Posts Tagged ‘GMC’

Key GMC reforms to be scrapped, DoH reveals

Healthcare Republic - 11th August 2010 5:10 pm

Key GMC reforms prompted by the Shipman Inquiry are to be scrapped to save money, the DoH has revealed.

The DoH wants to cut costs by reversing plans set out under the previous administration to transfer part of the GMC’s functions to the Office of the Health Professions Adjudicator.

Under the orginal proposals, the GMC would have retained its role in investigating and prosecuting fitness to practise cases, but the OHPA would have the final say on any sanctions against a doctor.

‘Fundamental’ changes at the GMC have convinced the DoH that plans to shift this responsibility are no longer necessary. The govenment’s revisedproposals are set out in a consultation published this week, which runs until 11 October.

Read more at Healthcare Republic.

Are we seeing the rise of the supra-regulator?

By Mike Broad - 3rd August 2010 3:32 pm

There’s a quiet counter-revolution going on in medical regulation.

Anyone remember the Office of the Health Professions Adjudicator? What do you mean “no”? The OHPA was set to put the final nail in the self-regulation coffin. As an independent board, it was supposed to take over the adjudication process from the GMC next April.

The GMC would still investigate the fitness to practise of doctors, but the OHPA would pass judgement on the evidence. Well, not anymore. OHPA has been dispatched by the new government (and it’s not happy). The GMC will continue to pass judgement but has to learn how to do it more effectively apparently.

It’s not the only quango to suffer under the new government. Anyone remember the Council for Healthcare Regulatory Excellence? Oh come on, don’t you bother reading all this stuff we produce. The CHRE oversees the professional regulators and can review any decisions it doesn’t like: this effectively introduced double jeopardy for some unfortunate doctors.

Anyway, it has to become a self-funding body in the shake up and the regulators will have to foot the bill.

What does this tell us? It tells us that the drivers around professional regulation have changed with the new government.

Firstly, the paranoia surrounding Shipman, and the subsequent inquiry, is starting to fade.

Secondly, the coalition government appears far less antagonistic about doctors than the one it replaced. It’s early days, but doctors appear to be part of the solution rather than the problem. Health ministers no longer appear to be trying to put doctors ‘in their place’, making them accountable shift workers who operate under a draconian regulatory system.

And, thirdly, the government wants cheaper regulation.

It’s interesting to note what’s happened to the General Social Care Council (the GMC for social workers). The GSCC is to be closed with its responsibilities falling to the Health Professions Council. The regulator was moving to a self-funding model, but the government decided this could be done more effectively under the HPC. Social worker’s annual fees are still set to double.

I guess the GMC must already know it has to be careful. The government sent it a clear message when it delayed revalidation for another year. It wants to support safe practise, but not at any price.

The GMC is due to spend £85.2m in 2010. Fortunately for it, doctors largely foot the bill. I’d still suggest it’s going to have to spend that money wisely otherwise we could see the rise of the ’supra-professional regulator’ as we have seen rise of the supra-inspection bodies.

GMC to investigate the length of hearings

Healthcare Republic - 2nd August 2010 9:05 am

A GMC working group is to investigate a rise in the duration of fitness-to-practise hearings and offer advice on how the process could be improved.

The move follows warnings from medico-legal experts that lengthier hearings are causing doctors greater financial and psychological stress.

Dr Michael Devlin, head of medical advisory services at the Medical Defence Union, said there was ‘no doubt’ cases had become longer and more complex in the past decade.

The number of heads of charge - specific claims made against a doctor - proposed by the GMC in an average case had risen sharply, he said.

‘In the past, 10 to 15 heads of charge might have been the average. [Now] it is not unusual to have in excess of 50 heads of charge,’ Dr Devlin said.

Read more in Healthcare Republic.

Looking forward to not having to pay the hangman

By Bob Bury - 19th July 2010 6:24 pm

A couple of weeks ago I was reporting my incredulity at the fact that the GMC had apparently got something right. Twice. But now normal service has been resumed, and just when I thought that nothing they could do could make me more dissatisfied with them than I already am, along comes their judgement in the case of Dr Jerome Ikwueke, the GP involved in the Baby P case.

They found that there were ‘serious failings‘ in his handling of the case, but then, he wasn’t alone in that. However, the fitness to practise panel chairman Dr Judith Worthington, said: “You don’t pose a risk of repeating this behaviour and there’s no evidence of deep-seated attitudinal or personality problems.” She also admitted that the GP had taken the appropriate remedial measures personally, and had changed procedures at his practice to minimise the risk of any similar failing in the future. She said, and who could disagree with her, that striking him off the register would not be “proportionate or in the public interest”. So what did they do? They suspended him (i.e. struck him off) for a year.

Which will achieve exactly what? It will deprive his patients of a GP they clearly have a lot of respect for (the panel received numerous testimonials to the quality of his care for them), and he will have a year away from his profession, with no income and no opportunity to put into practice the retraining he has already undertaken. I think we all know why the GMC took this craven action, but unusually, they actually came out and admitted it for once. They suspended the GP, said Dr Worthington, “in order to maintain public confidence in the profession and to declare and uphold proper standards of conduct and behaviour”.

In other words, they did it to appease the Daily Mail readers, whose spittle-flecked twin sets and florid, broken-veined complexions bear testimony to their incoherent and all-consuming need for a culprit. Any culprit. The GMC clearly accept that nothing beneficial will be achieved by Dr Ikwueke’s suspension, but it would rather pander to the general public’s lust for vengeance than make a reasoned case for allowing him to continue practising.

I have to laugh when people say it’s time that the medical profession lost the right to self-regulation. If this is self-regulation, I’d far rather take my chances with a lay judicial body, funded from public money, in the event that I was accused of malpractice. At least then I wouldn’t, in effect, be paying the hangman myself. The GMC should stick to their job of maintaining the register, and I reckon 20 quid a year should be plenty for that.

GMC commits to simplifying revalidation

By Mike Broad - 15th July 2010 11:30 am

The GMC is to simplify and streamline its revalidation proposals following a consultation process.

During the consultation, which ran from March to June, the GMC received over 940 written responses from doctors, employers and patients.

It said a key theme was the importance of ensuring that revalidation is as streamlined, simple and proportionate as possible. Many of those who responded emphasised that revalidation must contribute to the quality of care yet be cost effective.

In June, the new health secretary told the GMC to delay the roll out of revalidation for another year until the pilot studies have been properly assessed.

Niall Dickson, chief executive of the GMC, said: “We are committed to reviewing our proposals in the light of the responses and feedback from some of the early pilots.

“We share the view of many of those who took part in our consultation that revalidation must add value for both patients and doctors and must be workable in the pressured and busy environments in which most doctors work.”

In May, the BMA told the GMC consultation that it had no confidence in revalidation.

The BMA’s key concerns include uncertainties over cost; the complexity of the royal colleges’ specialist standards to re-certify doctors; and, the role of the royal colleges in sitting on revalidation panels and effectively regulating their members.

Commenting on the streamlining, a BMA spokesperson said: “The BMA is pleased the GMC has acknowledged that simplification of the revalidation proposals are required. This was a recurring theme throughout the BMA’s response.

“In particular, the GMC need to consider the specialist standards to ensure the process is fair, proportionate and workable. Given the extension to the pilots, there is now the opportunity to refine and develop a simplified system which can confirm a doctor’s fitness to practise whilst at the same time ensuring that time is not taken away from patient care.”

Read a blog on revalidation.

GMC to be given powers to test language skills

Healthcare Republic - 26th May 2010 11:20 am

The GMC believes it is “highly likely” to be handed powers to test the English language ability of doctors from the European Economic Area (EEA) who want to work in the UK.

Professor Peter Rubin, chairman of the GMC, said it is now clear that it is UK legislation, not European legislation, that will need to change to allow the GMC to take responsibility for language testing.

“Over the past three or four months we have taken a clear and public stand about the issue of language testing,” he said.

Legal advice sought by the GMC revealed “that it is a consequence of UK legislation not the European legislation that we are currently unable to test the language skills of EEA medical graduates”, Professor Rubin said.

As a result, it is “highly likely” that the GMC will be able to test the language skills in the future, he added.

Professor Rubin also said the GMC was pleased that the issue of language testing of EEA doctors was included in the new government’s coalition.

Read more at Healthcare Republic.

More face GMC fitness to practise panels

By Mike Broad - 24th May 2010 10:17 pm

A third more doctors faced GMC fitness to practise panel hearings in 2009 than the previous year.

The GMC’s annual report on the number of complaints received about doctors reveals that 270 panel hearings took place in 2009 compared with 204 in 2008.

This led to 85 doctors being erased from the medical register in 2009. Sixty eight were struck off at a panel hearing and 15 at review hearings, compared to 42 at panel hearings in 2008.

The most common allegation resulting in erasure from the register in 2009 related to improper relationships with patients - 15 cases in total.

The most common hearing outcome was suspension, with 77 doctors being suspended. The largest proportion of doctors appearing before a panel were specialists at 45%, followed by GPs on 37%.

The GMC believes that the increase is due to more enquiries being made by NHS, police and other public authorities, which has risen significantly since 2006. Referrals from these groups are likely to be more serious and therefore more likely to progress through to a public hearing. Overall the number of enquiries rose by 11% last year.

Paul Philip, director of standards and fitness to practise, said: “We are seeing an increasing number of referrals to our fitness to practise procedures from employers and other public authorities like the police but the reasons for this are not entirely clear. What is clear is that although there has been an increase in the number of cases the overall numbers represent a very small proportion of the 230,000 registered doctors in the UK.”

Doctors, however, suggested the rise was due to the imminent introduction of revalidation and employers seeking to get their houses in order.

Over three quarters of all doctors who went before a fitness to practise panel in 2009 were found to be impaired. A lower proportion of UK-qualified doctors faced impairment at the hands of the GMC than those who qualified in either Europe or further afield.

Paediatrician Southall back on the medical register

BBC Health - 4th May 2010 12:43 pm

Paediatrician Dr David Southall is back on the medical register after winning an appeal over a long-running dispute with the GMC.

The Appeal Court’s decision means he is able to practise medicine again.

The fitness to practise panel took action to strike Southall off the register in 2007 after he accused a mother of drugging and murdering her 10-year-old son.

The judges found that the GMC had failed to give adequate reasons over claims that Dr Southall had made.

The case has now been sent the case back to the GMC, which will be required to consider it again.

It found that his actions had added to the distress of the mother - Mrs M - following the death of her son, who hanged himself in 1996.

Lord Justice Leveson, giving the latest court ruling, said: “I am far from convinced that the public interest is truly served by a rehearing of the limited factual allegation that was made in this case, turning on the precise language used 12 years ago.

“If there is to be a re-hearing, I do not accept that it would be right for it to be conducted before the same panel; fresh minds should be brought to the issue in this case.”

Read more at BBC Health.

Read the background to this story.

GMC to review exam ruling following uproar

By Francesca Robinson - 9:03 am

A review of the legality of exams taken outside approved training posts has been announced by the GMC following uproar from trainees concerned that their qualifications may no longer be valid.

Anxiety was sparked among trainees last month when the GMC published a note clarifying legislation which states that exams must be taken within an approved training post in order to count towards a CCT (certificate of completion of training).

This ruling affects doctors who passed exams when they were not on training programmes and those who took exams during periods of unapproved training or work experience overseas.

In a bid to calm nerves, the GMC says that it will not be reviewing any CCTs which may already have been erroneously awarded.

It has also clarified that trainees who are not affected are those who sit exams during the foundation programme, are undertaking research, on maternity leave or working overseas - providing they maintain their training status.

Doctors who fall foul of the new ruling can gain entry to the specialist register via one of the equivalence routes and most can do the CP (combined programme) which is more straightforward and lower in cost than a CESR (certificate of eligibility for specialist registration), says the GMC.

The regulator says it will now explore whether it is possible to amend the legislation to provide greater flexibility around the timing of exams. 

But in a letter to trainees GMC chair Professor Peter Rubin says the bottom line is that the integrity and educational coherence of approved training programmes must be maintained.

The GMC plans to meet with the royal colleges, the deaneries, the BMA and the four UK health departments to develop a “pragmatic approach” to resolving this issue.

Professor Bill Burr, medical director of the Joint Royal Colleges of Physicians Training Board described the GMC ruling as “counter-intuitive, illogical and inconsistent” with the way training has been conducted in the UK.

“It is not sufficient to tell trainees that they are eligible for CESR (CP). In spite of claims to the contrary this continues to be viewed as an inferior qualification to CCT and in practice is a lesser qualification since it has no European recognition,” he said.

The ruling is causing problems for deaneries who are now having to gear themselves up to deal with doctors needing remediation in order to complete the MRCP. Problems could be massively compounded by doctors who decide to retake all or part of the MRCP to qualify for CCT, claimed Burr.

Royal College of Surgeons president Mr John Black said the The Joint Committee on Surgical Training was concerned that those responsible for administering programmes may face logistical problems trying to keep trainees in training posts until they pass exams. “We hope further discussions with the GMC will help unravel these issues,” he said.

The BMA’s junior doctors committee said the issue has caused “great anxiety “ among juniors. Committee chair Dr Shree Datta insisted that no additional juniors should be affected by any changes and action must be taken to reverse the negative effects of the GMC’s advice.

Calling on the GMC to re-define misconduct

JJ Oliver, Remedy - 30th April 2010 2:15 pm

The Remedy judicial review being heard on 11 May could drive a coach and horses through the meaning of misconduct, and the meaning of unfitness to practice.

Doctors who are involved in management will be anxiously awaiting the verdict, since they may find themselves personally liable for their managerial decisions in future. And appeal lawyers across the country will be looking to the judgement to see whether the GMC has opened the floodgates for them.

Doctors are always happy to whinge about their managers, but serious action against doctors in management is rare. The GMC has only taken action in a handful of cases. One such case was that of Dr Roylance - the chief executive caught up in the Bristol babies cardiac surgery storm.

The MTAS recruitment process was a unique disaster. Some of the superlatives used at the time still stand out; it was described as the “biggest disaster” in a generation, and the anger it generated has still not subsided. So when Remedy wrote to the GMC asking for the senior doctors responsible for it to be referred to a fitness to practice committee then they hoped that the case would be duly investigated.

But the GMC politely declined the opportunity to hold such an inquiry. At this point Remedy reached for their lawyers, and challenged the GMC to defend themselves in court.

The case raises significant issues well beyond the events of 2007. At the heart of it lies the prickly and complex issue of what constitutes unfitness to practice. What sort of actions outside the clinical arena will render a doctor unfit to practice as a medical practitioner? The GMC have defended themselves on the grounds that: 

Whatever the conduct of [The Proposed Defendants] with regard to MTAS, I do not consider that it can sensibly be said to impinge on their fitness to practise as medical practitioners.

Yet this seems to be at odds with many previous rulings. There are many doctors who have been removed from the medical register for what has been referred to as “bringing the profession into disrepute” and for “conduct unbecoming of a doctor”. And if, for example, the doctors under investigation had knowingly breached the laws affecting international medical graduates then would the GMC still be arguing that this had no effect on their ability to work as doctors?

There has never been a case of deficient professional performance brought against a doctor for managerial issues. If Remedy is successful then this verdict will send a cold chill down the spines of medical directors and doctors working for health authorities - especially in an era of financial uncertainty.

The case is being heard in the High Court on 11 May - five days after the general election. Remedy has created a Facebook group for supporters of their case. If you agree with us, please attend court or, failing that, express your support.

This verdict is going to be studied by medico-legal bodies for many years to come.