GMC gives evidence to inquiry

The UK General Medical Council has promised to strengthen its procedures for evaluating doctors' fitness to practise and to provide better public access to information about doctors' terms of registration. The move is an attempt to retain responsibility for regulating the medical profession in the United Kingdom and to secure the council's future.

The council was the target of widespread criticism in the hard hitting fifth report of the Shipman Inquiry last December. In April this year, it was forced to suspend the introduction of its new scheme for revalidating doctors (BMJ 2005;330:9, 1 Jan). Graeme Catto, president of the GMC, was optimistic that the proposed new changes would allow revalidation to be launched next spring.

“We need to make registration more meaningful so that we demonstrate that doctors are up to date and fit to practise. We need to make that positive statement that this doctor is fit to practise,” said Professor Catto.

The council's proposals are set out in a document submitted to a review by the chief medical officer for England, Liam Donaldson, of the issues raised by the Shipman Inquiry's report.

In the report, Janet Smith, the appeal court judge who chaired the inquiry, accused the council of pandering to doctors needs and for neglecting patients' interests. She recommended that unless the council improved its fitness to practise procedures and revalidation scheme it should lose the power of regulating the profession (BMJ 2005;330:10, 1 Jan).

The report called for a lay majority on the GMC and more lay representation at disciplinary hearings. The possible conflict between the interests of elected GMC members and the public interest is an important question, says the Council in its submission. Council reforms in 2003 led to an increase in lay membership from 25% to 40% and further changes may be introduced before the next election of medical representatives which takes place in 2007, it says.

A major thrust of the council's proposals is a change to the revalidation scheme. Under this, doctors in the United Kingdom will be evaluated for revalidation in different ways, according to the quality of the local systems for assessing doctors' performance at their place of work. If outside bodies, such as the Healthcare Commission, judge clinical governance structures to be robust—what the council calls “a GMC approved environment”—then revalidation will be based on a doctor's annual appraisals. But where clinical governance is poor or absent, doctors will have to prove that they are up to date and fit to be revalidated, by showing the results of patient and peer questionnaires as well as the results of appraisals.

Under the new procedures, doctors will still be required to maintain a folder that reflects the way they practise. Professor Catto admitted that in earlier proposals about revalidation, the GMC had not been sufficiently explicit about the information doctors would need to collect for their folders.

He accepts the recommendations in the Shipman report that GPs' folders should contain prescribing data and records of complaints, a record of continuing professional development activity, a patient satisfaction questionnaire, the results of clinical audit and significant event audit, proof of appraisals, and a certificate to show successful completion of a knowledge test.

In her report, Dame Smith was particularly concerned that the GMC was relying on annual appraisals to pick up dysfunctional or underperforming doctors when they were not designed for the task. Similarly, clinical governance was still in its infancy, but the council was depending on it to certify that doctors had no “significant local concerns” hanging over them to be able to apply for revalidation, she said.

“One of the mistakes we made early on was [assuming] that parts of the NHS would be equally efficient,” said Professor Catto. The risk based approach to registration, where doctors' workplaces are judged approved or not, is the GMC's response to this criticism.

The council's document also sets out plans to engage more with patients and the public by making a full register of doctors available online, along with undertakings and conditions attached to a doctor's registration.

Another aim outlined in the document was to develop a central portal for patients who have a complaint about a doctor. The current system is confusing with no clear guidance for patients wanting to register a complaint. Although the idea of a portal has been suggested before, progress toward one has been frustratingly slow, said Professor Catto. However, developing a streamlined complaints service required cooperation from other healthcare organisations, he added.