Developing Risk Based Regulation

1
Developing Risk Based Regulation
2
Developing risk based regulation

• GMC
• Principles of good regulation
• Four layer model of regulation
• Revalidation
• Meta risks
• Conclusions

3
The report of my death was an exaggeration
Mark Twain
4
Purpose

• 1858
• Whereas it is expedient that Persons requiring
  Medical Aid should be enabled to distinguish
  qualified from unqualified Practitioners
• Preamble to Medical Act 1858
• 2006
• To protect, promote and maintain the health and
  safety of the public by ensuring proper standards
  in the practice of medicine
• Medical Act 1983 (as amended)

5
Some facts about the GMC

• 240,000 registered doctors
• 15,000 new doctors pa, about 60 from outside UK
• 400 staff in two main locations London and
  Manchester
• Offices in Northern Ireland, Scotland and Wales
• 1,000 associates including 250 panellists

6
Modern medical regulation

• Independent, accountable regulation must
• Put patient safety first
• Support good medical practice
• Promote fairness and equality
• and value diversity
• Respect the principles of good regulation
• proportionality,accountability, consistency,
• transparency and targeting

7
Risk based regulation

• If regulators operate effectively, and use the
  best evidence to programme their work,
  administrative burdens can be reduced while
  maintaining or even improving regulatory
  outcomes.
• Risk assessment is an essential means of
  directing regulatory resources where they can
  have the maximum impact on outcomes.
• Regulators should use the resources released
  through risk-based assessment to provide
  improved advice, because better advice leads to
  better regulatory outcomes.
• Hampton Report, HM Treasury, March 2005

8
Four layer model

• Personal regulation.
• Team based regulation.
• Workplace regulation.
• National regulation.
• Plus
• International co-operation

9
Revalidation
Revalidation is a set of procedures operated by
the GMC to secure the evaluation of a medical
practitioner's fitness to practise as a condition
of continuing to hold a licence to practise
Adapted from the Medical Act 1983
10
Purpose of revalidation

• To create public confidence
• that all licensed doctors are
• up to date and fit to practise
• Sir Graeme Catto
• March 2005

11
Revalidation a risk based approach

• Initial collection of personal and practice
  information for each licensed doctor
• Screening tools such as questionnaires
• Use information to categorise into risk
  categories
• Accelerate initial revalidation for high risk
  groups, say over three years not five
• More intensive scrutiny where layers of
  regulation are missing or ineffective
• Identify trends
• Revise the algorithm

12
Lessons from Canada

• MEPP
• Those in need of performance enhancement or
  presenting greater risk of impairment include
• Graduated 35 years ago
• Specialists with 30 of practice outside their
  specialty
• Locums

13
Meta risks

• The language of risk
• Seen as light touch regulation by another name
• False antithesis
• Protecting patients
• Public and professional interpretation and
  perception

14
Confidence in regulation public
Confidence in way doctors are regulated - public
Fairly confident
53
Not very
confident
13
Not at all
confident
Very confident
Don't know
6
23
5
15
Risk based regulation public
Attitudes towards risk based regulation
Regulate in the
Focus on areas
same way
of risk
65
30
Dont know
None of these
4
1
16
Risk based regulation profession
Attitudes towards risk based regulation
Regulate in the
same way
Focus on areas
of risk
GP
HD
Neither
Don't know
0
10
20
30
40
50
60
17
There is no use trying, said Alice one can't
believe impossible things. I dare say you haven't
had much practice, said the Queen. When I was
your age, I always did it for half an hour a day.
Why, sometimes I've believed as many as six
impossible things before breakfast.
Lewis Carroll
18
Risk based regulation

• Proactive and preventative
• Evidence based
• Proportionate to the purpose
• Public and professional confidence and support
  through effective engagement

19
All regulation is for a purpose. Good regulation
is efficient in meeting its designated purpose.
And there is such a thing as good regulation. Bad
regulation is inefficient. And there is such a
thing as bad regulation. Efficient means cost
effective, that is, imposing no more cost on an
organisation than is necessary to do the job.
Thus, if the purpose of regulation is to bear
down hard on an activity then it may be seen as
burdensome by those affected, but it will be
efficient and good. Equally, regulation which is
unnecessarily intrusive will be inefficient and
bad if the purpose was to create a framework
which maximises freedom of operation. Sir Ian
Kennedy Learning from Bristol Are we?
20
One day Alice came to a fork in the road and saw
a Cheshire cat in a tree. Which road do I take?
she asked. Where do you want to go? was his
response. I don't know, Alice answered. Then,
said the cat, it doesn't matter.
Lewis Carroll
21
www.gmc-uk.org