The GMC and Clinical Governance

A communication from the General Medical Council
April 2005, Issue 12

Welcome

Welcome to the fourth edition of our e-bulletin for 2005.

In this edition we will bring you the latest on the Donaldson Review and the GMC's submission to the 'Call for Ideas'. There have been a number of recent press articles focusing on the GMC's perspective of Licensing & Revalidation and we have presented a précis of information as progress on this continues.

The start of the summer sees the beginning of another medical conference season and the GMC team will be participating at several key events. One of the events sees the launch of a new campaign to highlight the benefits of the PLAB test, which we have outlined in this edition.

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

GMC Submission on the Call for Ideas

On 20 April the GMC delivered the final version of our submission to the Chief Medical Officer's review. 

The document outlines the wide-ranging reforms the GMC has already implemented, including a smaller Council with increased lay membership, the streamlined fitness to practise procedures and the proposed introduction of licensing and revalidation for all doctors. It also highlighted in detail a number of themes, which the GMC identified as requiring attention in order to improve the effectiveness of regulation over the next five to 10 years.

• Making connections: the need to make more effective connections between the different elements in the regulatory environment. The crucial challenges will be to ensure the maintenance of national standards and principles of good practice at local level through effective appraisal and clinical governance mechanisms, and to establish a more effective interface between the respective responsibilities of employers and the GMC.
  
• Patient and public involvement: the need for regulation to develop a more creative approach to engaging with patients and the public so that regulation properly reflects the needs of those in whose interests it is intended to operate. Principles of good practice must continue to be developed, maintained and enforced in partnership with society as a whole. The GMC will strive to improve this partnership and make it more effective so that, increasingly, regulation becomes patient-led.
  
• Making registration more meaningful: the need to make our register of medical practitioners more accessible and relevant for users. The GMC is the only body with an up-to-date, publicly accessible database of doctors eligible to practise in the UK. Revalidation will make the medical register fit for purpose but we must also improve the transparency and accessibility of information. We need to seek ways to add value to our database for the benefit of patients, doctors and employers.
  
• A risk-based approach to regulation: the need for regulation to be targeted towards areas of perceived risk. We need to be fully conscious of the burden of regulation and ensure that it does not get in the way of good healthcare. We are developing a more flexible approach to regulation based on risk. We want to regulate with a light-touch where the regulatory risk is low and with a greater scrutiny where it is higher. But this approach to regulation points to the importance of effective local systems capable of identifying emerging or actual dysfunctional practice, and triggering any necessary regulatory intervention.
  
• Making sense of complaints and fitness to practise: the need to make clear the distinction between dealing with questions of fitness to practise (which is for the regulator to do) and resolving complaints (which is for others). This requires agreement on the respective responsibilities of healthcare organisations, the regulators and others in dealing with complaints, underpinned by advice and support systems designed around the needs of complainants, and of NHS and other organisations.

Information on the CMO's Review can be viewed via the Department of Health website.

GMC Licensing and Revalidation

Whilst the Donaldson Review continues to examine the issues arising from the Shipman Inquiry, the issue of licensing and revalidation has continued to be debated in the public forum. Finlay Scott, Chief Executive of the GMC, produced an article outlining the GMC's position on the subject, which was published in Doctor and Hospital Doctor magazines and follows closely on from the Pulse survey (12 March 2005) which highlights support for the GMC and its continuing reforms by doctors.

The 14 April issue of Hospital Doctor carried this feature in an article entitled 'The real role of the GMC'. The 19 April issue of Doctor carried the same feature, entitled 'Where the GMC really stand on revalidation.'

In his article, Finlay Scott focuses on the key issues facing both the GMC and the NHS in introducing a robust system of appraisal and revalidation. He supports the needs of doctors stating that: 'The great majority of doctors in the UK are good doctors, delivering high quality healthcare under circumstances that are often difficult and demanding.'

Revalidation is the most fundamental change in medical regulation since the GMC was established and whilst there have been some criticisms, which are justified, and we are working hard to address them, others are based on misunderstanding or deliberate misrepresentation.

It has been said that 'revalidation was conceived to detect doctors whose performance is failing”. This is wrong and philosophically misguided. As Sir Donald Irvine, former Chairman of Council of the RCGP and ex-President of the GMC, put it:

'Revalidation is based on the positive affirmation of good practice rather than the negative identification of 'bad apples'.'

Revalidation will make a major contribution to raising standards by requiring doctors to demonstrate that they have reflected on their practice, using evidence gathered through audit and in other ways. It will also help to protect patients by securing confirmation that doctors are up to date and fit to practise.

The article can be accessed via the links above and we will continue to keep you informed with the latest developments with both the Donaldson review and the introduction of revalidation.

Events

The GMC will be on the road again throughout the summer attending and participating in many of the medical conferences across the width and breadth of the UK. This year there is a new focus on Public and Patient Involvement, which was outlined in the last edition of the e-bulletin. We will also be hosting a breakfast seminar and a fringe session focusing on registration, at the BAMM conference and the PLAB test during the NHS Confederation. We would like to encourage anyone attending any of the events to attend the fringe sessions and to meet the GMC team on the stand and find out about the latest developments.

9 May GMC Medical Education Conference, London

11-13 May HR in the NHS, ICC Birmingham

24-26 May BAMM Conference, Brighton
Breakfast seminar, 8.00am, 25 May

15-17 June NHS Confederation, ICC Birmingham
Fringe session, 15.00-15.45, 15 June

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

GMC and Criminal Case Review Commission sign Memorandum of Understanding

The GMC has recently signed a memorandum of understanding (MoU) with the Criminal Case Review Commission (CCRC).

This sets out our respective roles, and how we will share information. Guidelines, defining how we will work together have also been agreed. It is believed the guidelines will help increase the effectiveness of both organisations by pooling efforts and resources and will support development through shared learning and experience.

The MoU covers:

• How the CCRC and GMC will communicate when their interests overlap during investigations including exchanging information about concerns which might impact on a doctor's fitness to practise or ability to give evidence as an expert witness
• How requests for information will be handled
• How they will collaborate to develop new ways of working
• How they will regularly update each other on their progress

The GMC has had a close working relationship with the CCRC, supplying them with information under Section 17 of the Criminal Appeal Act 1995. This provides the CCRC with the power to obtain material in the possession of a public body, which may assist the CCRC in any of their functions.

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GMC PLAB Campaign

The GMC will be running a campaign throughout the rest of the year to inform employers of the benefits of international medical graduates (IMGs) who have gained UK registration via the PLAB test. The GMC has been testing IMGs for 30 years, during which time the test has undergone extensive reforms and changes to ensure that it remains robust and fit for purpose. The PLAB campaign aims to raise the profile of the assessments that IMGs must undertake in order to obtain UK registration.

The test is developed and maintained by practising clinicians as well as experts in medical assessment. The content is based on research into what doctors actually do in practice and the assessment methods are internationally recognised as the best ways of assessing medical knowledge and skills. It ensures that successful PLAB test candidates have demonstrated that they are fit to practise in the UK in the modern NHS. All IMG candidates must complete the International English Language Testing System (IELTS) test before taking PLAB, which presently EEA doctors do not have to complete

PLAB and international medical graduates

• The PLAB test is a robust and effective measurement of a doctor's fitness to practise within the UK.
• The PLAB test is designed by doctors for doctors and is regularly reviewed.
• International graduates make an invaluable contribution to the medical profession within the UK.

The PLAB test has undergone constant development since its introduction and provides an interesting case study of current best practice in assessment. It will continue to be reviewed regularly to ensure that it remains in line with current thinking in medical education. This means that it fulfils its objective of assuring the quality and fitness for purpose of doctors entering the Medical Register.

A new information leaflet for employers is being developed and will be available shortly and the GMC will be hosting several speaking sessions, including the NHS Confederation Conference and ASME Conference, in order to address some of these issues in an open forum.

For more information about the PLAB campaign, please contact reform@gmc-uk.org.

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