Issue 8 - Summer 2016

Forum discusses revalidation and reducing the stress for doctors

The BME Doctors Forum met on 28 June. The group considered a range of issues including an update on revalidation and the GMC’s work to reduce the stress for doctors involved in its fitness to practise procedures.


Forum members asked whether a disproportionate number of BME doctors and international medical graduates (IMGs) are having their revalidation deferred. There is a perception that SAS doctors experience higher deferral rates.

The GMC said that it regards deferral as a neutral act, not a negative outcome or a recommendation that is designed to penalise the doctor. There are a number of reasons why a doctor’s revalidation may be deferred. For example, a doctor may have only recently gained a prescribed connection to a designated body, and needs additional time for their supporting information to be transferred. The data does not indicate that deferral rates for SAS doctors are higher than for other groups of doctors.

There are 3 reviews of revalidation currently underway. The Forum is scheduled to meet with Sir Keith Pearson, Chair of the GMC’s Revalidation Advisory Board in the autumn to inform his review.

Fitness to Practise

Forum members welcomed a number of changes being introduced by the GMC to streamline the fitness to practise process and reduce the stress for doctors involved in its proceedings. These changes include:

  • Piloting a new approach for referrals from organisations, including a structured referral form to capture information if a doctor has raised a concern in the public interest, e.g. whistleblowing
  • Piloting a new approach for dealing with complaints about a single instance of clinical care
  • Introducing a package of support for doctors in the GMC’s health procedures and more support at hearings for unrepresented doctors and communicating at an earlier stage with doctors.

These were some of the recommendations from the review led by Professor Louis Appleby earlier this year.

Independent research for the GMC shows ethnicity still a factor in future doctors' prospects.

The General Medical Council (GMC) has published new research and data on the progression of doctors from different ethnicities and backgrounds through exams and recruitment.

It shows that white UK medical graduates remain more likely to pass specialty exams than their black and minority ethnic (BME) counterparts, while doctors whose primary qualification was gained outside the UK or European Economic Area (EEA) are even less likely to do well in exams or recruitment.

The GMC sets the standards for all stages of UK medical education and training, and oversees the organisations which manage and deliver it to doctors. It is responsible for ensuring the pathways through medical training are fair and don’t disadvantage entrants from different backgrounds.

Find out more, including Niall Dickson's statement.

The PLAB test is changing from September 2016

The GMC assessment for international* medical graduates seeking to work in the UK is becoming more rigorous and more reflective of real-life practice. The new version of the Professional and Linguistic Assessments Board (PLAB) test will start from September 2016.

What are the key changes?

  • New questions and practical scenarios: these will have a stronger focus on the professional values and behaviours expected of doctors working in the UK.
  • Giving all candidates more feedback on their performance in each section of the test: this will help them address any knowledge gaps in preparation for work.
  • A revised practical assessment, including more and longer scenarios: these will reflect how doctors apply their knowledge and skills in practice – for example, candidates will carry out a practical procedure in a mock consultation setting, rather than demonstrating the procedure alone. Along with a new way of setting the pass mark, this will enhance the accuracy of the test.
  • The exam regulations will change: from September 2017 there will be a limit on the number of times the PLAB test can be taken. Successful candidates must have their application for registration with a licence to practise approved within two years of passing the test.

To pass the assessment, candidates must reach the level we expect of doctors entering their second year of the Foundation Programme. We continue to offer the Welcome to UK Practice programme to doctors who have passed the assessment.

How are you telling candidates and key groups about this?

We’ve been communicating the changes in a number of ways, since the start of 2016. Recent examples include:

  • Information on our PLAB website pages, including frequently asked questions from candidates. This has been one of the most popular documents across our website
  • A short video to highlight key changes, which has been shared on social media
  • A session with organisations representing international medical graduates, at our clinical assessment centre
  • A blog answering common questions about the changes, from our Head of Registration, Enquiries and Testing, Richard Hankins.

We’d welcome your support in sharing these updates with key interest groups and doctors in your network.

Why are you making these changes?

The PLAB test is the main route for international* medical graduates who want to work in the UK, so it’s essential that the test continues to be robust and reliable. The changes follow an independent review of the PLAB test.

We value the expertise that international medical graduates bring to this country and it’s important that these doctors can demonstrate that they meet our standards.

*Doctors who graduated from medical schools in the European Economic Area or Switzerland do not currently need to take the test.

How can the medical register be more relevant and useful?

We’ve recently launched a public consultation to ask for views on ways to improve the medical register (also known as the List of Registered Medical Practitioners – or LRMP). This follows independent research published last year, which found that the GMC’s medical register offers less information than registers in some other countries. It also suggested that people would like to see it include more information about doctors – though there were mixed views about what this should be.

Despite changes to the way medicine is delivered, the medical register does not provide much more information than the version that was first introduced as a hardback book in 1859. In fact, in many cases, it gives an incomplete picture of a doctor’s career.

What sort of changes are the GMC suggesting?

Some of the ideas and issues the GMC is asking for views on include:

  • changing the format of the medical register and making it easier to use
  • giving doctors the option to add extra information, such as career history, their scope of practice, any competing professional interests and their photograph
  • how any additional data could be validated to make sure the medical register remains a trusted source of information
  • how the GMC can meet the need for greater transparency and keep pace with public expectations, while being mindful of the privacy and safety of individual doctors.

Give your views

The consultation closes on Friday 7 October 2016. Find out more and take part.

Reducing the impact on doctors when we receive complaints about them

We are making several changes to our fitness to practise process to deal with complaints as fast as we can, avoid unnecessary investigations, and reduce the stress for all those involved. Anna Rowland, our Assistant Director of Policy, Business Transformation and Safeguarding, discussed these with our BME doctors forum in June.

Reducing stress

Professor Louis Appleby, from the Centre for Mental Health Safety at the University of Medicine, has worked with us to identify how to put mental health safety at the heart of our fitness to practise process. Together we have developed proposals to minimise the impact and stress on doctors – particularly those with health concerns.

We are now working on delivering these proposals during 2016–17 - some will be implemented swiftly and others will require more significant changes to our processes.

Fair for doctors

Last year, we published Sir Anthony Hooper’s independent review (pdf) of how we handle cases about doctors who raise concerns in the public interest. It recommended that we should better understand the background when an employer refers a doctor to us, as some doctors were concerned that employers can retaliate against doctors who raise concerns about patient safety by making an allegation about their fitness to practise.

To provide a safeguard for doctors, we are piloting a new process from this month. Healthcare organisations referring a doctor to the GMC should provide all essential information* via a new form, including information about whether the doctor has ever raised patient safety or system concerns, and making a declaration that the referral is fair and accurate. Where a doctor has raised safety concerns, we will gather more information before deciding if we need to open and investigate.

*the overall responsibility for the content of the form remains with the Responsible Officer.

Cathy James, Chief Executive of Public Concern at Work, talks more about how the changes should reduce the risk of disadvantaging doctors for having appropriately raised patient safety concerns locally.

Find out more about our work to address the recommendations in Sir Anthony Hooper’s review.

Faster and more focused

Since July, complaints involving a one-off instance of poor clinical care will be dealt with through a new pilot process. From our experience, we need to take action in only a small minority of these types of cases. By gathering more information at an earlier stage, we will be able to make a much quicker assessment of the seriousness of the incident, whether there are other concerns about the doctor, how the doctor responded to the incident and if they have accepted their error, helping us to avoid unnecessary investigations.

GMC training surveys data published for local action

The General Medical Council (GMC) has published the latest results of its annual surveys into medical education and training across the UK.

The national training survey (NTS) sought views from around 55,000 doctors undergoing postgraduate training. In addition around 44,000 trainers – senior doctors responsible for developing the next generation of consultants and GPs – were also surveyed for their views from the education frontline.

Among issues raised by doctors were the pressures of dealing with high workloads, and the fact that there were not always enough experienced staff to ensure patients received the treatment they needed.

Read more for further details here.

Detailed information about specialist registers published

The GMC's Specialist Application’s Team has recently published its third annual report. This covers all applications for entry to the Specialist and GP registers made in 2015, via both the CCT and CESR routes.

It includes details of success rates by specialty, as well as information about where applicants gained their primary qualification, and where they worked prior to applying for CESR. This year, the report includes tips from a range of successful applicants.

To read the tips and more, click here.