Good doctors, safer patients:

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Good doctors, safer patients GMC/ippr Seminar
workshop 5 October 2006
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Consultation

• Two reports
• 11 themes
• Three questions
• 44 recommendations

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Common themes

• Common themes running through the two reports
• Changes to governance and accountability
• Importance of defined operationalised standards
  against which to regulate
• Appropriate standard of proof
• Spectrum of revalidation across all healthcare
  professionals
• Devolution of some regulatory activity to a local
  level

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Other themes

• Other important themes within one report or
  another
• Number of regulators for non-medical professions
• Requirement to record post-registration
  qualifications
• Role of regulation for student healthcare
  professionals
• Need for standardised pre-employment English
  language testing
• Extending regulation to include healthcare
  support workers and new roles
• Importance, or otherwise, of a lay majority on
  governing bodies of the various regulators

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Questions

• Three overarching questions
• Do stakeholders support the principles upon which
  Good doctors, safer patients is based?
• Do stakeholders support the approach advocated in
  the two reports?
• What are the priorities for stakeholders in terms
  of implementation?
• In addition, stakeholders are asked to address
  the 11 themes or to comment on the merits of
  specific recommendations (within each theme).

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• We believe in a system of medical regulation
  that fosters the delivery of high quality care
  for patients, is based on clear standards that
  are fair, transparent and open, is properly
  coordinated across all four UK countries, is
  independent and accountable, and, above all, can
  command the support and confidence of patients,
  the public and doctors.
• Sir Graeme Catto, GMC Today, August 2006.

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• the General Medical Council is regarded as one
  of the better regulatory bodies internationally
  in the United Kingdom the procedures developed by
  the General Medical Council are often seen as
  innovative and forward looking.
• Good doctors, safer patients, Chapter 10 para 9.

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• We want to put an end to the idea that the
  General Medical Council is a representative body
  for doctors. It is not. Its primary role must be
  to protect patients.
• Secretary of State for Health January 2005

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• at no point in its long history has the GMC
  been able to command the respect of all its
  constituencies simultaneously.
• Good doctors, safer patients Chapter 10,
  paragraph 12.

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• It is not good for public confidence in medical
  regulation to see the main regulatory body so
  often mired in controversy.
• Good doctors, safer patients, Chapter 10
  paragraph 11.

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Aim

• To secure a regulatory system that
• Is independent
• Is fair
• Is efficient and effective
• Enhances patient safety
• Fosters the professionalism of doctors
• Commands the confidence and support of the main
  constituencies

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Likely response

• Functions and constitution
• Education
• Revalidation
• Clear way ahead
• Further points
• Supported by active communications and engagement
  between now and the end of the consultation

13
Functions and constitution

• Promote regulatory coherence and resist
  fragmentation
• Balanced Council that is reflective of the main
  constituencies doctors patients and the
  public NHS and other healthcare providers
  medical schools and Royal Colleges
• Council membership based on public interest and
  competence
• More board like
• Routes to Council membership must command
  confidence

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Education

• Three stages undergraduate, postgraduate and
  CPD
• Regulator must control entry to the register
• Therefore, undergraduate and PLAB to remain
  with GMC
• If reform required, then three stages with the
  GMC
• One possibility is a three board model
• Composition of Education Committee and boards
  tailored to roles and constituencies

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Revalidation

• Recertification, if confirmed, will take time to
  develop
• Meanwhile, we can make a start with re-licensing
• The NHS and others must make that possible by
  putting necessary elements in place
• National machinery in association with the
  departments of health to ensure delivery

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Clear way ahead

• Register as a national resource
• Extended range of information on register
• Accountability to Parliament
• Clear standards for specialist practice
• Strengthening of appraisal
• Importance of Good Medical Practice as foundation
  for operational guidance

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Further points

• Adjudication not yet clear how separate
  adjudication would work
• Standard of proof
• Centrally recorded information - must be
  attributable, verifiable and disclosable
• Strengthening of local procedures and workplace
  regulation and better fit with national
  regulation
• Accommodate healthcare systems in all four UK
  countries

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Whats the attraction?

• For Ministers? An acceptable, even desirable, way
  forward
• For patients and the public? A system with
  patient safety at its heart and clear,
  accountable, lines of responsibility
• For the profession? A system, which is fair, that
  commands public and political confidence
• For the GMC? An end to the Groundhog Day
  experience and to the associated opportunity costs

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Question

• What will it take to command the confidence and
  support of all the main constituencies and enable
  the enthusiastic support of politicians?

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Good doctors, safer patients