A new GMC report draws a picture of the medical profession in the UK and seeks to identify some of the challenges that persist.
In the report, called The State of Medical Education and Practice, the GMC acknowledges it has to be a more proactive regulator. Its aim in publishing the report is to promote discussion and debate on issues and trends that require attention or further analysis.
The following is a summary of the report’s findings and conclusions:
Key findings
The profession is diverse and changing:
1. There is an increasing number and proportion of female doctors.
2. Most commonly, doctors are in their early 30s.
3. More than a third of registered doctors completed their primary medical qualification outside the UK.
4. The medical profession is ethnically diverse compared with the UK’s general population.
5. The medical specialties in which doctors work vary enormously in size and are not always aligned to service needs.
Medical education’s importance in supporting good medical practice
1. Medical education and training need to be more responsive to changes in healthcare needs, the organisation and delivery of care, and the shifting expectations of patients.
2. There is a tension between service delivery and protected time for education and training, and this has been exacerbated by the Working Time Regulations.
3. Trainee doctors need high quality supervision and positive role models with strong leadership skills. Yet there is variation in trainees’ experiences of supervision.
Unacceptable variation in the standards of medical practice
1. In 2010 we assessed around 1 in 70 of all registered doctors - although many concerns were subsequently unproven.
2. The GMC receives proportionately more complaints about male doctors, older doctors and GPs.
3. In 2010 the top three types of concerns were about: clinical investigations or treatment; respect for patients; and communication with patients.
4. A small number of doctors are falling seriously short of the standards expected of them. Almost 1 in 3,000 registered doctors were struck off.
Achieving better medical practice
The report suggests that the medical profession is changing, the world in which doctors practise is evolving, and that standards of training and of practice vary.
Doctors today are training and practising in a complex and changing environment. Political devolution has led to greater differences in the way healthcare is organised and delivered in the four parts of the UK, it says.
Ongoing reform, especially major structural change in England, has created further uncertainty both about the future shape of healthcare and its capacity to meet future demand, the report says.
Equally important, healthcare in the UK, as in other developed countries, faces significant funding constraints. After ten years of unparalleled spending growth, the healthcare systems are now struggling to deliver what is expected from them with the resources they have. Given the wider difficult economic environment, it seems certain that tight and constrained budgets will be a feature for the foreseeable future.
In recent years, the policy focus has been on improving quality in healthcare. There must now be real concern about how funding constraints could affect the quality of care, including the delivery of education and training for doctors. There needs to be greater transparency in the way in which medical education and training is funded. If medical education and training, including CPD, is to maintain and improve standards it needs to be protected.
There also remains an ongoing debate about how to address the impact of the WTR, both on delivery of care and medical education and training. The GMC and others will continue to monitor the impact of reduced working hours.
Alongside these changes, the practice of medicine itself is becoming more complicated and technically demanding. In turn, that changes the way in which individual doctors exercise their responsibilities. Today’s doctors cannot master the vast expansion of knowledge and innovation that is driving forward the boundaries of medical science each day, the report claims. But they are expected to keep up-to-date and to know how and when to access information and advice to practise safely and effectively.
Their role goes beyond the application of knowledge - they need to be able to synthesise conflicting and incomplete information, deal with uncertainty and manage and communicate risk. In many cases, they need to do this knowing that they must accept ultimate responsibility for the patient in their care.
The report identifies six areas where the GMC believes there is a need for further debate and action:
1. Professionalism and leadership are crucial to good medical practice. Revalidation, when introduced, will help by bringing every conversation about a doctor’s practice back to the standards set out in Good Medical Practice.
2. Regulatory bodies need to redefine how they work. The GMC needs to proactively encourage good practice as well as take action when problems arise. And professional and system regulators need to work more closely together.
3. Doctors must take responsibility for raising concerns and need to be supported to do so. There needs to be a culture change around this. The GMC will support this, but there are actions for employers too.
4. Overseas qualified doctors need better support. They need to be properly inducted to UK practice and employers need to be confident they can speak and understand English to a good enough standard.
5. Doctors need to be equipped to deal with changing healthcare needs. We believe postgraduate training should be reviewed to ensure it is flexible enough to allow doctors to move between specialties. Doctors also need a higher level of core competence than training programmes currently allow.
6. We need to improve our understanding of medical education. In particular we need better outcomes data so that we can be assured that medical students are entering the workforce with consistent, and the right, skills and knowledge. In 2013, we will evaluate the impact of our updated standards for undergraduate education, Tomorrow’s Doctors (2009).
The GMC plans to publish The State of Medical Education and Practice annually and support it with further data and discussion.
Read the full report.
Tags: GMC, Induction, Medical education, Training
As per usual no real substance- how about enabling students to control their own clinical education by taking control of SIFT funding? What about giving students choice to purchase their own clinical placements anywhere within the NHS?
Having said all this, who at the GMC bothers to tackle the rampant cheating culture of medical school? There have been some examples of considerable cheating - which staff in one trust knew about as the minutes of the meetings show- but chose not to act. The GMC were informed - but dismissed it. The GMC are outdated and should be abolished.