The General Medical Council (GMC), which registers doctors to practice medicine in the UK, should be accountable to Parliament, a committee of MPs has said.
The GMC is formally accountable to the Privy Council but, “in the absence of a mechanism which makes this accountability effective, we intend to exercise this function ourselves on behalf of Parliament,” says the House of Commons Health Committee, reporting today on its review of the processes proposed by the GMC for revalidation of doctors.
Reform of the system was due to be introduced this year but in 2010 the government said this should be put back until 2012 to enable a thorough examination of the proposals, which are aimed at preventing the possibility of another Harold Shipman, the Cheshire GP who killed at least 218 of his patients from 1975 to 1998.
Revalidation of doctors has now been under discussion for over 10 years; this is too long, says the Health Committee. “Now that ‘late 2012’ has been set as the date of implementation, we look to the GMC to ensure that there are no further delays and that the current target date is achieved,” it says.
The MPs’ main concern with the GMC’s current proposals is that they give too little attention to how to deal with doctors whose practice gives cause for concern. “We regard this as an important weakness in the current proposals which the GMC needs to address if the introduction of revalidation is to help sustain public confidence in the medical profession,” they say.
The “instinctive” use of the word “remediation” in cases where a doctor’s performance gives cause for concern may have the effect of pre-judging the appropriate response to a particular set of circumstances, the MPs caution. “While it is important to ensure that the rights and legitimate interests of doctors are safeguarded, the primary purpose of revalidation is to protect the interests of patients,” they say, and call on the GMC to publish clear guidance to Responsible Officers about how they should deal with such cases.
The MPs broadly support the GMC’s proposal that revalidation should be based on the conclusions of employers’ appraisal systems, but point out that their inquiry received evidence that the record of employers’ appraisal is patchy. Therefore, they say: “the GMC needs to satisfy itself that all organizations which employ doctors have robust and consistent systems of appraisal in place on a timescale which makes possible its objective of introducing revalidation in late 2012.”
There also needs to be clear guidance about how Responsible Officers (usually local medical directors) should act when a conflict of interest arises between their responsibility to their employer and their responsibility to the GMC for professional regulation (eg, in cases of “whistle-blowers”), the MPs add. Therefore, the GMC needs to “consider further what safeguards may be desirable to protect the interests of individual doctors in circumstances where they believe a conflict of interest may have influenced the decision of a Responsible Officer,” they say.
Finally the Committee considered the issue of doctors for whom English is a second language. The ability of doctors to communicate effectively their patients is “fundamental to good medicine,” say the MPs, and they “expect” the GMC, “as the body responsible for revalidation and with a commitment to introducing it by late 2012,” to “satisfy itself that it has the necessary powers to fulfill this role.”
“If it is not satisfied - whether as a result of European Union (EU) legislation or for any other reason - we expect it to say so publicly and report to Parliament what changes are necessary to allow it to fulfill its function effectively,” the Committee concludes.
Commenting on the panel’s findings, GMC chief executive Niall Dickson said it was “good that MPs are clear that there must now be no delay” in the introduction of revalidation by the end of 2012 which remains the GMC’s “number one priority.”
Also, the Council would welcome the opportunity to report directly to the Health Committee on all areas of its work, including revalidation, he said, adding: “we have been calling for this for some time.”
And on the current problem that the GMC cannot check whether doctors from the EU are able to speak English so that they can practice safely, Mr Dickson said the GMC is determined find a solution and is “currently working with Ministers and officials at the Department of Health to ensure patients are fully protected.”