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Good doctors_ safer patients

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									Good doctors, safer patients: GMC/ippr Seminar workshop 5 October 2006

Consultation Two reports 11 themes Three questions 44 recommendations

Common themes
Common themes running through the two reports: 1. Changes to governance and accountability 2. Importance of defined operationalised standards against which to regulate 3. Appropriate standard of proof 4. ‘Spectrum of revalidation’ across all healthcare professionals 5. Devolution of some regulatory activity to a local level

Other themes
Other ‘important’ themes within one report or another: 6. Number of regulators for non-medical professions 7. Requirement to record post-registration qualifications 8. Role of regulation for student healthcare professionals 9. Need for standardised pre-employment English language testing 10. Extending regulation to include healthcare support workers and new roles 11. Importance, or otherwise, of a lay majority on governing bodies of the various regulators


Three overarching questions: 1. Do stakeholders support the principles upon which Good doctors, safer patients is based? 2. Do stakeholders support the approach advocated in the two reports? 3. What are the priorities for stakeholders in terms of implementation? In addition, stakeholders are asked to address the 11 themes or to comment on the merits of specific recommendations (within each theme).

‘We believe in a system of medical regulation that fosters the delivery of high quality care for patients, is based on clear standards that are fair, transparent and open, is properly coordinated across all four UK countries, is independent and accountable, and, above all, can command the support and confidence of patients, the public and doctors.’
Sir Graeme Catto, GMC Today, August 2006.

‘… the General Medical Council is regarded as one of the better regulatory bodies internationally … in the United Kingdom the procedures developed by the General Medical Council are often seen as innovative and forward looking.’
Good doctors, safer patients, Chapter 10 para 9.

‘We want to put an end to the idea that the General Medical Council is a representative body for doctors. It is not. Its primary role must be to protect patients.’
Secretary of State for Health January 2005

‘… at no point in its long history has [the GMC] been able to command the respect of all its constituencies … simultaneously.’

Good doctors, safer patients Chapter 10, paragraph 12.

‘It is not good for public confidence in medical regulation to see the main regulatory body so often mired in controversy.’
Good doctors, safer patients, Chapter 10 paragraph 11.

Aim To secure a regulatory system that: Is independent Is fair Is efficient and effective Enhances patient safety Fosters the professionalism of doctors Commands the confidence and support of the main constituencies

Likely response
Functions and constitution Education Revalidation Clear way ahead Further points
Supported by active communications and engagement between now and the end of the consultation

Functions and constitution Promote regulatory coherence and resist fragmentation Balanced Council that is reflective of the main constituencies – doctors; patients and the public; NHS and other healthcare providers; medical schools and Royal Colleges Council membership based on public interest and competence More board like Routes to Council membership must command confidence

Three stages – undergraduate, postgraduate and CPD Regulator must control entry to the register Therefore, undergraduate [and PLAB] to remain with GMC If reform required, then three stages with the GMC One possibility is a three board model Composition of Education Committee and boards tailored to roles and constituencies

Recertification, if confirmed, will take time to develop Meanwhile, we can make a start with re-licensing The NHS and others must make that possible by putting necessary elements in place National machinery in association with the departments of health to ensure delivery

Clear way ahead
Register as a national resource Extended range of information on register Accountability to Parliament Clear standards for specialist practice Strengthening of appraisal Importance of Good Medical Practice as foundation for operational guidance

Further points
Adjudication – not yet clear how separate adjudication would work Standard of proof Centrally recorded information - must be attributable, verifiable and disclosable Strengthening of local procedures and workplace regulation; and better fit with national regulation Accommodate healthcare systems in all four UK countries

What’s the attraction?
For Ministers? An acceptable, even desirable, way forward For patients and the public? A system with patient safety at its heart and clear, accountable, lines of responsibility For the profession? A system, which is fair, that commands public and political confidence For the GMC? An end to the Groundhog Day experience and to the associated opportunity costs


What will it take to command the confidence and support of all the main constituencies and enable the enthusiastic support of politicians?

Good doctors, safer patients

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