A new communication from the General Medical Council
August 2004, Issue 4

What's New?

Welcome

Welcome to the fourth issue of our reforms bulletin. In this issue we’ll be covering everything from medical education to a judicial review of our guidance on withholding and withdrawing treatment. We also give you the latest update on revalidation.

At present we are working to finalise the introduction of the licence to practise and revalidation reforms, the rules for which are being sent out for consultation later this year.

Please continue giving us your feedback, we want this bulletin to meet your needs and welcome your thoughts and ideas.

Consultation - Principles of Good Medical Education and Training

The GMC’s Education Committee has recently issued a draft of Principles of Good Medical Education and Training for consultation to more than 800 organisations and individuals including more than 500 NHS bodies. Further information about Medical Education is available from our website.

The draft Principles are deliberately generic and broad and not intended to supersede other sets of principles, standards or guidance issued by the Education Committee or other bodies involved in medical education and training.

For example, Tomorrow’s Doctors sets out the Committee’s outcomes and recommendations for undergraduate medical education and will continue to be the basis on which we quality assure medical schools. However, generic Principles of Good Medical Education and Training could encourage us all to consider the wider context in developing policies and procedures for specific areas of education and training. Consultation on the Principles, and their final publication in due course, accord with the Education Committee’s statutory function ‘of promoting high standards of medical education and co-ordinating all stages of medical education’.

The consultation period will run until Friday 12 November 2004. Subject to the issues raised in the consultation, a revised version could be brought to our Council with a view to publication early in 2005.

What does the future hold?

We are embarking on a project, entitled educating doctors of the future, whose aim is to foresee the changes in medical practice that will happen during the careers of students currently in medical school.

It is hoped the project will stimulate an informed and intelligent debate across the profession and public. We are keen for the clinical governance community to join in the debate. Some questions that might be worth considering are:

  • What are the challenges facing clinical governance leads given the changing face of medical practice?
  • What role can clinical governance play in shaping the future practice of doctors?
  • What is the relationship between professional autonomy and accountability?
  • How is the relationship between patient choice and evidence based care?

We have held meetings with Harry Cayton (Department of Health Director for Patients and the Public), the NHS Confederation and many others. We have set up an essay competition for 16-18 years olds. We are also considering whether to convene scenario planning events and are open to radical possibilities, so if you would like to give your input into the educating the doctors of the future project, please contact the GMC at futures@gmc-uk.org

New Fitness to Practise procedures - an update

The reforms are gathering pace within our Fitness to Practise directorate. Our aim is to introduce the reformed procedures on 1 November 2004.

We will therefore, shortly begin writing to all complainants and doctors to notify them that our procedures will be changing later this year. At the same time we will also explain to them the transitional arrangements that are involved in moving to the new procedures.

In summary, the changes will affect the way in which we decide whether to refer a case to adjudication, in particular:

  • The current screening and Preliminary Proceeding Committee stage will be replaced by a decision to be taken by a medical and lay Case Examiner (or if they disagree, the Investigation Committee)
  • The Professional Conduct Committee, Committee on Professional Performance and Health Committee will be replaced by a generic Fitness to Practise Panel adjudicating upon the question of whether doctor's fitness to practise is impaired and the power to impose a range of sanctions accordingly.

The way in which cases currently subject to a GMC inquiry will be handled as from 1 November 2004, depends upon the stage the case has reached by that date. 

We will keep you abreast of these and other changes in our next edition of the e-bulletin at the end of September.

Revalidation – a policy framework paper

Since the last edition of the e-bulletin we have published our Policy Framework for Revalidation - A position paper. The paper sets the context and background for revalidation before moving on to explain the purpose of it and how we propose this be achieved.

Clinical Governance Managers will play a key role in the new system and as such the paper is an invaluable tool for providing further information on revalidation ahead of the formal guidance to doctors, which is due to be published later this year. It is anticipated that we will make the guidance available for all subscribers to the e-bulletin as soon as it becomes available.

Health and performance reviews

The new integrated fitness to practise procedures, to be introduced this autumn, mean the health and performance procedures will cease to exist as such. We will in future consider doctors' fitness to practise in the round, but will still need different methodologies for dealing with different aspects of dysfunctional practice.

As part of a rolling development programme to prepare for the introduction of the new procedures, two groups, both chaired by Dame Deirdre Hine, have been charged with reviewing the management of cases raising health or performance issues.

Both groups have taken into account the significant changes in the regulatory landscape - such as the development of clinical governance mechanisms and the creation of new healthcare regulatory bodies - since the procedures were introduced; and how we might most effectively work with others in future.

Health

The Health Issues Review Group, which has just begun work, includes employer and patient representatives, experts in our current health procedures, and occupational health doctors. The Group will look at three main areas:

  • Whether the handling of concerns over doctors' health is sufficiently transparent and safeguards the public interest. This stream will also consider the monitoring of doctors and their clinical performance whilst they are in the procedures and the implications of revalidation in considering health issues.
  • Local arrangements for dealing with ill health, concerns about medical students with health problems and how we can better interact with local procedures.
  • How health issues should be dealt with in the new integrated fitness to practise procedures

The group will also take into consideration the findings of Dame Janet Smith DBE in the Shipman Inquiry's forthcoming report on medical regulation, and is likely to report in 2005.

Performance

Earlier this year, we completed a similar policy review of our performance procedures.

The review looked at the origins and aims of the procedures, how they operated in practice, and evidence bases for establishing poor performance. The report concluded that:

  • Our primary focus when considering performance issues should be on public protection. Remediation should be an objective, but only where it is consistent with this primary aim.
  • Evidence derived from local procedures or, for example, from an assessment carried out by the NCAA, could - subject to conditions outlined in the report - be used to build a picture of performance in the round.
  • In order for the procedures to be an effective and distinct part of a wider framework for protecting patients, there should be systematic feedback between the GMC and those referring the doctor at all stages of the procedures.
  • Hearings of Fitness to Practise Panels involving performance issues should be held in public, except where the Panel determines that there are grounds for all or parts of it to be heard in private.

Guidance update

Aspects of our guidance on Withholding and Withdrawing Life-prolonging Treatments have recently been subject to Judicial Review, on the grounds that they were incompatible with the European Convention on Human Rights.

We welcomed the opportunity for debate of the issues and were reassured by Mr Justice Munby’s statement that he had ‘absolutely no difficulty at all with the vast bulk of what the guidance has to say … [it] is a compelling piece of work … whose whole approach should greatly reassure patients and their relatives.’

However, the judgment concluded that parts of the guidance were not consistent with the European Convention on Human Rights. Our guidance gives details of the paragraphs which need to be changed. Overall, the judgment provides helpful clarification in a number of important areas, including making it clear that doctors are not obliged to provide treatment that is futile, or places an intolerable burden on the patient. It confirms our position that in cases where there is disagreement over the care of a patient, the courts should be approached for a ruling.

It's important that our guidance provides clear and unambiguous advice to doctors. We are currently studying the judgment in detail, to consider how best to translate Mr Justice Munby’s conclusions into guidance, and whether we should appeal.

GMC online services available

The Clinical Governance section of the GMC website offers a virtual platform for medical professionals involved in clinical governance, providing access to the latest information and news on the GMC reforms.

The site contains information and the latest fact sheets on the reforms, which can be downloaded, providing concise details on Fitness to Practice, Revalidation, Registration and Education. The pages also provide details of all upcoming events where the GMC will be exhibiting or speaking on the reforms programme and it also offers the opportunity for your input and feedback on the reforms.

For further information click onto the Clinical Governance pages or email us your feedback to reform@gmc-uk.org.

Record number of registrations

Last year a record total of 18,656 doctors registered with the GMC, compared with 11,234 in 2002, with nearly 14,000 registrations from overseas. The sharp rise in registrations can be attributed to applications prior to the amendment of the Medical Act, which had previously allowed doctors from many Commonwealth countries to obtain full registration without having to take the PLAB test. The change now requires most non-EEA graduates to take the exam.

To meet the increase in demand for PLAB testing the GMC extended the number of examination days for Part 2 of the PLAB test from three to four days a week. Last year 6,580 doctors took PLAB 2, compared with 3,741 in 2002, with a further 4,953 taking the exam since January 2004.

With 11,709 new registrations since January this year, the projection for the next 12-24 months is for a consolidation in registrations, although the 10 new member states that joined the EU in May could impact upon this.

Competition – last call for entries!

It’s not just the summer that is drawing to a close. The closing date for our essay competition is almost upon us, so if you know any 16- 18 years olds who would like to let us know what their vision is for doctors by 2050, then encourage them to get writing. They could also win £500.

We are looking for essays on what healthcare will look like in the future and fresh ideas, inspiration and new perspectives will all win points. Entries should start with five bullet points summarising the essay and can be submitted electronically to futures@gmc-uk.org by 31 August.

Full competition details are available on our website.

Events

The GMC Reforms roadshow is out and about again in September and October attending and participating in several key events. Additionally the GMC will participate in a new initiative at all three political party conferences with the introduction of The Health Hotel, a unique arrangement coordinating the activities of 27 health-related organisations. If you attending any of these events, please come along and say “hello” to the GMC staff.

ASME annual scientific meeting on fitness to practise, Liverpool 1 - 3 Sept

Appraisal & Revalidation, London, 15 Sept

Lib Dem Party conference, Bournemouth 19 - 23 Sept

Labour Party conference, Brighton 26 - 30 Sept

Conservative Party conference, Bournemouth 4 - 7 Oct

NHS Alliance conference, Bournemouth 20 - 21 Oct

If you're organising events in your area and would like a GMC speaker or materials, please let us know.

Feedback feedback feedback …

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Copyright © 2004 All rights reserved.