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Annual Accountability Hearing with the General Medical Council House of Commons Health Committee Annual accountability hearing with the General Medical Council Eighth Report of Session 2010–12 Report, together with formal minutes, oral and written evidence Ordered by the House of Commons to be printed 19 July 2011 HC 1429 [Incorporating HC 1203-i (Qq 1–66), Session 2010–12] Published on 26 July 2011 by authority of the House of Commons London: The Stationery Office Limited £14.50 The Health Committee The Health Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health and its associated bodies. Membership Rt Hon Stephen Dorrell MP (Conservative, Charnwood) (Chair)1 Rosie Cooper MP (Labour, West Lancashire) Yvonne Fovargue MP (Labour, Makerfield) Andrew George MP (Liberal Democrat, St Ives) Grahame M. Morris MP (Labour, Easington) Dr Daniel Poulter MP (Conservative, Central Suffolk and North Ipswich) Mr Virendra Sharma MP (Labour, Ealing Southall) Chris Skidmore MP (Conservative, Kingswood) David Tredinnick MP (Conservative, Bosworth) Valerie Vaz MP (Labour, Walsall South) Dr Sarah Wollaston MP (Conservative, Totnes) Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/healthcom. The Reports of the Committee, the formal minutes relating to that report, oral evidence taken and some or all written evidence are available in printed volume(s). Additional written evidence may be published on the internet only. Committee staff The staff of the Committee are David Lloyd (Clerk), Sara Howe (Second Clerk), David Turner (Committee Specialist), Steve Clarke (Committee Specialist), Frances Allingham (Senior Committee Assistant), and Ronnie Jefferson (Committee Assistant). Contacts All correspondence should be addressed to the Clerk of the Health Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 5466. The Committee’s email address is [email protected]. 1 Mr Stephen Dorrell was elected as the Chair of the Committee on 9 June 2010, in accordance with Standing Order No. 122B (see House of Commons Votes and Proceedings, 10 June 2010). Annual accountability hearing with the General Medical Council 1 Contents Report Page 1 Introduction 3 2 Revalidation of doctors 5 3 Fitness to practise 10 Pro-active regulation 14 Minority and Overseas Doctors 15 4 Voluntary erasure 17 Conclusions and recommendations 20 Formal Minutes 24 Witnesses 25 List of printed written evidence 25 List of Reports from the Committee during the current Parliament 26 Annual accountability hearing with the General Medical Council 3 1 Introduction 1. The General Medical Council (GMC) is the independent regulator of doctors in the UK. Numerous predecessor organisations have existed since the Medical Act of 1858,2 though the GMC and its current core functions were established by the Medical Act of 1983.3 The four key functions of the GMC are: • keeping up-to-date registers of qualified doctors; • fostering good medical practice; • promoting high standards of medical education and training; and • dealing firmly and fairly with doctors whose fitness to practise is in doubt.4 In undertaking these functions the GMC aims to be independent, fair, efficient and effective, to raise standards, to foster the professionalism of doctors and to command the confidence of key interest groups.5 2. The GMC is seen nationally and internationally as a robust, well-functioning regulator. The Commission for Healthcare Regulatory Excellence (CHRE) undertakes an annual review of the GMC and other regulators of health professions and publishes an annual review. In its annual review for the year 2010–11 the CHRE states that: The GMC has maintained and in many ways improved its levels of good performance across all of its regulatory functions this year.6 In its written submission to the Committee, the CHRE stated that: In CHRE’s view, the GMC performs well. It demonstrates excellence in several areas across its regulatory functions against a background of significant change. The GMC has an impressive commitment to continuous improvement, even in areas where it was already performing to a good standard, and to addressing challenges in medical regulation.7 3. The Committee has not uncovered evidence to the contrary. The GMC’s financial performance is good and it is making progress across a range of issues, including many of those we identified in our earlier report on the revalidation of doctors.8 4. Although, therefore, the Committee recognises that the GMC achieves a high level of operational competence, it remains concerned that the leadership function of the GMC 2 Medical Act 1858 3 Medical Act 1983 4 “The role of the GMC”, GMC website, 2011, www.gmc-uk.org 5 Ev 18 6 The Council for Healthcare Regulatory Excellence, Performance review report 2010–11, HC 1084-II, June 2011 7 Ev 44 8 Health Committee, Fourth Report of Session 2010–12, Revalidation of Doctors, HC 557 4 Annual accountability hearing with the General Medical Council within the medical profession, and within the wider health community, remains underdeveloped particularly in the areas of fitness to practise, revalidation, education and training and voluntary erasure. We hope that the GMC will embrace more ambitious objectives for professional leadership, some of which are described in this report. Annual accountability hearing with the General Medical Council 5 2 Revalidation of doctors 5. As we stated in our earlier report on this matter, revalidation is: […] a broad term used to refer to the policy of proactively ensuring that practitioners who are registered to practise are still safe and competent to do so. This contrasts with the policy of investigating competence only when complaints are made or concerns are raised.9 6. As we made clear in our earlier report, the Committee attaches considerable importance to the role of the GMC as the “owner” and “leader” of the debate about revalidation. The Committee welcomes the Government’s support for revalidation, and its willingness to facilitate its implementation; prime responsibility for planning and executing effective and timely revalidation does however, in the Committee’s view, rest squarely on the shoulders of the GMC. 7. In his memorandum of evidence to the Committee, the former President of the GMC, Sir Donald Irvine has flagged up a number of issues with the proposed system of revalidation as it stands. He alleges that the bar used by the GMC to establish good or problematic practice (in the GMC document Good Medical Practice10) in the context of revalidation “is set too low to protect patients properly”.11 In terms of revalidation, Sir Donald states that: In her final report [into the case of Harold Shipman] Dame Janet Smith said that “the reality of the ‘remarkably low’ standard above which doctors will be revalidated does not square with the claim that revalidation gives an assurance that the doctor is ‘up to date and fit to practise’”. Now, nearly eight years on, nothing seems to have changed. This is why urgent action is required.12 Whether this bar is set too low will be explored further in the chapter on fitness to practise (chapter 3). 8. Sir Donald goes on to highlight the work undertaken by the Society of Cardiothoracic Surgery of Great Britain and Ireland. All cardiothoracic surgical interventions in the UK are subject to peer benchmarking, the results of individual surgeons are published and the standards used for this are the standards that will be adopted for revalidation of cardiothoracic surgeons.13 He recommends that the process used by this organisation be adopted by the GMC and the medical royal colleges in their work on revalidation. 9 Health Committee, Fourth Report of Session 2010–12, Revalidation of Doctors, HC 557, p5 10 General Medical Council, Good Medical Practice, 2006 11 Ev 25 12 Ev 28 13 Ev 28 6 Annual accountability hearing with the General Medical Council 9. In its evidence to the Committee the GMC stated that they are engaging with the cardiothoracic surgeons on their work, so that they can learn from this with a view to refining the process of revalidation.14 However, they also point out that: […] obviously it is easier, in some ways, to measure outcomes in cardiothoracic surgery than it is, for example, in general practice or psychogeriatrics.15 10. The GMC also points out that revalidation must commence in 2012 as previously agreed and that: […] we certainly would not subscribe to a view that you cannot start revalidation until you have, for example, the level of outcome results which cardiothoracic surgeons achieve because, frankly, we would be sitting here in 20 years’ time still talking about why we do not have revalidation as a profession.16 11. The work undertaken by the Society of Cardiothoracic Surgery of Great Britain and Ireland in setting standards for that part of the medical profession is commendable. Its transparency will be welcomed by patients and should be a template (where clinically relevant) for further refinement of the revalidation process. 12. The GMC clearly has a considerable amount of work to undertake between now and the implementation of revalidation in 2012. Although we agree that all disciplines will not have developed their standards to an advanced level by that date, the GMC needs to accelerate its work with the medical royal colleges to further refine the standards for revalidation in specialist areas and to ensure that the process is meaningful to clinicians and transparent to the public.
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