the Human Rights Act 2000. Similarly NHS QIS falls under the remit 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 common law duty of confidentiality will also be maintained.
4. 21.  Each organisation will respect and take appropriate steps to protect the confidential nature of documents and information that the other may provide.
5. 22.  Where information exchanged between NHS QIS 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.
6. 23.   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 NHS QIS in confidence for an unrelated purpose.
7. 24.   Should NHS QIS provide documents relating to specific doctors, clinical incidents or Serious Service Failure investigations 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.
8. 25.   Examples of how the two organisations will exchange information and co-ordinate their activity include:
   1. a. NHS QIS and the GMC will share information about trends, concerns, data, approaches and initiatives, which are relevant to the shared aim of protecting the safety and well being of vulnerable people, improving the quality of health services and helping NHS Scotland including registered medical practitioners to provide high quality patient care.
   2. b. The GMC will inform NHS QIS of any investigations it conducts which raise significant issues about clinical governance, in NHS Scotland, including failures in information, appraisal and review systems and, in appropriate cases, will disclose to NHS QIS information about individual medical practitioners. Subject to the constraints of paragraphs 20, 21 & 22 NHS QIS will provide this information to the GMC about NHS Scotland services.
   3. c. NHS QIS 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.
   4. d. Each organisation will notify the other 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.
   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 NHS QIS may receive written and oral complaints from members of the public concerning aspects of medical care and treatment, NHS QIS 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. 26.  NHS QIS 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.
   5. e. Ensuring that potential and actual complainants receive accurate and helpful information on the appropriate avenue for pursuing any concerns.

Referring issues relating to an individual registered medical practitioner from NHS QIS to the GMC

1. 27.  A review or investigation conducted by NHS QIS, or information received by NHS QIS, 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 affecting the practitioner’s capability, serious service failures, adverse incidents or events, adverse clinical or performance indicators, or the findings of patient satisfaction surveys.
2. 28.  In such a case, the first course of action for NHS QIS will be to draw such matters to the attention of the Chief Executive or Medical Director of the practitioner’s employer 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) with a recommendation that referral to the GMC be considered. Where in the opinion of the Chief Executive and Medical Adviser of NHS QIS appropriate, sufficient or timely action is not taken, the Chief Executive or Medical Adviser of NHS QIS may, after giving notice to the employer, make a direct referral to the GMC.
3. 29.  NHS QIS staff will be guided by the following principles when referring a doctor to the GMC:
   1. a. The need to assure patient and staff safety.
   2. b. That referral from NHS QIS to the GMC is proportionate to the situation.
4. 30.  In all cases, NHS QIS staff may seek informal or formal advice from the GMC contact points (listed at Annex A).

Referring issues from NHS QIS to the GMC relating to clinical governance systems failure in NHS Scotland

1. 31.  Where NHS QIS staff or reviewers in the course of any review or visit to an NHS or independent sector provider who provides services under contract to the NHS, consider that problems identified in clinical governance systems could compromise safe practice, they will raise this concern explicitly with the Chief Executive or Director of Performance Assessment and Practice Development of NHS QIS. He/she will decide in consultation with the Medical Adviser to NHS QIS whether to contact the GMC.
2. 32.  NHS QIS and the GMC will continue jointly to consider how the activities of NHS QIS relate to any processes that are relevant to GMC revalidation.
   Referring issues from the GMC to NHS QIS
3. 33.  In keeping with the character of their working relations, the GMC and NHS QIS will discuss matters as openly and as regularly as possible by both formal and informal contact. The GMC may raise issues with NHS QIS through these meetings or at any other time by contacting one of the individuals named at Annex A.
4. 34.  Personal information is subject to the common law duty of confidentiality and 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.
5. 35.  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 NHS QIS when the GMC considers that to be in the public interest. The GMC may write formally to the Chief Executive or Medical Adviser of NHS QIS to disclose information about a fitness to practise investigation and/or to invite NHS QIS to consider appropriate action. Any formal approaches to NHS QIS will be taken by, or on behalf of, the Director of Fitness to Practise. The person referring the issue to NHS QIS will decide, on a case by case basis, whether it is appropriate to identify to NHS QIS 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. NHS QIS will assess any information or invitation received against its guiding principles.
6. 36.  Information passed to NHS QIS may result from fitness to practise investigations. These investigations may relate to individual medical practitioners with whom NHS QIS has a formal relationship For example, the medical practitioner may be an adviser, reviewer or member of a standards development group. Also, performance assessments under the GMC fitness to practise procedures may identify dysfunctional service provision. In such circumstances the GMC will refer the matter to the local NHS complaints system and notify NHS QIS that this action has been undertaken.

Investigations and inquiries relevant to both bodies’ functions

1. 37.  It is possible that an investigation by the GMC into a doctor’s practice could coincide with an NHS QIS investigation or review at the doctor’s place of work. Other statutory agencies may also be involved. Should such a situation arise, both organisations will be guided by the following principles:
   1. a. NHS QIS 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. Care must be taken at all times not to contaminate a trail of evidence or breach any common law duty of confidentiality which is the subject of either party’s enquiries.
   2. b. NHS QIS and the GMC will clarify boundaries of responsibilities and remits for the two investigations. Whilst those conducting investigations will work closely together, the investigations will remain separate and the limitations of each investigation will be clearly defined.
   3. c. NHS QIS and the GMC will recognise any police investigation - whether or not ordered by the Procurator Fiscal. Care must be taken not to interfere with due process or contaminate criminal enquiry evidence.

Reconciliation of Disagreement

1. 38.  Any disagreements relating to this MoU 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 NHS QIS 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

1. 39.  This Memorandum will be reviewed annually by the named contacts listed at Annex A . They will report their review to the Chief Executive of NHS QIS and the Director of Strategy and Planning at the GMC. In NHS QIS 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 NHS QIS Audit Committee’s review of governance. The GMC will monitor the MoU through its Fitness to Practise caseworkers, with a report going to the Chief Executive on an annual basis.
2. 40.  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. 41.  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.

Signed: ___________________________ Date: ______________________
Finlay Scott
Chief Executive
GMC

Signed: ___________________________ Date: ______________________
David Steel
Chief Executive
NHS QIS

Annex A

Contact details

NHS Quality Improvement Scotland

Dr David R Steel
Chief Executive
NHS Quality Improvement Scotland
Elliott House
8 – 10 Hillside Crescent
Edinburgh
EH7 5EA
Tel 0131 623 4298
David.Steel@nhshealthquality.org

Mrs Jan Warner
Director of Performance Assessment and Practice Development
Tel 0131 623 4288
Jan.Warner@nhshealthquality.org

Dr Harpreet Kohli
Medical Adviser
NHS Quality Improvement Scotland
Delta House
50 West Nile Street
Glasgow
G1 2NP
Tel 0141 225 6988
Harpreet.Kohli@nhshealthquality.org

General Medical Council

Finlay Scott

Chief Executive/Registrar

0207 189 5015
opce@gmc-uk.org
Regents Place

350 Euston Road
London NW1 3JN

Responsible for: formal review of memorandum

Paul Buckley
Director of Strategy and Planning
0207 7189 5022
pbuckley@gmc-uk.org

Responsible for: Memoranda and liaison with other organisations

Richard Marchant

Strategy and Planning

0207 189 5024

rmarchant@gmc-uk.org

Responsible for: Scottish Affairs, Development and Implementation of Memorandum of Understanding between NHS QIS and the General Medical Council

Jane Todd
Head of Scottish Affairs
35 Thistle Street
Edinburgh
EH2 1DY
0131 240 6411
jtodd@gmc-uk.org

Ben Collins
Scottish Affairs Officer
35 Thistle Street
Edinburgh
EH2 1DY
0131 240 6414
bcollins@gmc-uk.org

Responsible for: Fitness to Practise

Paul Philip
Director of Fitness to Practise
0207 189 5124
pphilip@gmc-uk.org

Jackie Smith
Head of Investigations 0207 189 5132 jsmith@gmc-uk.org

Responsible for: Registration

Martin Holt
Head of Applications
0161 923 6629
mholt@gmc-uk.org