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April 2007

A communication from the General Medical Council
April 2007, Issue 34

What's New?

Welcome
Simplifying Registration
Intelligence and International Liaison Team
Standards
Standards - Children & Young People Guidance
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Welcome

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

In this edition we bring you news of our plans to abolish limited registration, a category of registration which currently applies only to international medical graduates (IMGs).

Also in this edition, there is news on the GMC Intelligence and International Liaison Team, who work closely with other national medical regulators, enabling easier movement of qualified doctors and maintaining patient safety. We also bring you news of our consultation on the new Children and Young People Guidance, which is due to be launched in the Autumn.

Finally, we have some information on five workshops that are taking place in May and June on the issue of Consent.

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

Simplifying Registration

The GMC are planning for the abolition of limited registration, a category of registration which currently applies only to international medical graduates (IMGs). In future a new single registration framework of provisional and full registration will apply equally to all doctors no matter where they qualify.

This new move reflects longstanding GMC policy and brings to an end the old two tier system of registration, perceived by many as unfair to IMGs. It is founded on the twin principles of ensuring equality of treatment for doctors and assuring patient safety.

New framework

The new framework was made possible when we secured changes to the Medical Act 1983 last year. It represents an important step towards a single form of registration for all fully qualified doctors; and will, amongst other benefits, provide greater accessibility and clarity for patients and others consulting the register.

IMGs will in future be able to apply directly for provisional or full registration. They will no longer need an offer of employment beforehand, but will need to satisfy a number of criteria before we can grant them registration.

The new framework will also introduce the concept of approved practice settings: organisations with effective clinical governance systems in place which provide a suitable environment for newly registered doctors. All doctors granted full registration for the first time – UK graduates as well as IMGs – will be required to work initially within an approved practice setting. These settings will include organisations within and outside the NHS.

At the same time, there will be a new requirement for all applicants for full registration to satisfy the GMC that their fitness to practise is not impaired. This, coupled with a new power to erase doctors who are shown to have failed to disclose a relevant fitness to practise matter at the time of registration, means we will have comprehensive powers to refuse registration to individuals who are not fit to practise, and to remove the registration of those who can be shown to have concealed relevant information at the time of their registration.

Working with partners

We are now working closely with our partners in the four UK countries to ensure that systems across the health service are ready to support the changes to the registration framework. This includes ensuring that the criteria we wish to apply to approved practice settings are robust, workable, and fit with the mechanisms for assuring core standards which are already in place.

We will provide updates via the ebulletin, our website, as well as future editions of GMCtoday, which will include more information about the new framework and the timetable for implementation.

In the meantime, doctors requiring limited registration should continue to apply in the usual way.

Intelligence and International Liaison Team

The GMC Intelligence and International Liaison Team is located within the Registration Directorate. The team is involved in developing relationships with other regulatory authorities, both within the UK and overseas. One of the tasks dealt with by the team is processing notifications of disciplinary action taken by other regulators, so that the doctors cannot obtain GMC registration without their disciplinary history being taken into consideration. The team are also responsible for developing agreements with other regulators to exchange Certificates of Good Standing electronically. This makes the process quicker and reduces the risk of information being altered, as it is transmitted directly from one regulator to another.

The Intelligence and International Liaison team also deal with reports of unregistered practice – i.e. by medical practitioners who do not currently hold GMC registration and who are providing treatment or engaging in activities that would normally require the practitioner to hold GMC registration. It is an offence under S49 of the Medical Act to impersonate a registered medical practitioner, but the GMC has no remit to prosecute practitioners in these cases. The team therefore liaise with the Police and/or NHS Counter Fraud and Security Management Service (CFSMS) to take the case forward and ensure that the practitioner is charged.

To do this, the Intelligence and International Liaison team provide witness statements in relation to a doctor’s primary medical qualification(s), their registration history and their current registration status, in cases where the practitioner is being prosecuted for fraud by either the Police or the CFSMS.

Helping to provide effective control on entry to the List of Registered Medical Practitioners is the main focus of the team. To do this, they are involved in reviewing and developing a range of verification procedures (including qualification and identity checking) and anti-fraud policies. This is to reduce the risk of an unqualified or fraudulent practitioner obtaining GMC registration and therefore posing a risk to patient safety.

If you have any enquiries about the work of the Intelligence and International Liaison Team please contact Eadaoin Flynn, Intelligence and International Liaison Manager on 0161 923 6653, or by email at eflynn@gmc-uk.org.

Standards

Consent Guidance

The General Medical Council is developing new guidance to replace our existing guidance, 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 (reflecting the ideas about doctor/patient partnership that inform the new edition of Good Medical Practice).

As part of the consultation period on the new guidance, we will be holding a series of five workshops across the UK in May and June 2007. An audience of patients, carers and doctors will be invited to discuss and comment on (or participate in) an acted scenario involving a patient whose capacity to make decisions for themselves is affected by early-stage dementia.

The focus will be on patients’ wishes and concerns about decision making for current and future treatment, and how these can be identified and met. The aim of the workshops is to provide an opportunity for doctors, patients and carers to discuss their views and concerns about these issues together. The discussions at these workshops will inform the content of the guidance, which we plan to publish in early 2008.

We are working with the Alzheimers Society, the Scottish Dementia Working Group and Age Concern NI to invite patients and carers to take part in the events. We are also looking for doctors from a range of specialities to take part. We are interested in the views and experiences of all doctors who are involved in making decisions about treatment and care with patients who have fluctuating or diminished capacity, not just those doctors who specialise in the treatment of elderly patients or patients with learning disabilities.

We are holding workshops in

Cardiff at The Gate on Wednesday 30 May 2007
London at Battersea Arts Centre on Tuesday 5 June 2007
Belfast at The Baby Grand on Wednesday 6 June 2007
Glasgow at City Hall on Tuesday 12 June 2007
Newcastle at Northern Stage on Thursday 14 June

The sessions will run from 10:30am to 1.00 pm with tea, coffee and lunch provided.

Stakeholder Roundtable Consultation Event on draft revised GMC Consent Guidance

GMC Northern Ireland will also be hosting a stakeholder consultation event on the GMC draft revised guidance on consent. The revised draft guidance will be issued for consultation in May and this event will enable stakeholders to discuss any views or concerns directly with members of the GMC Standards and Ethics team.

The Stakeholder roundtable will take place in the Hillsborowe Room, Malone House, Belfast on Thursday 7 June from 10.00 am-12.30 followed by a finger buffet lunch.

Any organisations or individuals wishing to register to attend should contact Nichola Mallon at the GMC Northern Ireland office on 028 9051 7022 or by e mail on nmallon@gmc-uk.org, providing details of any special dietary requirements.

Standards - Children & Young People Guidance

The GMC is launching new guidance for doctors in relation to children and young people in autumn 2007.

We have been consulting children, young people and a wide range of stakeholders on the guidance, which states that doctors must always act in the best interests of children and young people and take into account their views. It covers a wide range of issues including confidentiality; assessing a young person’s ability to make decisions about their treatment; child protection; sexual activity and contraception.

There was an overwhelming response to the consultation, with a total of 185 responses to the full written consultation, and a further 366 responses from under 18s via the online consultation.

In addition the GMC met with key stakeholders including several of the medical colleges, government departments in London and Edinburgh, children and parents at the Evelina Children's Hospital, a number of interested MPs and Peers at a Parliamentary lunch, a visit and debate at a school in Wales and held round table discussions with interested parties in Belfast, Edinburgh and in Cardiff, where the Welsh Assembly Government's Children's Minister spoke.

The guidance will now be redrafted in light of all the comments received during the whole consultation process. As part of our communications activity to promote this consultation, poster competition has been held for children and young people across the UK. The details can be viewed on our website.

GMC Northern Ireland will be hosting a stakeholder consultation event on the GMC draft revised guidance on consent. The revised draft guidance will be issued for consultation in May and this event will enable stakeholders to discuss any views or concerns directly with members of the GMC Standards team.