The GMC is going through an enormous period of change, with the introduction of revalidation, the merger with PMETB and the shift in responsibility for adjudication in fitness to practise cases to the Office of the Health Professions Adjudicator.
In September 2007, as part of the inquiry into Modernising Medical Careers, Sir John Tooke recommended that: “PMETB should be assimilated in a regulatory structure with the GMC that oversees the continuum of undergraduate and postgraduate medical education and training, continuing professional development, quality assurance and enhancement.”
This was accepted by the government and PMETB is due to merge with the GMC in April.
Although the merger will bring regulatory responsibility for the whole of medical education and training under one roof, this consolidation of functions will not, in itself, achieve the full benefits envisaged by Sir John Tooke’s report.
To ensure that those benefits are realised the GMC invited Lord Naren Patel to lead a review of the current arrangements for the regulation of medical education and training and make recommendations that would inform future policy developments by the GMC.
The review’s draft report makes 27 recommendations to the GMC and they are currently out to consultation. Here is a summary:
1. All those involved in developing the skills and commitment of doctors must fulfil their responsibilities if the UK is to provide world class training. The GMC was urged to enhance links with other key interests, such as training providers and regulators.
2. Regulation has to reach across the different stages of doctors’ education and learning and support their transitions. Effective systems need to be developed for the transfer of information across all different stages.
3. Medicine is both a profession and a vocation. One of the goals of undergraduate medical education is to instil a culture of professionalism, and to begin the process of induction into the profession, that will inform doctors’ practice throughout their careers. It has been argued that the current undergraduate experience does not always achieve this and that student registration could be one way of fostering professionalism and a sense of professional identity. However, the review panel was not convinced. Instead it called on the GMC to evaluate the effectiveness of its existing arrangements for engaging with students and how professionalism is fostered by medical schools.
4. Newly qualified doctors need to be able to deliver the same standard of care regardless of where they qualified. Until now the GMC has set high level standards and allowed medical schools considerable flexibility in the way those standards are met. It must evaluate the effectiveness of the new requirements in delivering outcomes that are consistent and reliable to determine whether further measures are needed to achieve these ends.
5. Anomalies with the regulation of the Foundation Programme need to be addressed. Doctors in the first year of their foundation training may be working many miles from the medical school which is formally responsible for their training. This leads to an unsatisfactory lack of clarity over responsibilities. Equally unsatisfactory is the lack of any clear regulatory outcome required from the second year of the Foundation Programme.
6. The GMC should develop a framework for the accreditation of trainers. It should also look at the case for accrediting the environments in which education and training takes place, in addition to approving posts and programmes as currently undertaken by PMETB.
7. Above all, the GMC should develop a regulatory framework for the education and training of doctors in career posts. This is not only in the interests of the doctors concerned (who are often disadvantaged by limited access to training and CPD opportunities), it will also provide reassurance that these doctors are meeting national standards overseen by the regulator.
8. The public and employers must have confidence in the medical registers, and in the fitness to practise of doctors entering those registers. One factor militating against this is the lack of equivalence between the standards required of UK and European doctors entering the specialist and GP registers. The GMC should explore how this might be addressed. It proposes that European specialists and GPs should only be eligible for inclusion on the medical registers ‘at the point of first revalidation following completion of training’. This would require the GMC to uncouple the completion of specialist and GP training from the decision to allow a doctor onto the specialist or GP register. The move, it says, ‘could provide a mechanism for continuing to meet EC requirements in relation to recognition of training while ensuring greater equivalence in standards at the point of entry to the specialist and GP registers’.
9. The GMC should also examine, with the Department of Health, the current legislative anomaly that makes it possible for doctors not on the specialist register to take up locum consultant posts.
10. At the conclusion of specialty or GP training, participation in CPD is key to maintaining and further developing competence and performance. In 2004, the GMC issued guidance on CPD, but its regulatory role to date has been largely passive. Revalidation will provide a new focus for ensuring effective and appropriate CPD for all doctors but it will require the GMC to re-examine its role in this area. At the very least, it should provide clear guidance on what doctors will be required to do to keep up to date for the purposes of revalidation and the role of CPD within that.
11. The GMC should re-examine the current focus on assuring the quality of the processes used for training doctors. Instead, it should consider placing greater emphasis on outcomes and the quality of the individual trainees produced by those processes. What matters to patients is the quality of the doctors who treat them, not the processes by which they were trained.
Commenting on the report, Niall Dickson, chief executive of the GMC, said: “We have a great opportunity now to create a system in which every stage of education and training is fit for purpose, successfully prepares the doctor for the next one, where standards are constantly rising and which treats all doctors fairly, wherever they come from and whatever stage they are at in their careers.
“I hope the consultation stimulates debate and encourages as many as possible to comment on the conclusions and recommendations of the draft report. This will help us set the way ahead and ensure a robust approach to the regulation of education and training in the years to come.”
Doctors can consult on the recommendations until 9 March. A final report will be submitted to the GMC at the end of that month. Read the full list of recommendations.
Read more on the GMC’s corporate strategy 2010 to 2013.
The GMC should be radically cut and its function returned to that at its inception, namely protecting the public from quacks (e.g. ‘consultants in podiatric surgery’), PMETB’s remit repatriated to the Royal Colleges and medical schools limited to 125 - 150 students per intake.
Professional attitudes come from watching and learning, not by being preached to by the great and the good. EWTD should also be confined to the rubbish bin.
wrt paragraph 7: there is no advantage at all in this for the SAS doctors, who need to be left alone to settle into their new contracts. Imposing hurdles at this stage will be very onerous for them. What the really want is recognition and respect for their grade; they do not wish to become a slow training grade.