July 2006

A communication from the General Medical Council
July 2006, Issue 27

What's New?

Welcome

Welcome to the July edition of the GMC e-bulletin.

In this month's edition you will find the GMC's initial response the publication of the CMO's report into medical regulation, entitled Good doctors, safer patients, the latest changes to the Medical Act and the signing of a new MoU.

We also give you an update on activity in our devolved country offices as well as a summary of our highly successful campaign to raise awareness of our guidance on Withholding and Withdrawing Life-Prolonging Treatment.

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

The Chief Medical Officer for England's report 'Good doctors, safer patients'

The Chief Medical Officer Professor Sir Liam Donaldson published his review of medical regulation on Friday 14 July 2006. He was asked to undertake the investigation following the Shipman Inquiry lead by Dame Janet Smith.

The Secretary of State for Health welcomed the publication of Good doctors, safer patients and launched a period of consultation which will end on 10 November 2006.

The report, Good doctors, safer patients , makes recommendations on measures to strengthen the arrangements in place for the protection of patients. It contains 44 detailed recommendations for the GMC.

Proposed changes include creating GMC 'affiliates' to deal with appropriate fitness to practise cases locally, making the organisation accountable to Parliament, transferring the GMC's education role to PMETB and creating a new framework for revalidation.

The GMC's initial response

Commenting on the Chief Medical Officer's proposals, Sir Graeme Catto, President of the General Medical Council, said:

'Today's report from the Chief Medical Officer for England, Sir Liam Donaldson, has important implications for the way doctors are regulated right across the UK, and we will study its 44 recommendations very carefully.

We believe in a system of medical regulation that fosters the delivery of safe, high quality care for patients, is based on clear standards which are fair, transparent and open, is properly coordinated across the different organisations involved in all four UK countries, is both independent and accountable, and above all, which can command the support and confidence of patients, the public and doctors.  If the report leads to the continued development of such a system, it is to be welcomed.

In our submission to Sir Liam's review we identified a number of priorities for making medical regulation more effective, including greater patient and public involvement, better co-coordination between employers and the GMC, easier access for patients and employers to information about their doctors, and better targeting of regulatory resources. We are very pleased to see these priorities reflected in Sir Liam's report. 

In particular, we welcome:

  • Sir Liam's proposal that revalidation can now proceed based on strengthened local systems including appraisal, in line with our existing proposals
  • the enhanced role to be played by the GMC's unique registration database as a  key source of information for patients, employers and doctors
  • that the GMC should be directly accountable to Parliament. We have been arguing for this for many years.

Some of the other recommendations have significant implications, which will need to be thought through very carefully, and their regulatory impact tested and costed. Parliament recently legislated to put in place a new constitution and enhanced fitness to practise procedures. These arrangements have not long been introduced and it is not clear to us that the case for further change has been made and that the disruption that would be involved is justified. We would want to look carefully at these proposals.

We have considerable concerns, however, about the proposals Sir Liam makes in relation to medical education, which we do not believe would be in patients' best interests. The public have a right to expect good doctors, which means that they must be up to date and fit to practise throughout their working lives. That in turn means that medical education must be linked to our other functions including registration and revalidation.  The UK is, rightly, recognised as a world leader in medical education. The case for change has not been made.

We will continue our drive to create a modern, independent system of medical regulation which delivers for patients and commands the support of doctors. We look forward to contributing to the consultation and debate which will now take place.'

Below is a summation of the GMC reforms since 2000:

Fitness to Practise

  • More transparent, clearer determinations, list of registered medical practitioners shows hearings and outcomes
  • Clear and published sanctions criteria
  • Interim Orders Procedure introduced
  • Council members no longer involved in overseeing procedures or as panellists at hearings
  • Minimum erasure length extended from 10 months to five years
  • Improved complaints procedures by re-routing complaints not affecting a doctors' fitness to practise to local systems

Registration

  • publish register online with more information (GP register) and potential for including information useful to patients when we get practice date from introducing the licence
  • will abolish limited registration by end of 2006 to introduce a clear registration process for all graduates
  • while revalidation proposals on hold have been working on approved environments/risk based approach and introducing licence ahead of revalidation

Education

  • Revised version of Tomorrow's Doctors published in 2002 which identified the knowledge, skills, attitudes and behaviour expected of new graduates
  • The New Doctor published in 2005 put the principles set out in Good Medical Practice at the centre of training for provisionally registered doctors
  • Launched consultation on student fitness to practise, national assessment and the future of the undergraduate medical curriculum
  • Established a formal quality assurance programme for undergraduate medical education, and working with PMETB to develop a similar system for foundation programme training

Standards and Ethics

Governance

  • Reduced size of Council from 104 to 35 in 2003 - 19 elected doctors, 14 independently appointed lay people and 2 appointed doctors
  • Increased regularity of meetings for quicker decisions from twice yearly to six times

Accessibility

  • Improved website, communications (publications/call centre/media briefings) to enable easier access for patients and doctors
  • New IT system, Siebel, will eventually enable joined up information systems which improve response times and information accuracy
  • Reconstituted the Patient and Public Reference Group which advises the GMC on policy issues
  • Created a Readers Panel to check information we send out is clear and concise

Section 60 Order becomes law

On 19 July 2006 the Section 60 Order amending the Medical Act 1983 was ratified by the Privy Council and became law. The Order completed its passage smoothly through the Houses of Commons on the 4 July 2006 and the Lords on 6 July 2006.

A Section 60 Order authorises the creation or amendment of legislation governing a health professional regulator, so as to secure or improve the regulation of the profession. The Order is a form of Secondary Legislation known as a Statutory Instrument. These Instruments have the full force of law and using them prevents the need for an Act of Parliament every time a detail needs to be updated or added to.

The Order will bring further changes to the GMC's registration, education and fitness to practise systems. We will be discussing the implementation timetable with the Department of Health to plan for the various provisions.

During the Order's passage through the Lords, Lord Warner said: "Our work is making regulation more responsive to patients' needs and better at protecting them. There have been some suggestions that the Government should end the present system of professional regulation, but that would be the wrong response. Instead, the Government are strengthening regulation in the public interest.

''Regulatory bodies have risen to the challenge. The General Medical Council has played a full part in bringing the changes about and it has worked hard to develop the further proposals in this order with us-most of them began as GMC proposals.''

Conservative Health Spokesman Earl Howe said the Conservatives generally supported the Order, although raised concerns regarding the abolition of limited registration.

Liberal Democrat Health Spokesman Baroness Neuberger also welcomed the Order, saying that the Liberal Democrats broadly supported it.

Healthcare regulators sign information-sharing agreement with police chiefs

The Association of Chief Police Officers (ACPO) and the Crown Prosecution Service (CPS) have formalised their arrangements for sharing information with the General Medical Council (GMC), and the Nursing and Midwifery Council (NMC) to ensure public and patient safety.

A Memorandum of Understanding has been signed, setting out the responsibilities and legal powers of each body in the event of an investigation into potential criminal activity by doctors and nurses. This builds on considerable existing co-operation and communication, including an earlier Statement of Intent.

Detailed operational procedures have been drawn-up to support the principles for information sharing laid out in the agreement.

The regulators will inform the relevant police service where a practitioner may have committed a criminal offence that would put the public at risk. For example, under the new working arrangements, offences that the GMC or the NMC might refer to the police could include allegations of violence, racist or homophobic behaviour or involving pornographic material relating to children.

The arrangements will also ensure that the GMC and NMC are kept informed of police investigations involving one of their registrants in sufficient detail to enable them to decide what action, if any, is required, including whether to take interim action to restrict the right to practice pending the outcome of a police investigation.

Campaign raises awareness of end-of-life issues

Although GMC guidance is carefully researched and widely publicised, we cannot take for granted that it will necessarily be known, understood and applied by doctors in their everyday practice. The campaign to promote the guidance Withholding and Withdrawing Life-prolonging Treatments, which came to an end in July, was intended to raise awareness of the existence of this guidance and what it contains. The main aim was to promote good practice in decision-making for patients nearing the end of life, following on from the Appeal Court ruling upholding the guidance in 2005.

A total of 20 events, comprising multi-professional workshops, grand rounds presentations for hospital clinicians, and patient support workshops were held around the four home countries. Although primarily educational, these events provided a valuable opportunity for us to talk to doctors, other medical professionals, and representatives from the voluntary sector about legal and ethical concerns on withholding and withdrawing treatment. At the events for clinicians discussion was based around a series of case studies specially written for the campaign, and these proved a useful learning resource to stimulate a wide and open debate, which mostly had a very practical focus. In all the campaign reached over 1,900 clinicians and 150 patient advocates.

Putting Safety First For The Health Service

The Department of Health, Social Services and Public Safety in Northern Ireland has released Safety First: A Framework for Sustainable Improvement in the HPSS, which sets the agenda DHSSPS wants to see followed to deliver a safer health service and drive improvements to clinical and social care.

In the Section on Education, Workforce Development and Regulation the Department has highlighted the GMC proposed four-tier regulatory model as a way in which regulation can be used to promote quality and safety. They also highlighted the need for quality-assured appraisal systems to review performance and identify development needs.

New CMO for Northern Ireland

The Department of Health Social Services and Public Safety has announced the appointment of Dr Michael McBride to the vacant Chief Medical Officer position.

Dr Michael McBride has been Medical Director for the Royal Group of Hospitals in Belfastv since August 2002. As Medical Director at the Royal Hospitals, he has contributed to strategic change at trust, regional and national level. As the Trust lead for clinical and social care governance, he had responsibilities for all aspects of clinical quality and patient safety.

GMC Scotland Update

GMC Scotland has been focusing on supporting patients and the public to communicate with the health sector. The text for a GMC leaflet for people in Scotland considering reporting a doctor to the GMC has been agreed. The leaflet will help people to decide if their concerns should be addressed to the GMC and directs members of the public to both the NHS complaints handling procedures and useful support services.

Meanwhile, the new Independent Advisory and Support Service has been consulting widely as training for the advisors is developed. The GMC is delighted to have been able to input into this process and looks forward to offering appropriate training material in due course. We have also starting working with the Health Rights Information Scotland team on a project that aims to offer patients a menu of questions they can use to ensure that they secure the information they need when receiving treatment.

New appointment to GMC Wales Office

Darren Hughes joined the GMC Wales Office as Welsh Affairs Officer on the 26 th of June. Darren is responsible for communication of the work of the Wales Office internally and externally to a variety of audiences in conjunction with the Press Office and Public Affairs teams. Darren will work closely with and report to Natalie Drury, Head of Welsh Affairs and will be based in the Wales Office. Prior to joining the GMC Darren was the Senior Press Officer and latterly Campaigns Officer for a large rural campaigning organisation based in London. Darren's priorities will be to ensure that the work of the Wales Office is communicated to the GMC internally and that the work of the GMC is communicated internally and externally.

Commenting on his appointment Darren said: "I am very much looking forward to working for the GMC in Cardiff and promoting understanding of the work of the GMC Wales Office inside the organisation and also to the public, health organisations, patients and politicians here in Wales. I look forward to building productive relationships with key stakeholders here in Wales."

Occupational Health Smart Card Wales

The Occupational Health Smartcard (OHSC) was introduced by the Welsh Assembly Government in the Autumn of 2005 and is now used by all of the NHS trusts in Wales. The GMC Wales office is working with the Smart Card team to encourage as many doctors as possible obtain a card. This launch follows that of a similar launch by the Department of Health in England in 2001 although take up in Wales has been far higher. The OHSC programme aims to streamline and standardise the recording of personal, contractual and health clearance information on to the card so that when junior doctors take up new training posts almost all the necessary information is recorded ready for their new employer. All the information is carried on the card thereby greatly reducing costs and accelerating the transfer of all the necessary information.

Currently the card securely contains the following information;

  • results of Criminal Records Bureau (CRB)
  • GMC registration status with live link to GMC so will alert any registration query
  • contractual details, grade and specialty
  • medical history/immunisation records
  • next of Kin details
  • salary scale.

The fact that every trust in Wales has its own smart card reader means it greatly reduces the amount of paperwork and administration expense associated with doctors moving posts.

This enables smooth transition between posts and makes it far easier for doctors to keep track of all their professional information, including their unique GMC number. The scheme is supported by JDC and the BMA and is also encouraged by the National Association of Medical Personnel Specialists.

Angela Rackham, Medical Personnel Manager Cardiff and Vale NHS Trust, said: "The occupational health smart card will streamline the process of induction by enabling us to share key data with other Trusts. I would recommend that all junior doctors in Wales carry and update the card. The result will be significant savings for both the doctors and their employers."

Nearly 2500 doctors have registered and use the card in Wales. For further information or to apply for a card contact Carrie James on 02920 742507 or jamesc7@cf.ac.uk'

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