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MPs call the General Medical Council to account
The Health Committee, chaired by Rt Hon Stephen Dorrell MP, has published the conclusions of a brief inquiry into the processes proposed by the GMC for the Revalidation of Doctors.
In its Fourth Report of Session 2010-11 (HC557), Revalidation, the Committee says the GMC should be accountable to Parliament. 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", say MPs.
Revalidation of doctors has been under discussion for over 10 years; The Committee believes this is too long and concludes:
"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."
Reviewing the GMC’s current proposals MPs warn that too little attention has be given to the issue of 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," says the Committee.
"The Committee is concerned that 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. 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." MPs therefore recommend that the GMC must publish clear guidance to Responsible Officers about how they should deal with the cases of doctors whose performance gives rise to concern.
Looking at the systems proposed, MPs broadly supports the GMC's proposal that revalidation should be based on the conclusions of employers' appraisal systems. However, the Committee confirms that it received evidence showing that the record of employers on appraisal is patchy. "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" says the Committee.
The Committee particularly emphasises the importance which it attaches to patient and colleague involvement in the appraisal process – and therefore in the revalidation process. It recommends that the GMC should: "Undertake a review of best practice in gathering the views of patients and colleagues and develop its proposals in the light of that review".
MPs were also concerned that there should 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 (e.g. in cases of "whistle-blowers"). The Committee recommends: "the GMC 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".
Finally the Committee considered the issue of doctors for whom English is a second language.
"We regard the ability of a doctor to communicate effectively with his or her patient as fundamental to good medicine. As the body responsible for revalidation and with a commitment to introducing it by late 2012, we expect the GMC to satisfy itself that it has the necessary powers to fulfil this role; if it is not satisfied (whether as a result of 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 fulfil its function effectively."
The Committee welcomes the willingness of the GMC to allow its record to be examined on a regular basis and looks forward to "discussing these and other issues with the GMC" at the first of these regular meetings later in the year.