GMC Boss Calls for Urgent Regulation Overhaul

Tim Locke

February 25, 2020

General Medical Council (GMC) Chief Executive Charlie Massey says too much red tape is hampering overseas doctor recruitment.

In a speech at the Westminster Health Forum he outlined the "highly prescriptive" outdated legislation the GMC works under as medical regulator.

He pointed to barriers to recruiting doctors from outside Europe: "For example, the way the legislation works means that a doctor from outside the EEA [European Economic Area] would have to provide around 2000 pages of information and spend over 9 months gathering evidence to work as a GP or consultant in the UK."

Flexibility

He said more flexibility is needed to address the issue.

"While we expect around 10,000 overseas doctors to join the register this year, last year only 10 GPs or consultants from outside the EEA joined via the relevant specialist registration route and were able to practise at a senior level immediately."

Mr Massey said changes could be achieved without threatening care: "That doesn't mean a reduction in standards, simply a change to legislation to give us more discretion for determining how senior international doctors can demonstrate their knowledge and skills.

"And that could increase the rate at which senior doctors join the workforce – meaning more practitioners to support patients in need."

Mistakes

Mr Massey also tackled changes needed when investigating complaints and medical errors.

When the Medical Act was passed in 1983 the GMC received around 350 complaints that year. That's grown to more than 7000 last year.

"The result is that we spend the bulk of our time processing complaints – the majority of which come to nothing – rather than focusing our resources on stopping doctors getting into difficulty in the first place," he said.

He called the current rules "a blunt instrument".

"Under current legislation, we’re obligated to look into every allegation that meets our threshold. Even if it concerns a one-off mistake. And once an investigation is open we’re required to complete all prescribed steps, even if we know it’s likely that no further action will be required. The result is that around 80% of clinical cases are closed with no action taken."

He said: "Whilst there are some steps that we can and are taking to address this, legislative reform would allow us to be much more proportionate and precise, so we could prioritise the areas of greatest concern.

"This would not only reduce costs, and reduce the number of doctors taken out of the workforce while under investigation. It would also mean we could spend more time dealing with the small minority of doctors whose fitness to practise is a serious concern, and do so faster."

Human Factors

Mr Massey talked about "current stresses on the health system" and the need for actions to be "understood in the context in which they occur".

He said: "Last year we rolled out Human Factors training to all our Fitness to Practise decision-makers and case examiners, so the role systems and workplaces play in events is hardwired into investigations.

"We want to give doctors the assurance that their actions will be seen clearly against the backdrop of any system failings. This matters because doctors who are scared that honest mistakes will be used against them are not open when things go wrong – and that lack of openness can breed a culture where lessons are not learned when things go wrong."

He also spoke of the damage to the medical profession when doctors know there are problems but don't feel able to speak up. The Paterson Inquiry, he said, "demonstrated the need for most robust local governance. Responsible Officers (ROs) are a core part of this. But they do not always have all the information they need about a doctor’s practice. Existing regulation could be strengthened to improve information-sharing, better equipping ROs to identify and address failings much more quickly."

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