August 2006

A communication from the General Medical Council
August 2006, Issue 28

What's New?

Welcome

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

In this month's edition we bring you the latest news on the recent publication of the Chief Medical Officer for England's report, Good doctors, safer patients, with a response from GMC President, Sir Graeme Catto.

We also publish information on the recent European Court of Human Rights ruling on the Leslie Burke case and the final round up report on the GMC Withholding & Withdrawing campaign, which was aimed at providing greater awareness and education about the GMC guidance for both patients and doctors.

There is news on the new Health Act 2006, examining the governments proposals on Safer Management of Controlled Drugs , and its implications for healthcare organisations. Additionally, we outline the new GMC policy for substance abuse by doctors.

We also bring you an update on the List of Registered Medical Practitioners .

Finally, this month we are asking our readers to participate in a short survey and we ask that you take just a few moments to complete this.

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

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Good doctors, safer patients

Sir Liam Donaldson's report, Good doctors, safer patients, was published on 14 July 2006 and makes 44 recommendations. The Government is consulting on Sir Liam's report and over the next eight weeks or so we will be working with our partners on the report as a whole and on individual proposals.

Our starting point will be the GMC's statutory purpose - to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine. We believe in a system of medical regulation that fosters the delivery of safe, high-quality care for patients, is based on clear standards that are fair, transparent and open, is properly co-ordinated across all four UK countries, is independent and accountable, and, above all, can command the support and confidence of patients, the public and doctors.

Sir Liam's report presents an opportunity to take a significant step forward in improving safety for patients and modernising regulation. We have welcomed a number of Sir Liam's proposals, while others will need to be thought through and their regulatory impact tested and costed. In relation to one recommendation – the removal of responsibility for undergraduate medical education – we immediately said that this would be damaging to patients and that the case for change had not been made.

Good doctors, safer patients - Scotland

As part of the work around the two regulation reviews Good doctors, safer patients and T he regulation of the non-medical healthcare professions in Scotland, the Scottish Executive, in partnership with the UK healthcare regulators, is holding a number of stakeholder events.

Each event sets out to explore the Scottish stakeholder response to both reviews through themed workshops and discussions with a view to informing the advice and comment that the Scottish Executive will provide to the Department of Health in England.

Three regional events and one national event are planned. All events will be full day and places are limited - Melrose on 15 September, Glasgow on 20 September and Aberdeen on 3 October. The national event is scheduled for 17 October in  Edinburgh. If you would like to book a place or require more details, please contact RegulationReview@sc.grayling.com.

European Court supports GMC end of life guidance

In 2004 Mr Leslie Burke brought a successful judicial review of the GMC guidance Withholding and Withdrawing Life-Prolonging Treatments . His claims mainly related to what he sees as his right as a competent patient, suffering from a degenerative disease, to require artificial nutrition and hydration (AN&H) to be provided during the end stage of his illness when he can no longer communicate his wishes. The GMC appealed the judgement, as it seemed to make important changes to the law, which needed further testing and clarification.

In August 2005 the Appeal Court ruled that the guidance, as it stands, is lawful. It would not permit doctors to act in the way feared by Mr Burke. Indeed the court commented positively on the role the guidance could play in protecting patients' interests and went on to recommend that it should be ‘vigorously promulgated, taught, understood and implemented at every level and in every hospital'.

Mr Burke, who was refused leave to appeal to the House of Lords, applied to the European Court of Human Rights (ECtHR) for a hearing. In July 2006 the ECtHR rejected Mr Burke's application. The Court agreed that the GMC guidelines simply set out good practice for doctors, without altering domestic law or enshrining any unlawful instructions or recommendations. The judges' decision makes clear that patients can not pre-determine the administration of specific treatment in future unknown circumstances. Nevertheless, the Court confirmed that in the final stages of Mr Burke's illness, a doctor would be obliged to take account of his previously expressed wishes, and they observed that Mr Burke's current views about ANH could be set out in a living will or advance statement. The full decision can be read on the EctHR website.

The GMC welcomes the further reassurance, which the EctHR decision offers to Mr Burke and other patients and their carers. We will continue to work with the profession and public, to raise awareness of our guidance and promote good practice in this very sensitive and challenging area of decision-making, which has been highlighted by our recent successful campaign, further details of which can be found on the attached link.

Safer management of controlled drugs

The Fourth Report of the Shipman Inquiry focused on how Harold Shipman was able to obtain a large amount of controlled drugs over a prolonged period without detection.

The Government response, Safer Management of Controlled Drugs, accepted the case for strengthening the governance arrangements for controlled drugs, provided this could be done in a way that did not impede appropriate use of controlled drugs to meet patient needs.

The new Health Act 2006 requires all healthcare organisations and independent hospitals to ensure that they have robust arrangements for the safe and effective handling of controlled drugs in place and to share intelligence on controlled drugs issues. The Healthcare Commission will have responsibility for regulating the performance of healthcare organisations in relation to these requirements.

The legislation applies to Scotland and will be implemented to reflect the different organisational structure in that part of the UK. The Scottish Executive has confirmed that guidance for Scotland will be published in due course.

For further details please check out the attached article from GMCtoday.

New policy for substance abuse

In 2003, the GMC commissioned a review of its procedures for dealing with doctors whose fitness to practise is impaired by ill health. The review, carried out by the Health Review Group (HRG) under the chairmanship of Dame Deidre Hine, was completed last year and its recommendations have now been approved by the GMC Council.

One of the recommendations is to provide a policy on substance abuse. The GMC believes that personal use of controlled drugs and the inappropriate or excessive use of alcohol can seriously impair a doctor's fitness to practise. Often, the best way of dealing with substance misuse at work is in the workplace, and most organisations who employ doctors or contract out to them have their own drugs and alcohol policies in place. The GMC's policy on substance abuse complements local arrangements.

If doctors are found to have impaired fitness to practise linked to substance misuse, they will be subject to GMC restrictions. They will be required to comply with arrangements that the GMC makes for the testing and analysis of samples of blood, urine, oral fluids or hair for the presence of alcohol, drugs or their metabolites.

The frequency of testing will depend on the type of substance that has been misused and the assessed risk of relapse. A medical case examiner will therefore carry out a risk assessment before tests begin. The case examiners will also decide on whether tests should be announced or unannounced.

Samples for analysis may be taken with the doctor's consent by:

  • The doctor's GP or other registered medical practitioner
  • An employee or agent acting on behalf of the doctor's employer
  • An employee of an organisation contracted to provide testing for the GMC
  • The doctor's medical supervisor.

Samples will be analysed at NHS laboratories or other laboratories, which have been approved by the GMC. The results will be made available to the doctor, the doctor's medical supervisor and the GMC, unless the doctor specifies others to whom they should be sent. A leaflet, Supervising a doctor with restricted registration: Guidance for Chief Executive Officers, has just been published by the GMC. Please visit the GMC website at or contact publications@gmc-uk.org for a copy.

List of Registered Medical Practitioners

In the April edition of the ebulletin , we brought you news of changes to the format of the Register. The new online List of Registered Medical Practitioners, together with the new GP Register, went live successfully on 31 March. It includes the names of all doctors registered with the GMC and gives details of:

  • Doctors' reference numbers, names, any former names, gender
  • Year and place of primary medical degree
  • Registration status
  • Date of registration
  • Entry in the new GP or the Specialist Register
  • Any publicly available fitness to practise history.

Doctors' addresses are no longer routinely published by the GMC. We may be asked to provide your registered address to the British Medical Association, Medical Defence Organisations and Medical Royal Colleges and faculties so that they can keep their records up to date. We will only do so, where we are satisfied you are already a member.

If you would prefer us not to share your registered address with these organisations please let us know either by sending the GMC an email or by writing to: Registration Update Team, General Medical Council, St James's Buildings, 79 Oxford Street Manchester, M1 6FQ.

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