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September 2005

A communication from the General Medical Council
September 2005, Issue 17

What's New?

Welcome
Risk-based approach to regulation
What is Good Medical Practice? An invitation to a Public Meeting
GMC will refer some complaints to local NHS procedures
Education
Principles of Good Medical Education and Training
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Welcome

Welcome to the September edition of our ebulletin for 2005.

In this edition there is an insight into the risk-based approach to regulation the GMC propose to adopt. This approach will allow the GMC to devote greater resources to scrutiny of the highest risk categories, rather than spreading attention uniformly across all doctors.

The GMC is launching a series of high profile public meetings around the UK on What is Good Medical Practice? and we have the latest information on where the nearest event is taking place and how you can get involved.

In the July edition we outlined proposals that the GMC would refer some complaints about doctors back to NHS employers. This month there is an update on when this procedure will begin, in addition to factsheets for employers, which are also available on our website.

We also have the latest information from the Education team as they continue their comprehensive consultation on the Strategic Options for Undergraduate Medical Education.

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

Risk-based approach to regulation

In March 2005, the GMC Council discussed a paper on ‘ Developing a Risk-based Approach to Regulation: the Early Identification of Impairment' . The paper noted the conclusions of the Hampton Review, which the government had commissioned to explore how the regulation of businesses could become better targeted and more proportionate to risk. The Hampton Review concluded that regulatory effort and resource should explicitly be linked to regulatory risk, and that the benefits of such an approach would potentially include reducing the regulatory burden where it is safe to do so, so freeing up resources to focus on areas of higher risk.

The risk-based approach to regulation was endorsed by the GMC Council on 20th September and will help ensure that the majority of doctors should encounter a lighter regulatory touch. Those who are outside an approved environment or for other reasons (for example, doctors subject to GMC fitness to practise restrictions in the past) would be part of a potentially higher risk group, and will be subject to a greater level of scrutiny. This pro-active approach will allow us to allocate resources on the basis of a risk assessment. The GMC Council also agreed that doctors will be required to provide a description of their practice as a condition of receiving a licence to practise. The detailed implications, including costs and benefits, are now being analysed.

The risk-based approach relies upon the variety of layers, via which a doctor can be regulated, which forms a four-layer model of regulation:

Personal regulation , which reflects the way in which individual doctors regulate themselves, based upon their commitment to a common set of ethics, values and principles, which puts patients first.

Team based regulation , which reflects the increasing importance of team working and requires health professionals to take responsibility for the performance of the team and to act if a colleague's conduct, performance or health is placing patients at risk.

Workplace regulation , which reflects the responsibility that the NHS and other healthcare providers have for ensuring that their staff, and those who use their facilities, are fit for their roles. Workplace regulation is expressed through clinical governance and performance management systems.

Professional regulation , which is undertaken by the GMC and other statutory health regulators and, for example, by medical Royal Colleges where appropriate. Professional regulation is expressed through work on standards, education, registration and licensing, including revalidation, and fitness to practise procedures.

The great majority of doctors in the UK are good doctors, delivering safe and effective healthcare, often under difficult and demanding conditions. We must work with others to ensure that standards remain high and that prompt and effective action is taken to deal with actual or emerging impairment.

Medical managers will play a vital role in this new system; and we are working closely with those representing managers and employers as we develop our proposals.

For further information on the GMC Council papers relating to the risk-based approach to regulation please visit our website or open the attached links.

What is Good Medical Practice? An invitation to a Public Meeting

Manchester will host the first in a series of public meetings looking at what patients and the public expect from their doctors. The meeting is intended to stimulate debate, and will feed into the ongoing consultation of the General Medical Council's core ethical guidance ‘Good Medical Practice'.

The first meeting will be held in Manchester on 14 October and will be chaired by Anthony Wilson, well known in the city for his contribution to the media, arts and voluntary sector. A lively debate is assured from a varied and informed panel, including ex-GP and Private Eye satirist Phil Hammond, Dea Birkett writer, John Harris, Professor of Bioethics from the University of Manchester, and Allan Beswick from BBC GMR.

Following the Manchester meeting, events will be held in London, Thursday 27 October, Cardiff, Monday 21 November, Edinburgh, Tuesday 22 November and Belfast, Wednesday 23 November.

Each meeting will consist of a panel discussion of three scenarios based on issues arising from the new draft of Good Medical Practice, including conscientious objections, whistleblowing and professionalism. There will be an opportunity for questions and comments from an audience of doctors and patients, who will vote on the issues before and after each debate.

Topics to be debated in Manchester include:

Do we expect a higher standard of behaviour from our doctors than from other people?
When can a doctor reasonably remove a patient from their list?
Should a patient have a right to demand treatment that a doctor thinks they don't need or that may even do them harm?

If you would like to attend please email your name and postal address to gmpmanchester@gmc-uk.org or gmplondon@gmc-uk.org depending on which event you would like to attend. If you would like to attend on of the other meetings in Cardiff, Edinburgh or Belfast please email: ataylor1@gmc-uk.org

GMC will refer some complaints to local NHS procedures

The GMC receives over 5,000 complaints about doctors each year. Our powers and sanctions are linked to our responsibilities for maintaining the medical register. We are mainly limited to taking action on serious concerns, which call into question a doctor's fitness to practise and suitability to retain unrestricted registration. However, most of the complaints we receive do not fall into that category; and most would be best dealt with locally as, even if the allegations were proven, they would not be sufficiently serious to warrant action on registration. In addition, local NHS procedures and the Healthcare Commission (and its equivalent elsewhere in the UK) are often best placed to look at the patient's experience and identify systemic problems.

From 17 October 2005, the GMC intends to refer such complaints directly to the relevant NHS Trust or Primary Care Trust to take forward under their own complaints procedures. We will ask the employer to confirm receipt and to keep us up to date with the progress of any investigation until the matter has been concluded. Of course, the employer may refer the case back to the GMC at any stage where information gathered locally indicates that a doctor's fitness to practise may be impaired and that action on registration may be required to protect patients.

Further information about the GMC referring some complaints to local NHs procedures is available on our website. Alternatively, you may wish to ring our dedicated helpline on 0161 923 6424. The helpline will be available for employers from Monday 10 October 2005.

EDUCATION

Consultation

As a part of the GMC consultation on the Strategic Options for Undergraduate Medical Education , an event was hosted at Oxford Medical School on 1st September, where over 150 students debated the proposal for introducing a national assessment examination.

This pilot event, inspired by GMC Council member Professor Chris Bulstrode, and organised and chaired by Colin Chu, President of the Medical Students Association, was designed to encourage students to feedback on the Education Committee's consultation.

The debate ranged over a number of keys issues, including argument that national assessment would build upon the GMC guidance Tomorrow's Doctors, that curricula would be more tightly defined in the future and that a national examination would be fair and consistent. The opponents argued that national assessment would create unfair league tables of schools and ranking of students, would be unnecessary with the development of the Foundation Programme, and it could reduce diversity between medical schools.

The consultation runs until 31 October 2005, for more information please check our website.

Principles of Good Medical Education and Training

New guidance has been published on medical education and training. The Principles of Good Medical Education and Training set out aspirational , yet achievable, criteria for use by anyone designing a programme or course at any stage from undergraduate degrees to Continuing Professional Development (CPD).

This is a joint publication between the General Medical Council's Education Committee and the Postgraduate Medical Education and Training Board (PMETB) and the publication of the guidance further cements the relationship between the two regulators. Continuity of the principles underpinning all the guidance for medical education and training will help to ensure that education and training is a continuum throughout the careers of medical students and doctors.

Principles of Good Medical Education and Training has been awarded a Crystal Mark by the Plain English Campaign and is available on our website.

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