Features: Keeping fitness to practise fit for purpose
28 September 2009
Deputy Chief Executive and Director of Standards and Fitness to Practise, Paul Philip, explains how we ensure our procedures are relevant and fair.
Earlier this year we undertook a further review of our fitness to practise procedures which led us to consult on a series of rule changes which we introduced in August. Here Deputy Chief Executive and Director of Standards and Fitness to Practise, Paul Philip, explains how we ensure our procedures are relevant and fair.
How do you keep your fitness to practise procedures up to date?
We continually review our fitness to practise procedures to improve the quality of the process, our casework and our decision making. We are continually striving to find ways to make our procedures work better and we introduce changes from time to time to ensure that the process continues to work as fairly, efficiently and effectively as possible.
The need for change may arise from legal advice we receive about individual cases or because we have identified opportunities for improvement. Changing our procedures can be a complex business; any significant changes will normally involve a public consultation and training for staff, GMC panellists and others. We are conscious too of the importance of stability; we recognise that change can be disruptive if it is not carefully planned.
How often do you make changes to your fitness to practise procedures?
Since 2004, we have made a couple of significant changes. In 2007, we reviewed our procedures for entering agreements with doctors at the end of an investigation and in 2008 we introduced the civil standard of proof for findings of fact at hearings. Prior to 2008 we had used the criminal standard of proof which is intended specifically for criminal matters and is rarely used in civil or regulatory proceedings.
Why did you introduce the latest changes?
We don’t believe in changing our rules for the sake of it. The reformed procedures, introduced in 2004, brought significant improvements to our fitness to practise procedures and have remained largely unchanged since their introduction but, over time, we have identified the need for a number of improvements. The recent package of changes resulted from our operational experience and from legal advice on individual cases.
The changes include a power to conclude vexatious complaints. Such complaints are rare but, in the past, a small number of vexatious complaints have caused significant disruption and distress and diverted resources from our main role of protecting patients.
We have also included additional powers to review cases which we have closed at an early stage but where we have subsequently discovered that the decision was flawed.
Are there any other changes in the pipeline?
Over the summer we consulted on two new proposals. The first one is a proposal to deal with more cases concerning a doctor’s fitness to practise by entering into a formal agreement with the doctor after we have completed our investigation, rather than referring to a public hearing. This is known as consensual disposal and is intended to build on the changes we introduced in 2007.
These agreements usually involve the doctor restricting or limiting their practice in some way or undertaking a programme of retraining. These agreements mean we can get doctors retrained quickly rather than referring them to a hearing which can take time. We discussed this with our newly formed Reference Community in order to ensure we got views from patients and the public.
The second consultation involved a series of proposals for the fitness to practise hearings themselves. We hold approximately 250 hearings a year and sometimes we find they take longer than expected. We are seeking ideas for improving how we manage hearings so they are as speedy and efficient as possible. An example of a suggestion we have received is to have a more flexible system of pre-hearing telephone conferences.
Can legal cases affect the GMC’s procedures?
Case law can also have a significant impact on the GMC’s Fitness to Practise procedures. The case of Cohen v General Medical Council [2008] EWHC 581 (Admin) brought significant change to how Fitness to Practise Panels decide whether a doctor’s fitness to practise is impaired.
Since that judgement, panels can take account of what efforts a doctor has made to improve their performance and resolve the problem which gave rise to the complaint.