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Insight: GMC
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Niall Dickson
Chief Executive and Registrar of the GMC

 

Doctors and healthcare systems in the UK are experiencing financial and service pressures the like of which have not been seen for nearly 20 years. The impact will be felt in every practice throughout the country and on every practitioner.

Niall Dickson
Chief Executive and Registrar of the GMC

 

Doctors and healthcare systems in the UK are experiencing financial and service pressures the like of which have not been seen for nearly 20 years. The impact will be felt in every practice throughout the country and on every practitioner.

At one level, health regulators such as the General Medical Council (GMC) are insulated from this cold climate – our funds come direct from practitioners, not from the public purse. But the government has made it clear in its recent command paper on regulation that it expects the professional regulators to demonstrate that they are as efficient as they can be. We also recognise that we have a responsibility to use our funds wisely and keep our costs down.

In the past year we have begun to scrutinise every area of our work to identify where we can save money. In 2010, we saved more than £7m, 8% of our total spending. We are committed to saving a further 3-5% of our budget this year.

We are also trying to play our small part in reducing the financial pressure on doctors with fewer resources. From April this year we cut the annual fee for newly qualified doctors and those at the lower end of the income scale. Provisionally registered doctors will pay £100 a year, down from £145, and doctors in their first year of registration and doctors who earn less than £26,000 will pay £210, instead of £420. We have also reduced the costs of a Certificate of Completion of Training or a Certificate of Eligibility for GP Registration by £305.

Like the health service though, we also face rising demand – last year we received more complaints about doctors than at any time in our history. There were 7,153 complaints in 2010, compared to 5,773 in 2009 and 5,195 in 2008. This is a trend also being experienced by other professional regulators. To prevent us having to pass on the costs of all this to doctors, we need to rethink how we manage this work and we are currently consulting on major changes to our procedures (see Resource).

Our aim is to reduce the length of investigations and the number of hearings. We had 326 hearings last year, up from 270 hearings in the previous year, and about 90% of investigations are to be concluded within 15 months. At the same time we want to create a system that protects patients but is less traumatic, both for the doctor and everyone else caught up in the process.

But perhaps the greatest challenge for the modern regulator is to be more effective without imposing a regulatory burden on the professionals and systems for which it is responsible.

Size can be an asset here. We saved £1m last year when we took over the responsibilities of the smaller Postgraduate Medical Education and Training Board (PMETB), mainly through the savings made by the economies of scale and integrating the finance, information systems, facilities and human resources into one organisation. We have signalled to the government that we will not have to draw on bridging funds, which had been earmarked for the cost of the merger of the two organisations.

More importantly, we are determined to develop new ways to foster and support education at every stage of a doctor's career – from the outcomes we set for undergraduates, to the curricula and assessments we approve in postgraduate medicine and the development of continuing professional development (CPD) for those in frontline practice.

The most formidable challenge for us will also be a significant change for the profession. The long-awaited introduction of revalidation represents the biggest change to medical regulation in 150 years. Our register, which is currently an historical record of performance, will become a contemporary record of competence. Our priority must be to make sure the way we achieve this is simple, cost-effective and proportionate. It must provide patients and employers with the assurance that their doctor is competent and up-to-date, but it must also provide every doctor with the time and the opportunity to reflect on their practice.

We also need to work more closely with frontline practitioners to make sure we reflect the realities of their day-to-day practice. That is why we are launching two new teams in regions across the UK. Our new Employer Liaison service will support 'responsible officers', a new statutory role.

Organisations that employ doctors will appoint a senior licensed medical practitioner to act as a responsible officer. Key responsibilities for responsible officers are to make a recommendation on whether doctors in their organisation should be revalidated and also to deal with concerns about doctors, and our new service will support them in this role.

Our 'regional liaison officers' will help us engage locally in England with local medical committees, medical schools, clinical commissioning groups (CCGs), postgraduate deaneries as well as patient and carer organisations.

Through our work on standards, and at every stage of the educational process, we have to be relevant to every doctor throughout their career. We have to develop a relationship that is not based on the fear that one day a complaint may be made, but on the understanding that our main role is to affirm, encourage and support good and improving practice. In other words it is based on a continuous dialogue, not one-off interventions.

An illustration of this is the changing ethical challenges faced by doctors as the healthcare environment in which they work evolves. As GPs take on responsibilities for commissioning services and controlling budgets, many will face new dilemmas including conflicts of interest that arise between their role in the CCG and as a GP treating patients. We are currently consulting on revisions to our guidance on workplace issues and have just started a major review of our core guidance, Good Medical Practice.

This will involve a major consultation with the profession and the public, including a national conversation about what makes a good doctor in the UK today. We started identifying the key issues the consultation should address in some initial engagement with key interest groups, which started in February, and a new draft of Good Medical Practice will go out for consultation in October.

The Council of the GMC has set itself an ambitious agenda. We need to deliver more and demonstrate that as the regulator we can both protect the public and support the profession. The future for the GMC and other regulators cannot be as a remote enforcer of rules and regulations, but as an organisation that is alongside doctors throughout their careers, helping to drive up standards of education and practice.

Resource
GMC Fitness to Practise consultations
www.gmc-uk.org/concerns/fitness_to_practise_consultations.asp

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