Issues with revalidation mar overall good performance by GMC

02 April 2014

The Health Committee's annual review of the General Medical Council (GMC) has found that the GMC is making steady progress in protecting patients.

The Committee's report, which follows the regulator’s accountability hearing, warns, however, that more can be done to build confidence in the professional regulation of doctors.

The Committee found that:

  • The GMC’s fitness to practise successfully produce outcomes that protect patients from sub-standard doctors but failures to communicate the reasons for decisions and poor investigative practices have undermined a small number on investigations.
  • The system of ongoing revalidation of doctors has been launched smoothly but the Committee has serious concerns regarding the ability of responsible officers to oversee revalidation.
  • The Government’s legislative programme is likely to further delay reforms that would allow the GMC to appeal fitness to practice tribunal decisions.

Fitness to Practise

Commenting on the GMC’s fitness to practise procedures, Committee Chair Stephen Dorrell MP said:

"The GMC has worked hard to put in place effective safeguards to weed out the small number of doctors that present a risk to patients. The Committee endorses the steps the GMC has taken in this area, but it is disappointing that in small number of cases the GMC has not met its own high standards. We found examples of the GMC failing to properly communicate decisions to complainants and in another instance flawed decision making meant that key information wasn’t gathered in relation to a case where a patient died.

These examples are the exception rather than the, rule but the Committee recommends that the GMC reviews its fitness to practice procedures to prevent such mistakes occurring again and undermining the GMC’s reputation as the most effective medical regulator for addressing poor standards of care."

Revalidation of doctors and the role of responsible officers

A second core aspect of the GMC’s work which aims to maintain high standards is revalidation of doctors. Commenting on its implementation:

The Committee found that it is still too early to judge whether revalidation has substantially improved the professional development of doctors or been more effective in revealing flaws in their professional practice. What the Committee did find, however, was a worrying approach to the oversight of revalidation. Each designated body has a responsible for revalidating their medical staff, but the Committee found that the degree to which the responsible officer will be held to account is unclear.  Stephen Dorrell said

"In 2012 the GMC told us that the responsible officer would be held to account if the work of a doctor who had successfully met the demands of revalidation was later found to be wanting. At our most recent hearing the GMC suggested that the accountability function of the responsible officer is, in fact, embedded in the wider organisational responsibilities of the designated body. The implication being that it is the organisation that will be held to account and not the responsible officer.

The Committee is concerned that there appears to vacuum of personal accountability in the process of revalidation. By definition a ‘responsible officer’ should be responsible for the success or failure of revalidation, but at present it is not clear that this is how the system operates. It is imperative that the GMC clarifies the personal responsibility and accountability of responsible officers."

The Health Committee’s report also expresses concern over the number of responsible officers available to oversee the revalidation of doctors working in primary care. GPs are revalidated not by their own employers but by one of the 27 NHS England local area teams that oversees Clinical Commissioning Groups in England. Stephen Dorrell said:

"Just 27 responsible officers will be tasked with overseeing revalidation for approximately 45,0000 GPs in England. The Committee is concerned that, whatever the resources allocated to responsible officers, the sheer number of doctors they will be required to support will preclude the type of professional relationship necessary to make informed decisions about the standard of a GP's work."

GMC right to appeal fitness to practice panel decisions

The GMC has asked the Government to amend its governing legislation to allow it to appeal decisions made by the Medical Practitioners Tribunal Service (MPTS). The Government’s intention had been to give the GMC this power in 2014 by using a mechanism in secondary legislation called a section 60 order. The Committee discovered in oral evidence, however, that the Government now plans to introduce the reform in primary legislation as part of a proposed Law Commission Bill that will introduce wide ranging legal reforms for all the professional health regulators.

Commenting on the Government’s revised proposals Stephen Dorrell said:

"In 2012 the Committee called for the Government to give the GMC the right to appeal panel judgements, therefore it is very frustrating that this reform has met with even further delay. It appears that the Government will only introduce a draft Law Commission Bill in the next Parliament and the likelihood of the Bill receiving Royal Assent before the General Election is very remote.

It is essential that the GMC is able to appeal panel judgements in cases where they believe tribunals have failed to recognise the severity of failings in a doctor's practice. The Government should introduce a section 60 order to put this provision in place as soon as possible."

Image: iStockphoto 

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