Response of the BMA to the CHRE’s consultation document, 'Entry to registers'
April 2008
Thank you for consulting the British Medical Association (BMA) on the Council for Healthcare Regulatory Excellence's (CHRE) consultation document on entry to registers. The BMA is an independent trade union and voluntary professional association which represents doctors from all branches of medicine throughout the UK.
The lead persons in the BMA on regulation are Jacqueline Foukas (Head of Council Secretariat) and Catharina Ohman-Smith (Executive Officer, Council Secretariat).
Our response has been structured according to the questions set out in your letter, in particular the questions referring to which issues need to be addressed when reaching a single standard definition of good character and improving the flow of information.
CHRE projects on definition of good character and sharing information on entry between regulatory bodies and employers
1. Single standard definition of good character
(i) What work has your organisation already done towards defining good character?
The BMA regularly contributes toward efforts in defining good character as applied to doctors through its dialogue with regulators, the Royal Colleges and other professional associations. In particular, the BMA was a key participant in the recent Royal College of Physician’s report on medical professionalism and is currently looking again at similar issues in exploring the ‘role of the doctor’ with regard to the findings of the Tooke Report (2007).
Clearly, the definition of ‘good character’ has a central role in determining the constitution of the medical profession and we therefore support the definition of good character which already exists in the GMC’s Good Medical Practice (Good doctors - paragraph 1) and we expect that CHRE will be taking this into account:
‘Patients need good doctors. Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity.’
(ii) What issues have been encountered and how have these been resolved?
This question is more relevant for the regulatory bodies.
(iii) In seeking to reach a single standard definition of good character, what issues do you think will need to be addressed?
If a single definition of good character is introduced, it should be a transferable definition to allow it to be used among people of different nations or backgrounds. There is also a need to ensure that these standards are consistent with current UK practice, regardless of origin of registrants. The differences between societies could make it difficult for anything other than a very broad definition of medical ‘good character’ to be developed. We are concerned that the broadness of this definition might render it useless for actually identifying doctors who fall short of all the specific expectations of the country into which they are moving.
We suggest that good character definitions should include two principle components: the positives (things the applicant has done, including testimonial letters from appropriate and defined sources, e.g. deans of medical schools, heads of departments and college tutors, certificates of good standing from a national regulatory body ) and the negatives (things the applicant has not done such as, not having been investigated by the regulatory body, the police or hospital/medical school).
It is important that verifiable evidence is used or at least supporting evidence is produced to explain why an opinion has been formed. There should be no inclusion of unsupported accusations.
We do not believe that an examination to assess good character should be established. Examinations or tests should only be used if they can be irrefutably demonstrated to be valid, non-discriminatory and have a long history of accuracy; if examinations are used, they must be subject to appeal.
Good character attributes and indicators should be appropriate to the role under consideration and clear limits should be set on what may be considered appropriate evidence illustrating lack of good character.
2. Information on entry to the register
(i) What work has already been done by your organisation on the sharing of information by the regulatory body and the employer when a health professional enters employment for the first time?
This question is more relevant for the regulatory bodies.
(ii) What issues have been encountered, and how have these been resolved?
This question is more relevant for the regulatory bodies.
(iii) In seeking to improve the flow of information, as envisaged by the White Paper, what issues do you think will need to be addressed?
Improving information flow is not the only issue. Data security is equally important. We know that the safeguarding of personal information is hard to achieve. Doctors moving between jurisdictions would need genuine assurance that there will be adequate protection of the considerable volumes of personal data needed to assure regulators in each jurisdiction that they are bona fide doctors.
The information that is likely to be gathered is personal and confidential and of paramount importance to individuals since it is likely to have a bearing on their future employment prospects. Data security needs to be of immensely high standards and the guidelines on handling this data should specify who will have access, how long it will be stored, how will it be stored, how will it be transmitted, who will be allowed to share it and what will constitute an appropriate request to have sight of the data.
Unconfirmed allegations should not be submitted or requested, as they are considered hearsay unless proven. If individuals have had patterns of poor behaviour then these allegations should be investigated in an attempt to settle whether there are issues to address.
It is vital that only specified information should be shared – the regulator needs knowledge of only those aspects of an individual’s life that may have a bearing on the issue under consideration. If information cannot be shown to have a direct relevance to the issue under consideration then it should not be shared.
Applicants should know the nature (but not necessarily the content since this may need to be confidential) of the information that has been shared. Applicants should be able to contest the inclusion of information that cannot be demonstrated to have a direct bearing on the issue under consideration. The parties sharing the information should be required to justify the inclusion of disputed information.
(iv) Do you have any other comments, views or information which you think CHRE should take into account when taking this work forward?
The GMC should continue to ask doctors who have qualified in another country to produce a “Certificate of Good Standing” from the regulatory body in their country of origin, when applying to register.
Electronic methods of data transfer are not currently sufficiently secure and allow too wide a sharing of sensitive data. It is also vital that data is not shared with parties other than explicitly specified to the applicant at the time of application.
An appeal mechanism should be established.