National Health Service Scotland Counter Fraud Services and the General Medical Council

January 2008

1. Purpose

1. 1.  This Memorandum of Understanding (MoU) describes the roles of the GMC and CFS and identifies areas where cooperation between the two bodies is necessary. It sets down the principles underpinning the interaction between the two bodies and provides guidance on the exchange of information between them.
2. 2.  Annex A – Working Contacts, (which is regularly updated) provides details of contacts within the GMC and CFS, and describes the ‘routes' to take into each organisation in different circumstances.

2. Role of the GMC

1. 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. 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.

3. Role of CFS

1. 1.  CFS was established in July 2000. Its role is to provide NHSScotland with a comprehensive counter fraud service by delivering:
   1. a. pro-active detection of fraud and other irregularities against NHSScotland;
   2. b. full and fair investigations into alleged fraud or other irregularities by patients, staff, contractors or suppliers;
   3. c. open access to those wishing to report fraud and other irregularities;
   4. d. surveillance and covert human intelligence source management under the Regulation of Investigatory Powers (Scotland) Act 2000;
   5. e. provision of specialist advice to assist in the formulation of counter fraud policy and regulations;
   6. f. the recovery of resources fraudulently or corruptly obtained from the NHS.
2. 2.  Since its inception in July 2000 CFS has produced significant cumulative savings to NHS Scotland. An estimate shows that the financial impact of all the counter fraud measures implemented have yielded cumulative savings of around £18 million.

4. Principles

1. 1.  The GMC's independent role in maintaining the medical register means that its processes are distinct from those of the NHS. That said, the GMC is determined that its fitness to practise functions will be an effective part of a wider framework for protecting patients and providing effective medical services, including measures taken by NHS bodies and others. The GMC is committed to working collaboratively with CFS, the NHS as a whole, and others, to ensure that patients are provided with effective medical services. 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 CFS.
2. 2.  CFS is committed to reducing fraud in the NHS to an absolute minimum, and to put in place arrangements to hold fraud at a minimum level permanently. Working collaboratively with the GMC will ensure that allegations of suspected fraud or corruption arising as a result of any case about which the GMC has received information can be investigated. Even if the allegations do not concern whether a doctor's fitness to practise is impaired to a degree justifying action on registration, it is vital that CFS receives the information so that systems and procedures can be assessed for their ability to prevent, reduce, or detect fraud within the NHS in Scotland.
3. 3.  CFS and the GMC, despite having differing and complementary core functions, share a common goal to ensure that those who work within the NHS are professional and accountable in every aspect of their work and maintain the highest integrity. Both organisations will co-operate whenever possible in working to meet this common goal.
4. 4.  Both the GMC and CFS 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 vital that such information and documentation held is, on occasion, shared between the organisations if they are to perform their functions effectively. The GMC and CFS recognise that this exchange of information needs to be carried out responsibly and within the guidelines set out in this document.
5. 5.  It is understood by CFS and the GMC that statutory and other constraints on the exchange of information and intelligence will be fully respected, including the requirements of the Data Protection Act and the Human Rights Act.

5. Areas of possible communication between the GMC and CFS

1. 1.  Areas of possible communication between CFS and the GMC include (the list is not intended to be exhaustive): 
   1. a.   sharing of expertise and experience in the development of investigative methodologies; 
   2. b.  discussions about the strategy / policy of each organisation aimed at increasing the effectiveness of communication between them; 
   3. c.  discussions about individual doctors (where one or both organisations are investigating the doctor in question).

[NB: Annex A –Working Contacts sets out contact points within CFS and the GMC for these areas of communication.]

a.  Sharing of expertise and experience in the development of investigative methodologies

1. 2.  It is intended that regular meetings will take place between Managers within the Standards & Fitness to Practise and Registration & Resources Directorates at the GMC and counterparts at CFS. These meetings may involve discussion about particular cases (anonymised if appropriate) and the two organisations may be able to share information about approaches to investigation which have been successful in particular circumstances or about useful contacts within other organisations.

b.  Discussions about the strategy / policy of each organisation

1. 3.  Similarly, the regular meetings between the organisations will provide an opportunity to discuss strategic / policy developments which may impact each others' work. Whilst it is not possible to predict all future developments which may be of mutual interest, it is clear that when either organisation is reviewing disclosure policies, for example, discussion will be valuable. The GMC and CFS will notify the other of any events or activities which are of mutual interest, including any events or activities which relate to fraud awareness.

c.  Discussions about individual doctors

1. 4.  Whilst the GMC and CFS have very distinct roles, it is clear that there is an overlap where there are allegations that a doctor working in the NHS has acted dishonestly or fraudulently. Where this kind of issue is at stake, it is expected that information and documentation will be exchanged between the two organisations in order to allow both to carry out their core functions. CFS will seek the relevant Health Board’s agreement before discussions with the GMC about individual doctors take place.

6. When the GMC receives a referral or complaint

1. 1.  GMC investigations can be triggered by complaints (from members of the public), referrals (from NHS and other public bodies, including overseas regulators or investigatory bodies), or by information received from other sources (e.g. from press monitoring).
2. 2.  Where there are allegations against an NHS doctor (or indeed, where there are misdirected allegations against other NHS staff) CFS will be informed (if it is not clear that they are already aware) if there are clear allegations of fraud, corruption or theft. 
3. 3.  Also, in cases where there are other allegations of dishonesty or criminality, the GMC will disclose relevant information and documentation to CFS. However, whether such disclosure takes place will depend on the circumstances of the case. The seriousness of the allegations would be taken into account, as would the relevance of the allegations to the core function of CFS.
4. 4.  In cases where GMC staff are in doubt as to whether a case should be disclosed to CFS, they will make contact with the individual(s) specified in the attached annex in order to discuss the matter. Any discussions at this stage will be anonymised. GMC staff will be able to rely on the fact that if the specified CFS staff indicate that they wish to receive full disclosure, this will be on the basis that this is essential for CFS's core purpose, and so is in the public interest.
5. [NB: normally, cases in the categories mentioned above will be identifiable at the start of an investigation. However, GMC staff will be alert to the fact that such allegations may emerge as an investigation proceeds. In such cases, they will ensure that relevant information is passed to CFS.]

7. When CFS receives information or begins an investigation

1. 1.  Where CFS is aware that during or following an investigation clear evidence exists that an NHS doctor has been involved in fraud, corruption or theft, the GMC will be informed (if it is not clear that they are already aware) for consideration as to whether Fitness to Practise procedures should be invoked.
2. 2.  In cases where CFS staff are in doubt as to whether a case should be disclosed to the GMC, they will make contact with the individual(s) specified in the attached annex in order to discuss the matter. Any discussions at this stage will be anonymised. CFS staff will be able to rely on the fact that if the specified GMC staff indicate that they wish to receive full disclosure, this will be on the basis that this is essential for the GMC's core purpose, and so is in the public interest.
3. 3.  In cases where an investigation has concluded that there was no fraudulent activity, but indicates there may be concerns about the activities of a doctor, the information may be passed to the GMC depending on the seriousness of the allegations and their relevance to the GMC's core function.
4. 4.  When information is disclosed to the GMC there will be a discussion in advance about the timing of any action that the GMC may consider appropriate, including disclosure of the case to the employer and doctor. The GMC will respect any request to delay action which may compromise any current investigation. CFS recognises that action may need to be taken by the GMC where this is immediately necessary for the protection of patients.
5. 5.  In cases where CFS become aware of allegations or evidence that an individual may be posing as a registered (or licensed) medical practitioner, either through a stolen identity or fraudulently acquired registration, CFS will immediately contact the GMC Registration Directorate (contact details are at Annex A). CFS will provide all available information that might suggest that an individual is fraudulently posing as a doctor.
6. 6.  At all times CFS will seek the relevant Health Board’s agreement before discussions with the GMC about individual doctors take place.
   In these cases, the GMC's primary concern will be patient safety. The GMC will take whatever action is appropriate in the interests of protecting patients.

8. Coordination

1. 1.  The working relationship between CFS 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.
2. 2.  Disclosures from either organisation to the other will be regularly monitored to ensure that arrangements are working effectively.
3. 3.  This Memorandum will be reviewed annually by the named contacts at Annex A. They will report their view to the Head of Investigations at CFS and to the Head of Planning at the GMC who will jointly decide whether and how to report to the steering group at CFS and to the members of the General Medical Council.
4. 4.  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.
5. 5.  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. 
    

Signatories to the Agreement

Nicola Sturgeon
Cabinet Secretary for
Health and Wellbeing
Date: 28 January 2008

Finlay Scott
Chief Executive GMC
Date: 28 January 2008

Neil Billing
Head of Counter Fraud Services
Date: 28 January 2008

Annex A

Contacts

1. Identity of staff to discuss whether individual cases should be disclosed to the GMC.

CFS

Gordon Young
Head of Investigations
Telephone: 01506 705237
gordon.young@cfs.csa.scot.nhs.uk

GMC

Re: identity / Registration fraud:

Eadaoin Flynn
Intelligence & International Liaison Manager
Registration Directorate
Telephone: 0161 923 6653
eflynn@gmc-uk.org

Re: all other matters:

Jackie Smith
Head of Investigation,
Fitness to Practise Directorate
Telephone: 020 7189 5132
jsmith@gmc-uk.org

2. Identity of staff to discuss whether GMC should disclose individual cases to CFS.

CFS

Gordon Young
Head of Investigations
Telephone: 01506 705237
gordon.young@cfs.csa.scot.nhs.uk

GMC

Jackie Smith
Head of Investigation
Fitness to Practise Directorate
Telephone: 020 7189 5132
jsmith@gmc-uk.org

3. Identity of staff to discuss fraud awareness initiatives.

CFS

Maggie Worsfold
Patient Fraud & Communications Manager
Telephone: 01506 705254
maggie.worsfold@cfs.csa.scot.nhs.uk

GMC

Eadaoin Flynn
Intelligence & International Liaison Manager
Registration Directorate
Telephone: 0161 923 6653
eflynn@gmc-uk.org

4. Identity of staff to discuss amendments to the MoU and policy issues (e.g. GMC disclosure policy).

CFS

Neil Billing
Head of Counter Fraud Services
Telephone: 01506 705201
neil.billing@cfs.csa.scot.nhs.uk

GMC

Jane Todd
Head of Scottish Affairs
Communications Directorate
Telephone: 0131 525 8700
jtodd@gmc-uk.org

Simon Higdon
Head of Planning
Telephone: 020 7189 5424
shigdon@gmc-uk.org