Regulation of doctors – the proposed reforms
April 2007
The Government’s white paper, ‘Trust, Assurance and Safety – the Regulation of Health Professionals’, sets out a programme of reform for the regulation of health professionals. The proposals are based on the CMOs review of professional regulations ‘Good doctors, safer patients’
The BMA’s Consultants Committee (Central Consultants and Specialists Committee - CCSC) needs your views on these proposals and ways in which we should seek to influence them. The attached briefing document outlines the key issues that will directly affect consultants; we value your feedback, which can be sent to info.ccsc@bma.org.uk.
A web forum has also been designed for further discussions and to enable BMA members to share views: login at www.bma.org.uk/ccscforum4.nsf/alltopics?OpenView&Login
At a glance: regulation reform proposals and how they will affect doctors
1. Revalidation
Revalidation will be required for doctors to demonstrate their continued fitness to practice and will have two components: relicensure and specialist recertification.
1.1 What is relicensure?
All doctors wishing to practise in the UK will require a licence to practise, which will be issued by the General Medical Council and will need to be renewed every five years. The relicensure process will be based on:
- standards of practice set by the GMC
- a revised system of NHS appraisal
- any concerns known to the doctor’s medical director and the GMC Affiliate
1.2 What is recertification?
All doctors on the specialist and GP registers will need to demonstrate that they meet the standards that apply to their medical specialty by recertification. These standards will be set by the medical Royal Colleges and their specialist societies and approved by the GMC. Recertification will be carried out at regular intervals of no more than five years and, where possible, will coincide with relicensure.
Evidence may be drawn from a range of sources and activities, including employer appraisal, clinical audit, simulator tests, knowledge tests, and patients’ feedback, continuing professional development or observations of practice. The cost of recertification will be recovered either through a direct payment to the relevant Royal College or through fees to the GMC, and the Government will be holding further discussions on these details.
1.3 What form will the appraisal system take?
Doctors will be required to engage in an annual appraisal, which will involve an independent 360-degree feedback exercise. The appraisal process will include assessment that assesses whether performance has met specific standards, and looks forward at any changes that might be needed. The appraisal arrangements will need to take account of the large number of doctors who work outside the NHS, as well as in NHS Trusts, Foundation Trust and primary care.
1.4 What would happen if a doctor failed to revalidate?
Where doctors working in clinical practice fail to meet the requirements of revalidation, they would spend a period in supervised practice or out of practice, prior to assessment, in order that an individual plan of remediation and rehabilitation may be put into place. See question 3.3 for more details.
2. Handling of local concerns
2.1 What are GMC Affiliates?
The CMO proposed the creation of GMC Affiliates in the workplace, to act as the first port of call for concerns about doctors. The White Paper, however, proposed having GMC Affiliates at SHA level only and in England they will lead regional medical regulation support teams.
2.2 What are responsible officers?
Responsible officers will be either the medical director, or another doctor designated by the employer or the GMC, and all doctors will have to relate formally to the ‘responsible officer’. The designated officer will therefore take on the roles originally envisaged for more local GMC Affiliates in ‘Good doctors, safer patients’. It is envisaged that they will address concerns about doctors, oversee local revalidation processes and be a central point for holding and sharing information on complaints and concerns about doctors
2.3 What are recorded concerns?
‘Recorded concerns’ is the proposed system of recording concerns about doctors’ conduct or practice locally. They will track patterns of misconduct and behaviour over time and place. There is concern, however, that the smallest complaint against a doctor, justified or otherwise, will appear on their GMC record and highlight them as ‘potential problems’.
3. Handling of national concerns
3.1 How will the standard of proof change?
The White Paper proposes that in the adjudication of fitness to practise cases, panels should use the civil standard of proof, with a sliding scale, rather than the criminal standard. The criminal standard of proof requires that panels must be convinced that the facts are fully proven beyond any reasonable doubt, or they must find in favour of the health professional. In contrast, the civil standard of proof requires that the facts are judged more likely than not to be true (‘balance of probabilities’). However, the civil standard of proof can be flexibly applied, such that in the most serious cases, the sliding civil standard is almost indistinguishable from the criminal standard.
3.2 Will the GMC continue to have an adjudication function?
The White Paper recommends the complete separation of adjudication on fitness to practice from investigation and prosecution. This function will therefore be removed from the GMC and handed to an independent body. Doctors and the GMC will have the right of appeal against the decision of the independent body to the High Court or the Court of Session.
3.3 What support will there be for doctors where fitness to practise is called into question?
The proposals emphasis support and rehabilitation for doctors by requiring the National Clinical Assessment Service (NCAS) and the GMC to work with employers to agree specific packages of rehabilitation and conditions of practice. A comprehensive assessment of the practitioner will be required. A national advisory group will be formed to help ensure the appropriate and early intervention in health and related matters.
4. Governance of the GMC
4.1 How will the GMC membership change?
To establish greater independence of the professional regulations, the White Paper seeks to ensure that all regulatory bodies have a parity of lay/professional membership as a minimum. All members of all councils will be appointed independently by an Appointments Committee against specified criteria and competencies. Those that seek parity, rather than a majority of lay membership, will be subject to greater accountability requirements and will be subject to review in 2011.
5. Timeframe for change
5.1 When will these proposals be implemented?
The Government will consult with key stakeholders on the development of a detailed implementation programme, but there is currently no set timeframe for implementation. Many of the reforms require primary legislation, and other measures need to be enabled by secondary legislation.