What goes on in the House is reported by Kingsley Napley

The House of Commons Health Committee published its Fourth Report of Session on 3 December 2012.

By way of background, the Health Committee obtained evidence from representatives of the General Medical Council (GMC) and the newly formed Medical Practitioner Tribunal Service (MPTS) on 4 September 2012. The purpose of the evidence was to assist with the annual review of accountability hearings with the principle regulators in the health sector.

Those involved in the process from the GMC and MPTS were:

• Professor Sir Peter Rubin, Chair of Council
• Niall Dickson, Chief Executive
• Una Lane, Director, Continued Practice and Revalidation
• His Honour Judge David Pearl, Chair of the MPTS

The role and functions of the GMC

The Medical Act 1983 gives the GMC four main functions:

• Keeping up-to-date registers of qualified doctors
• Fostering good medical practice 
• Promoting high standards of medical education and training
• Dealing firmly and fairly with doctors whose fitness to practise is in doubt.

The GMC cites its purpose as ‘….to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine’.

The Health Committee’s purpose through its annual accountability hearings is to assess how effective the GMC is in performing each of its aforementioned roles. The three areas of interest at present are:

• The arrangements for revalidation of doctors
• The professional leadership activity undertaken by the GMC in the last year; and
• The regulation activity undertaken by the GMC (which includes the establishment of the MPTS).

Revalidation

From 3 December 2012 all doctors registered with the GMC whom are licensed to practise medicine will be required to provide evidence of their ongoing fitness to practise. Prior to this arrangement, no such check of a doctor’s practise existed.

The aim revalidation is to bolster public confidence in the profession, and to provide further evidence to the public that doctors registered with the GMC and licensed to practise have up to date medical knowledge and are fit to practise medicine.

In cases where a doctor’s practise gives rise for concern, the GMC will have a role in remediation through a number of processes.

Language competence of licensed doctors

In 2011, the Health Committee expressed its dissatisfaction to the legislative bar on routine language competence testing by the GMC of doctors from the European Economic Area (EEA) and Switzerland, who wish to practise in the UK.

Niall Dickson provide an update to the Health Committee, and stated that the Government proposes to bring forward for enactment by the end of 2013 an order under section 60 of the Medical Act 1983 which removes the aforementioned prohibition.

Professional leadership

In its 2011 report, the Health Committee whilst acknowledging strides the GMC had made in this area, also considered that its leadership function ‘within the medical profession and the wider health community’ was not sufficiently developed. The areas in need of the most development were cited as fitness to practise, revalidation, education and training and voluntary erasure.

In response, the GMC took steps to strengthen its leadership function in a number of ways, notably by sending guidance on Raising and acting on concerns about patient safety to every registered doctor in the UK. The guidance reinforced to doctors that they must act on every occasion where patient safety is at risk. In order to assist in this process, the GMC plans to launch a confidential helpline for doctors and others to raise concerns about patient safety, which they do not feel able to raise at a local level.

Professional regulation

There has been a steady increase in the concerns reported about doctors to the GMC. The GMC conducted its own research to ascertain some of the factors driving the increase. In its Annual Report for 2011 the GMC stated the increase was due to “changing attitudes on the part of doctors and the public towards raising concerns, and improved clinical governance”.

Fitness to practise investigations

The GMC plans to revise and speed up its fitness to practise procedures through a number of procedures, which include allowing doctors in cases which are not disputed to accept sanctions without a full hearing and face to face meetings with complainants to explain the process.

Completion of fitness to practise cases

The Council for Regulatory Healthcare Excellence (CHRE) set the GMC a target to complete 90% of its fitness to practise cases within 15 months of the date of enquiry. This target was met by the GMC in 2010 and 2011.

MPTS

The MPTS came into being in June 2012 as an independent service of the GMC’s complaint handling, investigation and case presentation functions. The establishment of the MPTS fulfilled an undertaking given by the GMC to ensure a clear division between its role as investigator and presenter of cases as well as the adjudication on those cases.

The Health Committee made recommendations in a number of areas, but the key areas are as follows:

• The process of informing patients of cases where a doctor is required to undertake remediation as part of the revalidation process is not sufficiently clear. These procedures require clarification; 

• The GMC must take action with regard to the language testing of doctors whose primary qualification is from outside of the EEA and Switzerland;

• Seeking feedback from patients as part of the revalidation of doctors every five years is not sufficient and therefore the GMC should consider a more challenging target; and

• The GMC is invited to report in 2013 on the proportion of its fitness to practise cases concluded within 12 months in 2012.