A new communication from the General Medical Council
October 2004, Issue 6

Welcome

Welcome to the sixth edition of our reforms e-bulletin. Our fitness to practice reforms are just a few days away from being implemented. In this issue you’ll find the absolute latest on them as well an update on the licensing and revalidation consultation.

We are also delighted to announce that from today, we are able to provide access to a monthly summary of all fitness to practice decisions via a secure website link.

The circulation of the e-bulletin continues to rise with another 100 subscribers joining since last month. We have spread the word internationally with new subscribers from the US, Ireland, India and Pakistan.

Please continue to send us your feedback, questions and ideas for topics you would like to see covered in future editions.

Revalidation – Regulations Consultation

The introduction of Licensing and Revalidation reached an important stage last month with the launch of the draft Licence to Practise and Revalidation Regulations formal consultation process. The formal adoption of the regulations will represent the final legislative step to allow the GMC to implement the proposed changes in registration from 1 April 2005.

This road to reform started back in 1995 with the publication of Good Medical Practice, which set out for the first time the values and principles of practice that patients are entitled to expect from their doctors. Good Medical Practice now provides the underpinning platform for licensing and revalidation.

We first consulted our partners on the new arrangements in 2000, and in 2002 the Medical Act (1983) was modified to allow the GMC to operate a system of Licensing and Revalidation.

We published our prospectus on the proposed arrangements in April 2003 and in July this year we published our Policy Framework for Revalidation. A copy, along with the draft Licence to Practise and Revalidation Regulations and accompanying guidance is available on our website.

Consultation on the draft Licence to Practise and Revalidation Regulations closes on 26 November 2004. Licensing and Revalidation will be implemented on 1 April 2005.

In the coming weeks we will be writing to employers and doctors to describe the new arrangements more fully. We would welcome managers’ help with communicating the changes locally – resource packs containing a Powerpoint presentation and other useful documents will be available from early November. Please contact us if you would like to receive one.

Additionally this autumn we launch MyGMC, an online self-serving web portal, open 24 hours a day 7 days a week, that aims to improve the way in which the organisation interacts with doctors on a day-to day basis.

This will also enable doctors with a personal reference PIN and password to access their personal details and check their registration status, all at the touch of a button.

We will continue to produce regular updates, through the e-bulletin, on Licensing and Revalidation issues that will be of interest to you.

Decisions Circular

Following a recent comprehensive survey of our stakeholders it became clear that there was a need for employers and clinical governance leads to have access to information about our fitness to practice decisions. As a result we have created a secure area on our website where you can view our monthly decisions circular bulletin.

The Decisions Circular is updated at the start of each month.

Under the guidance of the Data Protection Act this information is not for public dissemination, so we ask that you do not give out the login details.

FTP –Update

The revised Fitness to Practise procedures will be implemented on 1 November 2004. The rules and guidance that underpin the new procedures have now been approved by the Privy Council and the GMC’s Council.

A guide to the new procedures for medical directors and clinical governance managers has been produced and can be accessed via the Problem Doctors section of the GMC web site from Monday 1st November.

What changes are taking place?

The changes are the result of a lengthy review and subsequent consultation. They are designed to improve the way in which the GMC deals with concerns by making our processes simpler and more streamlined than those currently in operation.

In summary, the changes will affect the way in which we investigate complaints prior to deciding whether to refer a case for adjudication and the way in which cases will be dealt with at the adjudication stage. Under the new procedures, complaints about doctors will no longer follow separate streams for health, performance and conduct. Instead, we will be looking at the doctor’s fitness to practise in the round.

Greater levels of investigation into complaints at the initial stages of our procedures will take place and the current screening and Preliminary Proceedings Committee stages will be abolished. There will instead be a single investigation stage, at the end of which the decision to refer a case to adjudication will be taken by Case Examiners. Case Examiners have been appointed by the GMC following a rigorous recruitment process to undertake this role. All decisions will be taken by two Case Examiners, one medical and one lay. Where the Case Examiners do not agree, the matter will be decided upon by the Investigation Committee (a statutory committee of the GMC).

At the adjudication stage, 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 a doctor’s fitness to practise is impaired and with the power to impose a range of sanctions accordingly.

When can the GMC take action?

The GMC can only take action against doctors whose names are on the medical register. These include hospital doctors and general practitioners, whether in the NHS or private practice.

We can only take action if the doctor’s behaviour calls into question whether he or she should continue to be registered with us. We can take action if the doctor:

• has behaved badly/inappropriately;
• has not done their job properly;
• has received a criminal conviction or caution in the British Isles or elsewhere
• is unable to practise due to physical or mental ill-health;

has been found guilty by another regulatory body either in the British Isles or overseas.

What should you do if I you have a concern about a doctor?

Our role of licensing doctors to practise is one part of a wider system of dealing with complaints and concerns about doctors' work and behaviour.

Local action

In many cases, concerns about a doctor can be managed effectively at a local level. The NHS has procedures for handling serious concerns about an individual's conduct and capability. It has also produced a toolkit for handling complaints in the NHS.

The National Clinical Assessment Authority

The National Clinical Assessment Authority (NCAA) can advise trusts about the handling of concerns about the professional performance of individual doctors and about effective local systems for handling poor performance.

It will also carry out assessments of doctors where there are concerns about poor professional performance, but patient safety is not considered to be seriously at risk. As the NCAA advises employers, it can advise only if a doctor is in stable employment.

The GMC and the NCAA have developed a Memorandum of Understanding about how the organisations should co-operate.

FTP Seminars

The GMC’s fitness to practise seminars are being well received with both the London and Manchester almost full. As a result of this demand, and the GMC's commitment to building a presence in each country, we are hosting two more in Scotland and Wales.

The Welsh seminar is being run on January 19 2005 in Cardiff, the speaker there will be Robert Loughlin, Head of Change Management at the GMC. A Council member will also be attending.

The Scottish event is being held in Glasgow on 1 November 2004 and the speaker is Paul Philip, Director of Fitness to Practise at the GMC, and Council member Brian Keighley. If you would like to attend either event or to find out further information pleas email Kirsty Sear.

The sessions will provide attendees with an overview of the reforms and focus on some of the key changes. They will also provide attendees with an opportunity to raise any questions they may have, particularly about the practical implementation of the new rules.

Case studies learning

Our first tranche of case studies covering guidance on what to do in difficult situations has been well received.

As a result we are presently drafting a second batch which we anticipate publishing by the end of October. These will be drawn from real life instances covering: honesty and integrity, inappropriate relationships with patients, practising outside competency, professional competence, appeal against erasure and excessive prescribing.

These can be found in out ethical guidance section of the website, so don’t forget to check back at regular intervals for new cases.

There is also a new case study on male circumcision, which appeared in the October edition of GMC News.

Prescribing Medicines – FAQ’s

In September the Council approved for publication a series of FAQs on prescribing.

These FAQs address the issues most often raised with the GMC. They describe how the principles in Good Medical Practice can be put into practice.

The guidance they contain has been the subject of debate in Council and a consultation with the profession, patients, the UK Health Departments and others. The final FAQs recap on the principles of good prescribing, and give further advice in some difficult areas, including:

• Prescribing ‘off label’
• Prescribing unlicensed medicines
• Prescribing for patients via e-mail or the internet
• Issuing repeat prescriptions
• Prescribing in private clinics including slimming clinics

The GMC’s guidance should not be read in isolation. Many other organisations provide more detailed guidance in specific areas and the FAQs end with a list of such organisations and links to their websites.

• The FAQs are on the GMC website and paper copies are available on request from our publications department
  Tel: 020 7915 3507
  E-mail publications@gmc-uk.org

The Standards and Ethics Committee will be considering further FAQs on issues relating to prescribing during 2004 and 2005. These will be included on our website as they are completed. If you have comments on the FAQ’s or would like to suggest issues not covered so far, please contact standards@gmc-uk.org.

Events

Our reforms road show is out and about again in November with appearances at the following events:

9-10 November, IHM, Glasgow

12 November, NCAA, London

At the IHM event the GMC will be delivering fringe sessions on our fitness to practise reforms. While our president, Sir Graeme Catto, and Paul Philip, Director of Fitness to Practise, will also be attending the NCAA conference.

If you are planning to attend any of these events please come and see us on our stand.

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Copyright © 2004 All rights reserved.