We have run a consultation on the future of the medical register. Here, Richard Marchant, one of our Assistant directors, looks at what an initial analysis of the responses has told us.
The medical register has been going since 1859. Originally a great big hardback book, our forebears introduced it so that patients could differentiate the qualified doctors from the quacks.
Of course, nowadays it is all publicly searchable online. But technological advances aside, the register hasn’t actually changed much since the nineteenth century – essentially it tells you if a doctor is licensed to practise and where and when they qualified.
That’s why we decided it was time to carry out a formal consultation on what – if any – changes people thought we should make, looking at how the register might better reflect a doctor’s past attainment and current expertise. The range of options we put forward had been informed by earlier testing of our thinking with various audiences, including some preliminary research involving around 1,000 stakeholders. The consultation was our chance to test further what we had learned.
During the consultation period we directly engaged with a wide range of people and groups, including local branches of Healthwatch, employers, patient organisations and doctors via sessions run by our liaison services across the UK.
The consultation generated a huge response, with around 7,500 submissions – from GPs, consultants, doctors in training, medical students, members of the public and organisations. About half of the responses were from individual doctors. This is by far the largest response to any consultation we have ever run, testament to the depth of feeling many, doctors in particular, have on this subject. We would like to thank those who took the time to give us their views.
What people told us
It is going to take us a while to get through all the responses and carry out a thorough analysis. But so far we have examined a sample of the feedback from some of the main categories of respondents, such as doctors, the public, employers, medical royal colleges, defence societies, representative bodies and other organisations. From this sample we are starting to see some common themes emerging. And we are listening to what you are telling us.
The purpose of the register
In our consultation we had said that the register is intended to provide information about individual doctors practising in the UK. It is for patients, employers and commissioners of services and indeed anyone with an interest in the care and treatment doctors provide. Where appropriate the information should help users make decisions about who to trust with their care or who to employ or contract with. This was an updating of the register’s original purpose, but not a fundamental change.
From what we’ve seen so far, the majority of respondents felt that the purpose of the register should continue to be simply to provide assurance that the doctors listed on it are appropriately qualified and fit to practise medicine. Some people said they felt changing the purpose of the register would risk us going beyond our remit as a regulator.
Safety and privacy
A common thread in the responses we have analysed was that publishing additional information about doctors could pose a risk to their safety and privacy.
But we spotted that many doctors who expressed anxiety about this were under the impression that we were planning to put private and sensitive personal data on the register – such as home addresses, email details, phone numbers and dates of birth.
We did ask about whether doctors should be able to add their own photograph ID and practice location to the register if they wanted to. The feedback from the responses we’ve reviewed so far is that doctors do not see the benefit of this. Some expressed concerns about the proposal because of the potential risks of stalking, violence, fraud and identity theft against doctors and their families, particularly for those working in sensitive areas such as forensics and psychiatry.
Reflecting current practice
We also asked what people thought about ensuring that the register accurately reflects the current practice of individual doctors. There are currently around 43,000 doctors who are neither on the GP or Specialist Registers, nor in training – yet the register shows nothing about the nature of the valuable roles which these doctors play. This is a particular issue in respect of the approximately 20,000 Staff and Associate Specialist doctors in the UK who, although working within specialties, are not recognised on the register as doing so. And we know from previous research that even a doctor’s entry on the Specialist Register is often not a reliable indicator of the field they are currently practising in.
Responses so far show there is some support for this proposal and some have told us that this information would be valuable. No decisions have been made on this, but we have had some initial conversations with the Academy of Medical Royal Colleges to explore some of the practicalities of describing doctors’ practice on the register if that was felt, in principle, to be useful for those consulting the register.
Creating a tiered approach
Feedback indicates that there are reservations about creating a voluntary tier to the register, as this had the potential to be misinterpreted by patients. Respondents also felt that doctors might feel pressured to add voluntary information to the register so as not to be adversely judged by the public. Some have expressed concern that providing more information would create an additional burden for doctors.
We will continue to analyse the remainder of the responses to our consultation and a full report will be coming out in February 2017. We won’t make any decisions about the development of the medical register until that point. However, like all the consultations we hold, what we do next will be informed by what people have told us and in particular any concerns they have raised.
What we can say now is that we definitely will not – ever – be putting sensitive personal data about individual doctors into the public domain, either via the register or in any other way. We will be doing some exploratory work with the Academy of Medical Royal Colleges to see if it would be possible and practical to capture information about doctors’ scope of practice on the register in an accurate and meaningful way, which is not costly and avoids imposing extra burdens on doctors. We will let you know in February how our thinking has developed on that.
But whether or not we decide to add more information to the register, we are determined to improve the functionality of what we’ve got now; to make it more accessible to all audiences, simpler to understand and easier to search so that it meets the needs of the 21st century rather than the 19th.
Jo Wren, Lead Regional Liaison Adviser (RLA) for the South of England, answers your questions about our consultation on the medical register.
Dr Judith Hulf, Senior Medical Adviser at the GMC, gives a doctor’s view of the potential benefits of changes to the medical register.