February 2007
A communication from the General Medical Council
February 2007, Issue 33
What's New?
Welcome
Welcome to the February edition of the GMC e-bulletin.
In this edition we have focsed primarily on the recent Government White Paper concerning healthcare regulation in the UK.
Also in this edition, there is news on the GMC work to review and consult on the Seeking Patient’s Consent guidance. An update from the GMC Wales and Sctoland offices and information about a new charter that has been drawn up by a large number of Healthcare bodies in order to ensure patient safety.
Please continue to send us your feedback, questions and ideas for topics you would like to see covered in future editions.
Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century
As expected the Government has published its White Paper, Trust, Assurance and Safety - The Regulation of Health Professionals in the 21st Century together with its response to the Shipman, Neale, Ayling and Kerr/Haslam Inquiries.
As you will appreciate the Government’s documents run to several hundred pages. We will need to read them carefully and analyse their proposals but it is already clear that the Government has substantially accepted the package of proposals we put forward in November 2006.
Clearly some of the changes proposed require primary legislation so it is likely that it will take some time before these are introduced.
GMC Response
Our formal response to was given by Sir Graeme Catto at a press briefing, a full copy of which is below. If you would like to watch a copy of the press briefing please visit the GMC’s website.
GMC President, Sir Graeme Catto, said: "This is an important day for both patients and doctors.
"We agree with the Government and with the Chief Medical Officer for England that the White Paper provides the basis for a lasting settlement in relation to professional regulation.
"We are particularly delighted that the White Paper incorporates so many of the proposals we published in November last year. They were designed to ensure a regulatory system that commands the confidence and support of all those who receive and provide healthcare.
The Secretary of State has recognised the importance of our statutory role in controlling entry to the register and the standards for entry. We are pleased that our model of interlocking functions has been endorsed. This includes our three board model for education training, which would bring together the coordination of all stages - undergraduate, postgraduate and continuing professional development.
An extension of our role in defining and assuring standards of practice.
We suggested in 1998 that there should be a system of ‘revalidation’ of doctors. We are looking forward now to being able to begin re-licensing and re-certification as soon as practicable. We will build on our existing strong relationships with the medical Royal Colleges as the custodians of specialist standards to deliver this.
To ensure public confidence, we believe the GMC must be seen to be independent. In our package of proposals on healthcare professional regulation, we suggested that the composition of the council should be changed to ensure a balanced membership with equal proportions of medical and lay members. We also support clear accountability to parliament.
We have already agreed to introduce the civil standard of proof flexibly applied and will implement this when the appropriate legislation has been passed.
This White Paper proposes a major extension of the GMCs role in developing GMC ‘affiliates.’ This is a bold proposition and we will participate fully in its development. The vast majority of doctors in this country are good doctors delivering high quality healthcare under demanding circumstances. However, a small minority are not; and we are determined to work closely with local healthcare management on the early identification of problems and on appropriate remedies, to ensure that patient safety is enhanced.
"The White Paper confirms that the GMC will be the sole investigating authority for serious complaints against doctors. The GMC sets the standards which determine whether a doctor loses their licence. Under these proposals the GMC will now gain a right of appeal which we have long sought over cases where we consider a decision is too lenient.
"The White Paper says an independent body should carry out the adjudication of cases. This is an incremental change: we have already introduced independent panels. This goes a step further. We will now work constructively to achieve a smooth transition to the new arrangements.
"The GMC has already undertaken a very significant programme of reform. However, there is more to do. Regulation is a dynamic process - it should not stand still. It must be scrutinised, challenged and improved to take account of our changing society and the changing healthcare environment.
"Our priority now is to end the uncertainty for patients and doctors. We believe we can do that. We look forward to working with all those who must be placed at the heart of the regulatory system - patients and the public, doctors, the medical schools and Royal colleges, the NHS and other healthcare providers.
"In November 2006 we argued for an independent and accountable system of medical regulation that would:
- Put patient safety at its heart
- Be independent of government as the dominant healthcare provider and independent of dominance by any single group
- Provide an integrated regulatory framework based on the GMC’s four interlocking functions: controlling entry to the medical register; setting standards for medical education and training; determining the principles and values that underpin good medical practice; and taking firm but fair action against doctors when those standards have not been met
- Ensure that professional regulation and workplace regulation connect in a coherent manner that reflects their distinct but complementary roles
- Be objective, fair, accessible and transparent so as to command the confidence and support of those receiving and providing healthcare
- Be suited to the local context in all four UK countries.
"The four inquiries tragically demonstrated what can go wrong when a tiny number of doctors depart from the high standards that are rightly expected of them. We believe that the proposals in this White Paper provide the basis for effective regulation in the future. "
For further information please visit the GMC Website.
Standards: Seeking Patient's Consent
Work is well advanced on guidance to replace the booklet Seeking Patient’s Consent: the ethical considerations (1998). The new guidance will be broader in scope than its predecessor, placing greater emphasis on how doctors and patients work together to make good decisions, and providing a framework that will apply to the range of situations that doctors face in practice.
The new guidance will reflect changes in the law, including the new mental capacity legislation and case law that requires doctors to explain the range of risks associated with a proposed intervention. For the first time, we will be providing detailed advice for doctors on how to assess and communicate risk, covering issues such as the content, presentation and timing of discussions with patients and how to handle difficulties such as uncertainty over the level or nature of risk.
Alongside the main guidance document, we are developing supporting materials, which will expand on the main guidance and illustrate how the principles apply in some of the different practical situations that doctors and patients face.
A three-month consultation period will begin in May 2007. As well as inviting comments on the text of the guidance, through a written consultation, we are looking into other ways to test the new approach and explore the obstacles that can prevent patients being fully involved in decisions about their care.
This will include a series of five events across the UK, focussing on the challenges of involving patients with fluctuating capacity in making decisions about their care and treatment. Doctors, patients and carers will be invited to take part in facilitated discussions and comment on (or participate in) a scenario that explores the key issues and challenges.
Full details of the consultation will be posted on the News and Consultations page of our website, www.gmc-uk.org.
Healthcare bodies pledge on patient safety
A number of key healthcare organisations have made a public commitment to work together to improve the safety of care received by patients, following at a high-level summit hosted by the National Patient Safety Agency (NPSA) and the Healthcare Commission.
The summit reinforced the message that the safety of patients is at the heart of healthcare, and that all organisations involved in the provision of care have a role to play in achieving this.
As a response to Safety first, the recently published report from the Department of Health, the NPSA and Healthcare Commission have jointly drawn up a charter of commitment and action. This identifies several key actions which signatories will commit themselves to.
So far 25 Chairs and chief executives of national organisations in the healthcare sector have signed the charter on patients’ safety.
This new public declaration of commitment will affirm that the organisations signing the charter will:
- Encourage renewed engagement, contributions and challenge from professionals, from other health service staff and organisations, and from patients and the public to support us in delivering our commitment to safety
- Ensure that safe care is a key priority in our work - in practice, not just words
- Work together on programmes and initiatives to contribute to improvements in the safety of care that will benefit patients
- Exchange information, data and intelligence actively when it is appropriate to do so in the interests of patients’ safety
- Encourage all those responsible for providing healthcare to report adverse events, when things go wrong, or “near misses”, so that lessons may be learned
- Contribute to the creation of a culture and environment, which promotes improvement and learning by individuals, organisations and systems, to prevent harm.
For further information please visit the NPSA website.
GMC Wales
GMC Wales engage with key stakeholders on Trust, Assurance and Safety - The Regulation of Health Professional in the 21st Century.
The Wales office has been actively engaging with key stakeholders in order to gauge reactions and communicate the GMC's position on the Government's white paper.
Minister Hosts Stakeholder meeting at the Welsh Assembly
As part of the consultation process on the children and young people's guidance Children's Minister, Jane Hutt AM hosted a meeting at the Welsh Assembly on behalf of the GMC for all stakeholders. Over 30 stakeholder groups attended and there were valuable discussions on key aspects of the guidance. This will help ensure that the views of people that work with children in Wales, as well as the children themselves, is taken into account in the final guidance.
Welsh Political Party Conferences
Political parties in Wales are in pre-election campaign mode, holding conferences in the coming weeks. Now that GMC Wales is well established on the Welsh health and political scenes our aim this year is to communicate the positive work of the GMC such as the Children and Young People's guidance consultation, Good Medical Practice and the Wales specific leaflet on "How to complain about your doctor". We will also be delivering a presentation at each conference, along with other health organisations, to outline our key areas of work to the Assembly Members and prospective candidates.
The conference dates are;
- Labour Party Conference. 22nd to 24th February.
Venue Cymru, Llandudno. - Conservative Party Conference. 3rd and 4th March.
Sophia Gardens, Cardiff. - Liberal Party Conference. 9th to 11th March.
DVLA Building, Swansea. - Plaid Cymru Conference. 24th March.
Y Galeri, Caernarfon.
For further information please visit the GMC Wales website.
GMC Scotland
Following the success of the four stakeholder events held in September and October last year to explore the two reports: Good doctors, safer patients and The regulation of the non-medical healthcare professions, the Scottish Executive is holding four further stakeholder events to share the contents of the Government White Paper on the future regulation of the health professions, published on 21 February. The events will provide an opportunity for interested parties to discuss the main themes from the White Paper and to identify the process of implementation in Scotland. The full day events take place in Edinburgh, Monday 2 March; Glasgow, Thursday 8 March; Aberdeen, Thursday 15 March and Newtown St Boswells, Friday 16 March - register at Regulationreview@sc.grayling.com. The UK health regulators are participating in the roadshows and the GMC will be involved in all four events. CEO and Registar, Finlay Scott, will be leading workshops at both Edinburgh and Glasgow.
How to Complain About a Doctor
The new GMC guidance booklets for Scottish patients on How to Complain About a Doctor have been widely circulated across Scotland. The booklets are available in Citizens Advice Bureau as well as through NHS Scotland and the electronic version is linked to many relevant websites. Stakeholders and intermediary bodies have welcomed the country specific information, which directs patients to local complaints procedures and sources of advice. The booklet explains what the GMC can - and cannot do - and includes a complaint form.
Memorandum of Understanding
Following the success of the year old Memorandum of Understanding with the Association of Chief Police Officers, covering England, Wales and Northern Ireland, we are working up a similar information exchange protocol with ACPOS. It is hoped that the Nursing and Midwifery Council and the Procurator Fiscal Service will also participate in the agreement.
Children's guidance
Work continues on the new Children's guidance. The drafting team visited Scotland on 5th February and attended a series of very useful meetings, including sessions with the Scottish Executive and the Scottish Commissioner for Children and Young People. A focus group drawn from relevant voluntary and community organisations was extremely successful and provided excellent input into our thinking - we are very grateful to everyone who gave their time.
For further information please visit the GMC Scotland website.
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