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The GMC and Medical Regulation Sir Graeme Catto Wednesday 4 February 2009

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The GMC and Medical Regulation Sir Graeme Catto Wednesday 4 February 2009 Hailsham Chambers, Old Hall, Lincoln’s Inn. Our purpose. To protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine

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The GMC and Medical Regulation

Sir Graeme Catto

Wednesday 4 February 2009

Hailsham Chambers, Old Hall, Lincoln’s Inn

our purpose
Our purpose
  • To protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine

Medical Act 1983 (as amended in 2000)

our interlocking functions

registration

education

fitness to practise

standards

Our interlocking functions
our recent history
Our (recent) history
  • 1858: The ‘General Council of Medical Education and Registration’ established
  • 1995: Good Medical Practice
  • 1998: Bristol case ends, Shipman arrested
  • 2004: Fifth Shipman report
  • 2006: Good Doctors, Safer Patients
  • 2007: Trust, Assurance and Safety
  • 2009: A reconstituted Council
our aim
Our aim
  • To secure a regulatory system that is…
    • Independent
    • Fair
    • Efficient and effective
    • Enhances patient safety
    • Fosters the professionalism of doctors
    • Commands the confidence and support of key interests
some common themes
Some common themes
  • Ineffective local systems
  • Patients uncertain how to register concerns
  • Reluctance to report dangerous colleagues
  • Poor co-ordination across systems
  • Management by exception
our response a four layer model
Our response…a four layer model
  • Personal regulation
  • Team-based regulation
  • Workplace regulation
  • National regulation

Plus...

  • International co-operation
state of the nation
State of the nation
  • Personal regulation

…alive and kicking

  • Team-based regulation

…must do better

  • Workplace regulation

…good in parts, but room for improvement

  • National regulation

…getting better, but not there yet

future issues revalidation
Future issues…Revalidation
  • A set of procedures operated by the GMC to secure the evaluation of a medical practitioner’s fitness to practise as a condition of continuing to hold a licence to practise. (Adapted from the Medical Act 1983)
  • To create public confidence that all licensed doctors are up to date and fit to practise. (GMC, 2005)
  • Introduction of the licence to practise – in 2009 - as a first step towards Revalidation
future issues standards
Future issues…Standards
  • Good Medical Practice as a framework for appraisal and assessment
  • Guidance on, for example:
    • 0-18 years: guidance for all doctors
    • Consent: patients and doctors making decisions together
    • Personal beliefs and medical practice
    • Acting as an expert witness
    • End of life issues
    • Confidentiality
future issues education
Future issues…Education
  • The merger of PMETB with the GMC:
    • A single continuum of all stages of medical education and training
    • A more strategic approach
    • A single point of contact for key interests
    • Bringing together best practice from both organisations
    • Greater resources (250,000 registrants v 50,000 trainees)
    • An integrated approach across regulatory functions
future issues affiliates
Future issues…Affiliates
  • Government proposed a network of GMC Affiliates, appointed to work at local level to provide support, advice and guidance to employers in managing concerns about doctors.
  • Intended to bridge the gap between national and local regulation
  • Pilots taking in place in North London and West Yorkshire
  • Responsible Officers - to bolster local clinical governance
  • Regional Medical Regulation Support Teams (RMRSTs) - to focus on macro issues relating to complaints handling.
future issues adjudication
Future issues…Adjudication
  • Establishment of a new adjudicator, the Office of the Health Professions Adjudicator (OHPA), to replace adjudication on fitness to practise cases by the GMC
  • GMC to have a right of appeal against unduly lenient fitness to practise decisions by OHPA
  • OHPA to take account of the GMC’s Sanctions Guidance based on Good Medical Practice.
  • Chair to be a senior lawyer of ten years’ standing
what do people think
What do people think?

Source: GMC Tracking Survey conducted by GFK-NOP

a final thought
A final thought…
  • Regulation for the majority;
  • Regulation of the minority
1 personal regulation
(1) Personal Regulation
  • Regulates own practice
  • Shows commitment to a common set of values,

behaviour and relationships that underpin the trust

the public has in doctors

  • Puts patients first
  • Uses knowledge, clinical skills and judgement to

protect and restore human well-being

  • Protects patients from risk of harm posed by a

colleague’s conduct, performance or health

2 team based regulation
(2) Team-based regulation
  • Accepts responsibility for the team as a whole
  • Accepts responsibility for others in the team
  • Works in partnership with members of the wider

healthcare team

  • Protects patients from risk of harm posed by a

colleague\'s conduct, performance or health.

3 workplace regulation
(3) Workplace regulation
  • Ensures that doctors are fit for their roles
  • Operates effective clinical governance
  • Creates an organisational infrastructure to support

doctors in the exercise of their professional

responsibilities

  • Assigns clear responsibilities
  • Takes prompt and effective action if actual or

emerging impairment puts patients at risk.

4 national regulation
(4) National regulation
  • Controls entry to profession and to specialties
  • Fosters good medical practice, setting out generic

values, ethics and principles

  • Determines standards for education and training
  • Ensures continuing fitness to practise
  • Deals firmly and fairly with doctors whose fitness to

practise is or may be impaired

  • Grounded in research; and risk based
  • Independent
  • Commands confidence and support of key interests
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