The GMC is reviewing the way it tests doctors from overseas but not EU countries who want to register in the UK.
The regulator will review the Professional and Linguistic Assessments Board (PLAB) test, which doctors qualified outside of the UK and EU currently have to undergo before they join the UK medical register.
Read more at GP.
The GMC is to review its controversial policy of offering staff private medical insurance this year, as the regulator seeks ‘efficiency gains’ that would allow it to offer further cuts to GP fees in 2013 and 2014.
The GMC’s resources committee is to look specifically at the GMC’s policy of offering full-time staff private medical insurance in 2012, after an outcry from GPs over the £280,000 spent on the staff perk.
Alongside routine reviews of staff pay and other benefits such as maternity cover, the GMC said it is looking for ‘further efficiency gains’ that would allow it to make further reductions in its fees.
Read more at Pulse.
The GMC is consulting on new arrangements for the recognition and approval of medical trainers.
The proposals are designed to improve the quality and consistency of medical training across the UK, the GMC says, by clarifying the roles and responsibilities of those who deliver training as well as the parts played by the regulator, postgraduate deaneries and medical schools.
Local education providers such as NHS trusts would have to use a new system for showing how they identify, train and appraise trainers.
Postgraduate deaneries and medical schools would be responsible for holding the names of all recognised non-GP trainers and showing the GMC what local arrangements are in place to maintain standards.
This would include named educational supervisors, named clinical supervisors, lead coordinators of undergraduate training and making doctors responsible for overseeing students’ educational progress.
The GMC will use its existing standards structured into seven areas. Local education providers such as hospitals and general practices would use the seven areas to show how they develop trainers.
The new system is designed to help raise the profile of trainers, ensuring they are supported and subject to effective and fair appraisal. The standards trainers will be expected to meet are already set out in Tomorrow’s Doctors (2009) for undergraduate training and The Trainee Doctor (2011) for postgraduate training.
It follows the success of approving GP trainers - GP trainees have the highest satisfaction scores (87%) of all medical trainees (74.6 to 83.7%), according to GMC figures.
Niall Dickson, the chief executive of the GMC, said: “Doctors who train other doctors are absolutely critical to developing and improving standards of care - they help to shape the next generation of doctors and are important role models for medical students and trainee doctors. We want to give this formal recognition by identifying and recognising the contribution they make to improving standards and protecting patients.
“We would need new legal powers to approve non-GP trainers on an official basis, until then, we believe the proposed recognition system will ensure that more formal arrangements are in place.”
Respond to the consultation.
The GMC spends approximately £280,000 a year on providing private medical insurance to almost 500 of its staff.
Information released by the GMC this week shows the regulator, which receives the vast majority of its funding from doctors’ fees, has offered its employees private medical insurance since 1997, and now provides it to 480 of its 640 permanent staff across the UK, at an average cost of £583 per employee.
Read more at Pulse.
The GMC is cutting the annual fee paid by doctors by £30 - the first cut since its introduction in 1970.
The fee reduction is part of a package of measures agreed by the GMC’s council earlier today. Along with the Annual Retention Fee being reduced from £420 to £390 for doctors holding registration with a licence to practise, provisionally-registered doctors will pay £95 a year, down from £100 in 2011 and £145 in 2010.
Those doctors holding registration without a licence to practise will be charged £140 down from £145 per year. All these reductions are effective from 1 April 2012.
Furthermore, any doctor whose total gross annual world-wide income from all sources is less than £30,000 will qualify for a 50% reduction in their annual retention fees due after 1 April 2012. The current threshold is £26,000.
Niall Dickson, the chief executive of the GMC, said: “We have a responsibility to provide value for money and, as far as we can, to control our costs. Last year we were able to freeze the annual fee paid by all doctors and cut the fee paid by newly qualified doctors. As a result of further efficiencies achieved across the organisation, we are able this year to pass on savings to all doctors.”
The GMC attributed the fee reductions to improving operational efficiency, which has led to savings of over £8 million in 2011. Examples of savings include expansion of the in-house legal team, reducing our requirement for external lawyers; reducing the number of panellists sitting on panels from five to three; and greater use of e-communications rather than paper.
In addition to the annual fee reductions, the cost of a Certificate of Completion of Training (CCT) will now be £390, down from £500 in 2010. And the cost of a Certificate of Eligibility for Specialist Registration or GP Registration (CESR or CEGPR) will be £1500, down from £1600.
Dickson added: “We are making these reductions at the same time as facing increasing demand on our services and delivering major initiatives that will benefit doctors and patients, including the introduction of revalidation, the Medical Practitioners Tribunal Service, and the roll-out of employer and regional liaison teams.”
The 245,000 doctors on the register will save an estimated combined total of over £6.5 million, the GMC estimated.
Read a blog on the issue.
GMC chief executive Niall Dickson is to apologise after more than 200 doctors were mistakenly sent letters from the regulator informing them they were subject to disciplinary investigation in 2010.
The blunder occurred when the GMC wrote this week to 2,500 doctors who were investigated by the GMC last year, asking them to offer feedback on the process.
Due to what the GMC described as a ‘clerical error’, the letter was accidentally sent to 209 doctors who had not been investigated.
Read more at Pulse.
A major consultation on Good Medical Practice - the core guidance for doctors - has been launched by the GMC.
The draft guidance suggests that doctors should have greater influence over, and responsibility for, all areas of a patient’s care. And when they are the patient’s lead clinician, they are also responsible for the continuity of care.
Doctors are asked to take a lead role in making sure a patient’s safety, comfort and dignity are always maintained throughout their care.
The guidance also calls on doctors to take prompt action to deal with problems with basic care, particularly for patients who are unable to drink, feed or clean themselves. And they must also offer help if they think a child or vulnerable adult’s rights might have been abused or denied.
Niall Dickson, chief executive of the GMC, said: “This guidance makes clear that a doctor’s responsibilities do not begin and end with providing clinical treatment. They have a vital role to play to improve standards of basic care. When this goes wrong, as it did at Mid Staffordshire NHS Foundation Trust and elsewhere, patients can face serious harm.
“Good Medical Practice is about more than setting a minimum bar below which standards of practice must not fall, or against which disciplinary action is taken. It must be a means of promoting excellent care and fostering the leadership and commitment that lie at the heart of medical professionalism.”
The new draft of Good Medical Practice includes some new advice to doctors covering their behaviour online and the use of social networking sites; taking into account a patient’s broader history - including spiritual, religious, psychological, social and cultural factors; and, encouraging patients to stay in or return to employment or other purposeful activity.
For usability, the revised edition of Good Medical Practice is considerably shorter than the current guidance, and for the first time the GMC will produce a patient version - to make clear what patients should expect from their doctor.
The consultation will run until 10 February 2012, and the final version will launched in the Autumn.
Consult on the guidance.
Nearly a quarter of trainee doctors report that on a regular basis they are forced to cope with challenges for which they feel inadequately prepared, a survey reveals.
The annual survey of junior doctors, by the GMC, which provides a comprehensive picture of the views and experiences of 46,000 trainees across the UK, suggests there’s a need for improved supervision and feedback by consultants.
Twenty eight per cent of trainees report that they rarely or never receive feedback from senior colleagues.
Respondents continue to raise concerns about the Working Time Regulations, which were introduced in the summer of 2009. Almost two-thirds say they regularly work more than the limit of 48 hours a week, while nearly a third claim it’s taking them longer to meet the competences they need in their training.
The GMC is calling on senior doctors, managers and medical educators to help tackle these concerns as a priority. It is consulting on proposals for the approval and recognition of trainers to help strengthen arrangements for support and supervision.
The GMC does point out, however, that most training is meeting its standards. Overall satisfaction with training among juniors is continuing to increase, with 79% of doctors rating their training as excellent.
Niall Dickson, chief executive of the GMC, said: “Overall, trainees continue to be very satisfied with their training, but the concerns they have raised need to be urgently addressed by all those with responsibility for supporting doctors. In these difficult financial times for the health service throughout the UK, it is vital the education and training are protected and that these young doctors are given the support they need not only to provide good care now but to develop into great leaders for the future.”
The research reveals that a quarter of newly qualified doctors did not feel ready to take the next step in their careers.
Dickson added: “The trainee survey is a vital part of our work to support improvements in medical training and to make sure it meets the standards we require. Together with the postgraduate deans we will use these results to support inspections and to provide feedback to those responsible for providing education.”
Dr Tom Dolphin, chair of the BMA’s Junior Doctor Committee, said: “The GMC’s survey reveals some serious concerns about the level of supervision some doctors receive. In the current economic environment training is a soft target. We are concerned that, in an effort to save money, the time consultants can dedicate to training is being squeezed. We must ensure that trainers are given the time to train and supervise.
“We cannot afford to be complacent about the quality of training and supervision as it will have direct impact on the quality of healthcare that can be delivered to patients in the future.”
Ben Dean, an orthopaedic registrar, who carried out a survey on training for Remedy UK earlier this year, commented: “The issue with supervision is very complex. The supervision of training is something that has been affected by reduced hours and the consequent shift systems, hence reduced continuity of both patient care and training.
“Certainly increasing hours would help as it would improve supervisor training continuity and increase the experience gained by trainees. But people also need to regulate training properly.”
Revalidation is a good idea - there I’ve said it.
Set to be introduced late next year to prove doctors’ fitness to practise, revalidation will be based on a stronger approach to appraisal.
There’s no doubt it will soak up more precious time, but the appraisal process holds opportunities that justify it. The opportunities for self-reflection are few and far between in the NHS, and used properly the process should for most be an enabling tool that allows doctors to set useful goals and measure their progress.
It won’t catch another Shipman, but then according to the GMC it was never intended to. The party line is that it’s always been about preventing another Bristol rather than snaring serial killers.
While I’m not the biggest fan of the GMC, if revalidation enables employers to address performance issues earlier and locally without having to resort to the big stick then that’s got to be a good thing.
So, for me the principles behind it are sound, but there are still worrying problems facing its implementation. Despite revalidation being in train for over a decade, we’re still not ready for it.
This is partly due to repeated changes to the revalidation proposals in the wake of the Shipman Inquiry. But it’s also because employers and the GMC have traditionally been reactive organisations - prepared to clean up a mess, but unable to prevent them in the first place. The current plans for revalidation are proactive, but the system they’re being implemented into isn’t and it’s not up to speed yet.
Large chunks of the NHS clearly aren’t ready for a November 2012 launch. The proper application of appraisal is still patchy both geographically and among different roles, with SAS doctors having depressingly low levels of participation.
And now we have question marks being raised over the validity of multi-source feedback - from both colleagues and patients - as an accurate marker of performance. This follows evidence that many doctors will struggle to access data that supports their claims of competence.
This is not confidence inspiring, particularly when the latest stats show a sharp rise in the GMC striking doctors off the register.
The other elephant in the room is the capability of doctors in a hard pressed NHS to keep up-to-date to the satisfaction of revalidation. As the funds dry up in the NHS, training budgets and study leave are disappearing.
Either the accumulation of CPD points will become trivialised because doctors will not get the opportunity to access meaningful external training, or doctors will have to increasingly pay for training themselves and attend in their own time. These are hardly the hallmarks of high performing organisations, and the GMC’s current consultation on CPD is unlikely to resolve the issue.
The incredible uncertainty surrounding the management of postgraduate education with the passage of the Health Bill doesn’t help.
The extensive piloting of revalidation does give the GMC an opportunity for effective implementation. And it’s definitely time to get the job done. But revalidation has to be more than a process, a tick box exercise. It’s systems have to bear scrutiny and be universally accepted. Revalidation has to be embraced by both employers and doctors for the benefits to be realised. And from where I’m sat, I’ve seen scant evidence that the GMC is winning the profession’s hearts and minds.
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Official assessments of doctors’ professionalism demonstrate systematic bias, a study reveals.
The researchers, from the Peninsula College of Medicine and Dentistry, in Exeter, warn that assessment involving feedback from patients and colleagues should be considered carefully before being accepted due to the tendency for some doctors to receive lower scores than others, and the tendency of some groups of patient or colleague assessors to provide lower scores.
The research investigated whether there were any potential patient, colleague and doctor-related sources of bias evident in the assessment of doctors’ professionalism.
It is particularly relevant because the GMC is set to introduce a new system of revalidation for all doctors next year and it is likely to involve the use of multi-source feedback from patients, peers and supervisors as part of the evidence used to judge a clinician’s performance. The results will contribute to a decision on whether doctors are fit to continue practising.
The researchers used data from two questionnaires completed by patients and colleagues. A group of 1,065 doctors from 11 different settings, including mostly NHS sites and one independent sector organisation, took part in the study which has been published on bmj.com.
They were asked to nominate up to 20 medical and non-medically trained colleagues to take part in an online secure survey about their professionalism, as well as passing on a post-consultation questionnaire to 45 patients each. Collectively, the doctors returned completed questionnaires from 17,031 colleagues and 30,333 patients.
Analysis of the results that allowed for characteristics of the doctor and the patient to be taken into account, showed that doctors were less likely to receive favourable patient feedback if their primary medical degree was from any non-European country.
Several other factors also tended to mean doctors got less positive feedback from patients, such as that they practised as a psychiatrist, the responding patient was not white, and the responding patient reported that they were not seeing their “usual doctor”.
From colleagues, there was likely to be less positive feedback if the doctor in question had received their degree from any country other than the UK or South Asia. Other factors that predicted a less favourable review from colleagues included that the doctor was working in a locum capacity, the doctor was working as a GP or psychiatrist, or the colleague did not have daily or weekly professional contact with the doctor.
The researchers say they have identified “systematic bias” in the assessment of doctors’ professionalism.
They conclude: “Systematic bias may exist in the assessment of doctors’ professionalism arising from the characteristics of the assessors giving feedback, and from the personal characteristics of the doctor being assessed. In the absence of a standardised measure of professionalism, doctor’s assessment scores from multisource feedback should be interpreted carefully, and, at least initially, be used primarily to help inform doctor’s professional development.”
The GMC, which commissioned the research, said it wanted to understand more about how feedback can play a part in improving doctors’ practice.
Niall Dickson, the Chief Executive of the General Medical Council, suggested that feedback still had an important role to play in revalidation despite the findings.
He said: “This study found that feedback doctors receive may vary depending on a variety of factors, such as the specialty they work in or where they qualified. It does mean the results have to be treated with care and when we publish the final version of our questionnaires later this year, we will also produce clear guidance on how to use them.
“Being aware and taking account of how patients and colleagues view your practice is important for every doctor but it is only one part of the supporting information that doctors will bring to their appraisals. It will be considered alongside all the other information about a doctor’s practice and is not something which you can ‘pass’ or ‘fail’. It assesses an individual doctor’s strengths and areas for development to help them improve their practice – it is not a way of comparing doctors with one another.”
Read more.
